EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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E W NEWS & OPINION 36 A symposium on clear lens extraction at the 2013 ESCRS Congress gave attendees expert opinion across the globe F our major cataract and refractive societies from around the world—the E uropean Society of Cataract & Refractive Surgeons (ESCRS), American Society of Cataract & Refractive Surgery (ASCRS), Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS), and Latin American Society of Cataract & Refractive Surgeons (LASCRS)—hosted a Combined Society Symposium that shared ideas on "Clear lens extrac- tion: have we lost our way?" At the symposium, held at the 2013 ESCRS Congress, physicians gave presentations on the topic on behalf of each society. Presenters included co-moderators Graham Barrett, MD, Perth, Australia, from APACRS, who opened the sympo- sium with the presentation "Clear lens extraction for presbyopia: have we gone mad?" and Cesar C. Carriazo, MD, Barranquilla, Colombia, from LASCRS, who gave an overview of the "TIP-CHOP" technique in "Improving techniques and results (TIP-CHOP)." The other presenters were Steven C. Schallhorn, MD, San Diego, who gave the talk "Clear lens extraction: is it plain greed?" for ASCRS, and Leonie Los, MD, Groningen, the Netherlands, who discussed "In the long-term: PCO, YAG, and retinal detachment" for ESCRS. Following a discussion, Ioannis Pallikaris, MD, Crete, Greece, pre- sented "Clear lens extraction in young patients: indications and con- traindications" for ESCRS; Raymond Applegate, MD, Houston, presented "Comparing image quality of a variety of IOL designs with that of phakic young eyes that can still accommodate" for ASCRS; and Nick Mamalis, MD, Salt Lake City, pre- sented "How many multifocal IOLs are explanted and why?" for ASCRS. Another discussion was fol- lowed by Luis Izquierdo, MD, Lima, Peru, who presented "Clear lens ex- traction/refractive lens exchange: is there a difference?" for LASCRS; and Keiki Mehta, MD, Mumbai, India, who presented "Premium IOLs and premium cataract surgery are a mis- nomer" for APACRS as the final talk of the symposium. Role of surgeon Peter Barry, MD, Dublin, Ireland, ESCRS president, who chaired the symposium, asked Dr. Schallhorn, former director, cornea service and refractive surgery, Naval Medical Center, San Diego, what role the surgeon and cataract play in the clear lens extraction environment, especially in the light of work done by ESCRS and ASCRS in this field. Dr. Schallhorn concluded that the clear lens extraction procedure has low risk of threatening vision with high efficacy and patient satisfaction. "It is a credit to these societies that we have the technology, skills, understanding, and acceptance to safely place intraocular lenses in eyes to the great benefit of mankind. It wasn't long ago that this was viewed with disdain," Dr. Schallhorn said. "So where are we going in the future? That is easy, technology only goes in one direction, forward. We will have even more incredible tech- nology available to us in the near to March 2014 by Erin L. Boyle EyeWorld Senior Staff Writer Combined Society Symposium offers clear lens extraction overview Levels of patient satisfaction after clear lens extraction. Data is based on a study conducted at Optical Express comprised of 14,726 eyes of 7,692 consecutive patients who underwent a CLE to reduce dependence on spectacles/contact lenses in a presbyopic population. Source: Steven C. Schallhorn, MD mid-future for cataract and/or clear lens extraction procedures," he said. Opening presentation Dr. Barrett began the symposium with an overview of results of clear lens extraction, looking to answer the question of whether it is a mad, or illogical, idea to remove the natu- ral crystalline lens without cataract formation solely for the correction of presbyopia. He said he wanted to examine why "not only industry but physi- cians in this environment of reduced reimbursement may be focused on this potentially large market." A Google search of clear lens ex- traction for presbyopia yields a great deal of information about the proce- dure, he said, showing that it pro- vides quality vision at all distances without spectacles and the "added inducement that you won't develop cataracts." However, searching for the pub- lished papers on the topic results in far fewer finds, and "you have to ex- tract data regarding presbyopic cor- rections from publications on clear lens extraction for myopia or hyper- opia." "But if we do so, we can say that the unaided acuity looks pretty good, almost 100% 20/30 or J4 or better, but we see that there's about a 10% loss of best corrected visual a cuity," Dr. Barrett said. "Approxi- mately 89% are within +/–0.5 diopters of emmetropia with good predictability. But beyond those fig- ures, we know that there are issues." Those issues include waxy vision and halos, which can occur with the multifocal lenses often implanted in these procedures. P atient satisfaction can be adversely impacted in these cases. Dr. Barrett provided case results of patients who had consulted him for a second opinion in the last three months who were unhappy following clear lens extraction for reasons including waxy vision, scatter, halos, or dysphotopsia. " I think you have to advise pa- tients that in the long term macula function may deteriorate, which it is likely to, and this could impact their acuity. Furthermore, even the long- term promise of not wearing glasses may be illusory because astigmatism is not static and does tend to progress to against-the-rule with time," he said. Closing presentation Dr. Mehta closed the symposium with a frank discussion about pre- mium IOLs. He said the lenses have been defined as premium for many reasons, including cost, but that the idea of an IOL being called "premium" and therefore part of a "coveted category" is a misnomer. He said that the quality of a lens is not determined by the cost, but the cost is rather driven by medical reimbursements. "The patient must believe … that doing better surgery, utilizing more advanced lenses and tech- niques, is what we call rational sur- gery, not premium," Dr. Mehta said. "Let's make our patient believe, that for us, she is premium, and her eyes deserve the best possible premium vision we can give her." EW Editors' note: The physicians quoted have no financial interests related to this article. Contact information Barrett: barrett@cyllene.uwa.edu.au Mehta: admin@mehtaeyeinstitute.com Schallhorn: scschallhorn@yahoo.com 18-47 News_EW March 2014-DL2 copy_Layout 1 3/6/14 2:46 PM Page 36