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EW CATARACT 38 October 2015 material, videos, by speaking with a technician or counselor, and by speaking directly with the physician. In conclusion, Dr. Weikert said that careful and thoughtful pre- operative planning is essential for success. Identify potential problems before entering the OR, he said, and obtain accurate biometry to maximize the likelihood of hitting refractive and visual targets. Taking the time to carefully assess patients' goals and realistically set their ex- pectations will definitely pay off in the long run. EW Editors' note: Dr. Weikert has financial interests with Ziemer (Port, Switzerland). Contact information Weikert: mweikert@bcm.edu by Ellen Stodola EyeWorld Staff Writer ties in measuring the true corneal refractive power and predicting the effective lens position. Astigmatism correction should also be consid- ered, and surgeons should assess both the astigmatism magnitude and location using multiple meth- ods. Finally, Dr. Weikert spoke about the importance of a surgical plan. Failing to plan is planning to fail, he said. The first step is to assess pa- tients' visual goals, which includes factoring in their lifestyle, distance and near vision needs, the desire for reduced dependence on glasses, their financial resources, and their satisfaction with residual refractive error. Dr. Weikert suggested that the surgeon determine the suitability of different options to achieve these goals. He also recommended pre- senting information to the patient in multiple formats, such as written to answer questions about things that can affect the surgery, such as a history of trauma, what medications they use, any allergies they have, etc. Dr. Weikert recommended that the surgeon systematically evaluate the entire eye to identify risk factors, looking for potential issues with the lids/lashes, sclera, conjunctiva, cornea, anterior chamber, iris, lens, intraocular pressure, or retina. In terms of biometry and IOL calculations, he said that the most commonly used IOL calculation for- mulas are based on geometric optics using a simplified model of the eye conceived in the 1970s. Formula choice is typically dictated by axial length. However, there are special cases to consider, such as patients with long eyes. Additionally, IOL calculations after corneal refractive surgery may require special consider- ations due to the increased difficul- Surgeons should have a preop strategy for cataract patients T he preoperative evaluation is an important part of the process for surgeons who handle cataract patients. Mitchell Weikert, MD, Houston, discussed this in his presentation at the 2015 Combined Ophthalmic Symposium (COS) in Austin, Texas. He said it's valuable to take a step back from time to time and look at the goals of the preoper- ative evaluation of cataract surgery patients. Per the American Academy of Ophthalmology Preferred Practice Patterns, the indications for cataract surgery include: the visual func- tion no longer meets the patient's needs; cataract surgery provides a reasonable likelihood of improve- ment; there is clinically significant anisometropia in the presence of a cataract; lens opacity inhibits management of posterior segment disease; or the lens causes inflam- mation, angle-closure, or medically unmanageable open angle glauco- ma. There are important contrain- dications to consider as well, such as when the patient does not desire surgery, when glasses or visual aids already meet the patient's needs, when surgery will not improve visu- al function, when the patient's qual- ity of life is not compromised, when a patient cannot safely undergo sur- gery, when informed consent cannot be obtained from the patient, and when postoperative care cannot be arranged. Dr. Weikert broke his preop- erative strategy down into 3 main goals: identify potential problems before entering the OR, obtain accu- rate biometry readings and IOL cal- culations, and gauge patient needs and set realistic expectations. In order to identify potential problems before heading to the OR, the surgeon should conduct a detailed history and physical examination of the patient. This includes documenting the patient's subjective complaints or symptoms and identifying the necessity of the procedure both objectively and subjectively. Patients need to be able Cataract indications and preop tips Cataract surgery indications Cataract surgery contraindications • Visual function no longer meets the patient's needs • Patient does not desire surgery • Cataract surgery provides a reasonable likelihood of improvement • Glasses or visual aids already meet the patient's needs • Clinically significant anisometropia in the presence of a cataract • Surgery will not improve visual function • Lens opacity inhibits management of posterior segment disease • Patient's quality of life is not compromised • Lens causes inflammation, angle closure, or medically unmanageable open-angle glaucoma • Patient cannot safely undergo surgery • Informed consent cannot be obtained from the patient • Postoperative care cannot be arranged

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