Eyeworld

World view New technological advancements in cataract surgery O ver the past few years there has been an abundance of advancements in cataract surgery technologies that have refined the procedure for more efficient surgery and better patient outcomes. In this issue of EyeWorld, we delve into these advancements not only for the cataract surgical procedure itself, but also for diagnostics, com- bined procedures, drug delivery, and intraocular implant advancements. When performing cataract surgery today, many more questions arise than just those about removing the nuclear lens and inserting an implant. Patient expectations are higher and demands for refractive cataract outcomes are more intense due to patient education. There are many nuances that one must address prior to or during cataract surgery, such as the issue of correcting corneal astigmatism with ei- ther a toric IOL or corneal relaxing incisions. In one feature article, we delve into the world of aberrometry and discuss with Drs. Wolsey, Weinstock, and MacDonald the benefits of more refined preoperative diagnostics as well as intraoperative diagnostics to help guide astigmatism treatments and improve refractive outcomes. When looking at intraocular lens implants, there are many options, which can sometimes be confusing and overwhelming for both the physi- cian and the patient. Multifocal IOL choices are now more abundant with newer low-add multifocal IOLs that can be advantageous to the right patient or fail to provide the necessary near acuity for others. Drs. Masket, Hamilton, and Lee eloquently outline the importance of patient selection with respect to personality and ocular comorbidities, as well as the importance of setting patient expectations. The article outlines spacing eye surgeries and assessing outcomes and happiness before selecting the IOL for the second eye. For our combined glaucoma and cataract patients, we now have so many more microinvasive options to help control IOP and minimize the need for pressure-lowering drops. Drs. Ahmed, Lewis, and Vold outline the new MIGS devices and how these may now be standalone procedures for some patients to help control IOP. However, patient selection for optimizing outcomes is key. The latest technological advancement is femtosecond laser-assisted cataract surgery. But in its current iteration, is it truly better than traditional cataract surgery? Drs. Ramanathan, McLeod, Chiu, and Srikumaran review the procedure and outcomes in another feature article on femto. Perhaps it is more optimized currently to enhance refractive cataract outcomes. But one must keep in mind that patient counseling is essential, and there are signifi- cant costs and perhaps a slight increase in OR times. There have been recent advancements in drug delivery systems for adjuvant care of the cataract surgery patient to help minimize inflammation, pain, and infection both during and after cataract surgery. Drs. Lindstrom, Chang, Liegner, and Lewis delve into the pros and cons of intracameral anti-inflammatory and anti-infective agents versus traditional drop therapy. Dr. Bafna, in turn, introduces us to the idea of a punctal plug drug release device that could turn out to be a very novel way to provide sustained release therapy. Technological advancements are necessary in medicine to improve out- comes with more efficient and hopefully cost-saving advantages. However, although exciting for both the patient and the doctor, the underlying theme of all the articles seems to be the importance of informed consent, patient counseling, and proper patient selection. EW Rosa Braga-Mele, MD, MEd, FRCSC cataract editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S April 2016 Volume 21 • No. 4 Publisher Donald R. Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Bradenton, Fla. Michelle Dalton Reading, Pa. Rich Daly Arlington, Va. Lauren Lipuma Washington, D.C. Matt Young Malaysia Senior Contributing Writer Maxine Lipner Nyack, N.Y. 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