EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW FEATURE 88 Challenging cataract cases • October 2017 AT A GLANCE • A careful retinal exam is key in diabetic patients, and use of OCT, OCTA, and fluorescein angiography may be warranted. • Managing the expectations of diabetic patients is important, as they may not have a perfect outcome. • Multifocal IOLs may not be a good choice for diabetic patients because they reduce contrast sensitivity. by Ellen Stodola EyeWorld Senior Staff Writer Diabetic patients should be identified and managed prior to cataract surgery W hen preparing for cataract surgery, oph- thalmologists have to consider a variety of factors, including other diseases and comorbidities. A patient with diabetes may require special considerations, and a careful examination prior to surgery should be performed. It may be helpful to have a retina specialist involved. David Boyer, MD, Retina-Vit- reous Associates Medical Group, Los Angeles, Bonnie Henderson, MD, Ophthalmic Consultants of Boston, Boston, Keith Warren, MD, Warren Retina Associates, Overland Park, Kansas, and Walter Stark, MD, retired professor of ophthalmology, Johns Hopkins University, Balti- more, weighed in on the diabetic patient presenting for cataract sur- geon, how the cataract and/or retina surgeon should proceed, which med- ications may be helpful, and other factors for a successful surgery. Evaluating a diabetic patient Dr. Boyer said the age of the patient, control of diabetes, and presence of diabetic retinopathy all need to be evaluated to help determine what lens is most appropriate. "If the patient has tractional detach- ment or appears he or she may need vitrectomy surgery in the future, the cataract surgeon should avoid silicone lenses and hydrophilic lenses," he said. "If there is macular edema, multifocal lenses should not be used." He added that preoperative OCT, OCTA, and wide field fluores- cein may be indicated. Cataract surgery in the diabetic patient Non-proliferative diabetic retinopathy with diabetic macula edema and cataract Proliferative diabetic retinopathy and cataract Source: Keith Warren, MD