Article

This Cloud Has a Silver Lining

It’s a great time to have cataracts; here’s why

“Mrs. Mercedes, I have good news, and I have really good news. The natural lenses in your eyes are prohibiting you from getting the best vision. In fact, the glare you notice at night and the reason you think you need to update your glasses is because of this organic aging, much like the graying of your hair. You may know it by its notorious name of a cataract. Today, we now have the ability to replace that older lens with an implant, via a laser or a small incision, and the implant can restore your ability to see like you did when you were younger. This modern-day outpatient surgical process can give you amazing vision! Let me tell you more…”

As we live among a “grey tsunami,” this conversation, or something similar to it, is a common one. And yet, historically, we, as optometrists, limit our patients by not having it sooner. The conventional discussion around cataracts has been reserved to the geriatric lenticular endgame, as opposed to the genesis of the lens dysfunction. However, as technology advances, the mind-set of the practitioner has to follow, so as not to limit our patients’ vision.

1-2+ anterior cortical changes with a 3+ milky nuclear sclerotic cataract.

COMMIT TO IDENTIFYING CATARACTS

As with any disease state, the sooner we diagnose cataracts and ready our patients for the inevitable procedure, the better prepared they will be. Unlike other conditions we treat, such as AMD, which may leave our patients with permanent visual consequences, a cataract is often a slow march to decreased vision. Degradation of vision is not as apparent and less detectable — unless you are painting your house yellow when the color is really white! But, as less people are retiring and more are continuing to live active lifestyles, as well as spending time on computers and digital devices, patients may be more likely to notice visual strain, as demand on intermediate vision becomes more burdensome with the aging of the lens. Your patient needs to be provided with their options and inevitable needs from your office; failure to educate your patient most likely will result in a loss of confidence or worse — that patient becoming a former patient.

If we look at cataract surgery as a gift that will enable our patients to function with less dependence on glasses, then we are actually viewing this as a refractive procedure. Modern lens implants, in an otherwise healthy eye, are only limited by the patients being un-informed — that’s where we come in. Discussing the aging process of the lens earlier sets the framework for these discussions when the patient is prepared to have surgery.

Aside from the refractive advantages, there is a more important reason to discuss lens changes with our patients: safety. Falls are the leading cause of injury in older Americans. More than one out of four older people — those older than the age of 65 — fall each year, according to the CDC. Additionally, fatal crash rates per mile traveled increase noticeably among those age 70 to 74 and are highest among those age 85 and older, according to the Insurance Institute for Highway Safety. Cataract surgery has been shown to have a modest decrease in patient’s risk of serious traffic crash, as the driver, according to JAMA Ophthalmology. These statistics serve as a reminder that the safety of our patients is linked to the removal of the cataract.

COMMUNICATE THE OPTIONS

When a patient enters my lane, the mind-set is to analyze their needs and give them a proactive recommendation so they can achieve sustainable quality of vision. When you engage in this discussion at the inception, you are then better equipped to prepare the patient for the surgical journey. Continuing with the discussion outlined here, I present the patient with the best opportunity to obtain the vision they desire, based on their unique needs. Today, we choose from a myriad of options that best serve our patients:

  • Monofocal. A single-power IOL, often used to provide the patient with clear distance vision.
  • Toric. A single-power IOL that also corrects for astigmatism.
  • Multifocal. An IOL that provides simultaneous vision by splitting light into multiple foci, likely distance and near.
  • Multifocal toric. An IOL that provides for distance and near clarity, but also corrects for astigmatism.
  • Accommodating. An IOL that provides for pseudo accommodation in vision by shifting the IOL forward.
  • EDOF. An IOL that uses diffractive ridging in the lens to provide for a vision range of near to far.

For example: “Mrs. Mercedes you stated how you love to bike and looking at your bike navigation is important. The EDOF lens will let you see your navigation system and provide you with the clarity of the trail ahead, all in the same eye. More importantly, you may only need to use a light magnifier for reading small detailed print.”

Dense posterior sclerotic cataract
Images courtesy of Dr. Bloomenstein

ADAPT YOUR PRACTICE

I have always felt that the word “practice” was a perfect adjective for the work we do; since we are always learning and gaining new insights. Optometry adapts to newer technology as quickly as our cones adapt in light, however we are slower to adapt to sea changes in early prevention. Throughout the next few pages, this guide will help you better appreciate the pre- and post-operative management of modern day cataract surgery. Moreover, providing a path to co-management of your patients with the surgical center, a critical part of any cataract surgery.

Cataracts are an indication that we are still alive and showcase the imperfections that exist in our bodies. We can all help our patients by demystifying the negative connotation surrounding the word “cataract.” “Mrs. Mercedes, this is a great time to have cataracts.” OM