Setting the Stage

Article By Stephen G. Slade, MD

Medical practitioners, and ophthalmologists in particular, always keep an eye toward the future (pun intended), constantly devising and evaluating innovations that may better serve our patients’ needs. Although corneal refractive surgery received much of the attention in the late 1990s and early 2000s, the focus has been shifting in recent years back to the cataract market with the advent of refractive and presbyopia-correcting IOLs. Cataract surgery is an enormous industry. Each year in the United States, more than 3,000,000 cataract surgeries are performed translating to a billion dollar market for industry alone. Medicare still holds about two-thirds of the patients, although that percentage may shift as the nation adopts new healthcare laws.

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The baby boomer population is entering the cataract age, and these individuals will be candidates for cataract and presbyopic treatments for years to come. In fact, it is likely that ophthalmic residents who are earning their medical licenses now will be treating baby boomers for the rest of their careers. Are we ready for them? Although cataract patients are becoming more like their refractive counterparts in terms of demanding excellent visual quality and spectacle independence, data adapted from the latest FDA trials for the Crystalens AO IOL (Bausch + Lomb, Rochester, NY) and the WaveLight Allegretto Wave excimer laser (Alcon Laboratories, Inc., Fort Worth, TX) show that cataract surgery does not give patients the same quality of uncorrected visual acuity as LASIK (Figure 1 [slide 7]). Yet, many baby boomers have already had LASIK surgery and expect that they will be able to see prefectly without spectacles after cataract surgery as well. Can we meet this expectation? We need to prepare ourselves for the coming boon and set the stage for meeting these patients’ demands, or else we risk disappointing our patients.

Currently, only 20% of the more than 8,000 eye surgeons in the United States consider themselves cataract and refractive surgeons, and approximately 6,000 U.S. surgeons say they only perform cataract surgery. Any ophthalmologists implanting presbyopia-correcting IOLs such as the Crystalens Accommodating IOL should consider themselves a refractive-cataract surgeon and need to organize their practices as such. For those practitioners who have not yet adopted these lenses, it is wise to do so in this changing healthcare climate. For surgeons in both camps, this monograph presents data, surgical techniques, and patient-management strategies regarding the use of the Crystalens AO IOL based on years of clinical experience. Hopefully, the information is valuable no matter what type of practice you have.

LASIK Orange County – Harvard Eye Associates in Orange County, California specializes in LASIK laser vision correction.