by Paul Batson, O.D. Center Director VisionAmerica of Birmingham I was reading a really interesting article last week that I've been thinking about. Some of you will find that funny. One, that I enjoy reading journal articles and two, that I was actually "thinking." Last September, the British Journal of Ophthalmology published an article titled, Distribution of preoperative and postoperative astigmatism in a large population of patients undergoing cataract surgery in the UK [1]. The study reports that out of the 110,468 eyes within the study, 42% had preoperative corneal astigmatism >1.0 Diopter while 78% had >0.5 Diopter. (For the record, I am submitting a proposal to go over and suffer through a month while touring the UK to validate their data!)
While we certainly cannot draw direct population comparisons between our patients and those in this UK study, I think there are enough similarities that would allow us to pause and think about the data. Let's assume that we want to be fairly conservative and only think about patients with 1.0 D of cylinder or more. If that is the case, this would indicate that approximately 40% of our patients are probably really good clinical candidates for some form of cylinder correction at the time of cataract surgery. However, a 2017 survey of the Outpatient Ophthalmic Surgery Society demonstrated that only 11.8% of surgeries over the previous 12 months received a toric IOL[2]. Why the discrepancy? I would have expected those numbers to at least be a little closer. I think it comes down to one of two options. Either one, we are educating our patients about their opportunities for refractive correction at the time of cataract surgery and they are choosing to not pursue that option or two, we are only offering refractive correction options to a few people (probably close to 11.8%) that we think may be interested. My assumption is that it's probably the latter. If your toric IOL adoption rates for patients undergoing cataract surgery are not approaching these numbers, I have three quick suggestions: 1. Use the keratometry from your autorefractor to give you an estimate of corneal cylinder on every patient you are referring for cataract surgery. If the corneal cylinder is 0.75D or more, make sure you mention refractive IOL options to your patients before they leave. 2. I think back to the busy LASIK days. The practices that had the highest number of patients undergoing LASIK were often those practices with well-educated team members. A consistent message for your cataract patients is critical. If you would like to provide your team with additional education on advanced technology IOL's, please let me know and we can arrange for one of our Practice Development Managers to provide a training program. 3. Don't make assumptions for patients. Choosing the type of IOL used during cataract surgery is a once-in-a-lifetime decision. I've been guilty of making decisions for patients in the past. I might have assumed, based on perceived cognitive ability or other socioeconomic factors, that this patient would not want an advanced technology IOL. I think we must remove those preconceived judgments and treat and educate everyone the same. One of the easiest ways to do this is with cataract brochures. If you haven't received any of our latest cataract and IOL educational brochures, please let me know and I will make sure one of our Practice Development Managers will drop them off. These provide a quick and easy way to provide some basic education to every patient. I hope you find this helpful. We never want to be (nor will I allow us to be) a practice that pushes or "sells" IOL technology. However, I firmly believe that we do our patients a disservice if we are not at least educating them about their options. Refractive IOL technology and their results have advanced tremendously over the years and toric IOL's are an easy discussion to have with patients. I hope this helps. Let me know what you think. (If I post any pictures from the UK over the next few months, then you'll know that I was approved to go "validate" their study!) [1]Day AC, Dhariwal M, Keith MS, et al Distribution of preoperative and postoperative astigmatism in a large population of patients undergoing cataract surgery in the UKBritish Journal of Ophthalmology Published Online First: 06 September 2018. doi: 10.1136/bjophthalmol-2018-312025 [2]Ophthalmology Management, Volume: 21, Issue: May 2017 The Ophthalmic ASC May 2017, page(s): 16-18, 20
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