Risk Factors
In general, cataract surgery is extremely successful, and patients are satisfied with the outcome, especially if they have been counseled on what to expect. Occasionally, residual refractive error may require a secondary procedure (such as a laser vision correction enhancement) or astigmatic correction (such as an arcuate keratotomy) to allow for optimal visual outcome and satisfaction. Despite optimization of the ocular surface, treatment of residual refractive error, and neuroadaptation, patients are occasionally unable to tolerate specific IOL technology and an IOL exchange can be considered. If a patient is unable to adapt to their IOL, an IOL exchange for a monofocal lens should be offered after an expanded discussion on the risks of a second surgery and loss of presbyopia correction with a monofocal IOL.
Referral Guidelines
Consider a referral to a refractive cataract surgery specialist for patients who have had prior refractive surgery including LASIK, PRK or RK, have pre-existing pathology that could render them a borderline candidate for a premium IOL, or require an expanded evaluation and discussion to determine which lens is the best lens for them. Working with a refractive cataract surgeon who has experience with premium lens technologies is beneficial in assessing patient candidacy and lens selection.
Further Reading
Kohnen T, Suryakumar R. Extended depth-of-focus technology in intraocular lenses. J Cataract Refract Surg. 2020;46(2):298-304. doi:10.1097/j.jcrs.0000000000000109
AcuFocus. The IC-8 IOL: Big Advantages Through Small Apertures. The Ophthalmologist. Published online September 9, 2019.
Brierley L. Refractive results after implantation of a light-adjustable intraocular lens in postrefractive surgery cataract patients. Ophthalmology. 2013;120(10):1968-1972. doi:10.1016/j.ophtha.2013.03.010