When evaluating the patient, it is important to get to know them well. What do they do for a living? Are they retired? What are their visual demands in life? Do they do a lot of nighttime driving or spend a lot of time on the computer? What are their visual priorities? One critical question to ask is: After cataract surgery, do you want to accomplish many of your daily tasks with or without glasses? It is critical to gauge a patient’s interest in surgery and set appropriate expectations. The clinician can then customize the implant technology to the patient’s desired outcome.
Patient Assessment
All patients should undergo a careful pre-operative assessment, including a thorough clinical exam, diagnostic testing, and a goals questionnaire to identify any pre-existing pathology that may preclude a patient from being a candidate for a premium IOL. Ideal candidates for premium lens technology are those without ocular comorbidities. Irregular astigmatism, higher order aberrations (HOAs) or corneal or macular pathology can preclude patients from being good candidates for this technology.
Diagnostic Testing
Good quality testing, including but not limited to topography, biometry, OCT imaging, wavefront analysis, tear film analysis, and endothelial cell count for corneal pathology is critical. Testing can be confounded by ocular surface disease, so it is important to optimize the surface prior to performing the diagnostic testing. Patients may need repeat biometry after treating dry eye or other corneal conditions. vitrectomy. In contrast to gene-augmentation therapy, CRISPR/Cas9 genome editing is specific not only to a particular gene, but also to certain mutations in that gene.
Pre-existing pathology that may preclude patients from certain IOLs:
- Optic neuropathy
- Amblyopia
- Retinal pathology preventing “good vision” in an optically clear setting
- Irregular astigmatism (e.g., keratoconus)
- Elevated higher order aberrations
- Corneal scarring or corneal dystrophies such as Fuchs’ dystrophy