CCS 2025: Getting to know the refractive surgery patient population

In a Collaborative Care Symposium (CCS) 2025 presentation titled "Refractive Lens Exchange and Refractive Cataract Surgery," Mitch Ibach, OD, FAAO, spoke alongside Dagny Zhu, MD, discussing lens-based refractive surgical options for patients, particularly focusing on addressing vision correction needs in an aging population. In an interview with Optometry Times, Ibach highlighted several key considerations in modern vision correction strategies, including patient demographics and motivations and surgical approach, among others.

Ibach highlighted that the refractive surgery patient population consists of an aging US population seeking independence from glasses and contacts; patients who are interested in refractive surgery, but often at a life stage where corneal procedures might not be optimal; and patients with a desire to reduce dependence on corrective eyewear.

The 2 surgical approaches that are centered in the presentation include visually significant cataract surgery (partially covered by insurance) and refractive lens exchange (typically paid out-of-pocket). Both approaches aim to meet patient refractive goals, whether targeting solely distance vision with reading glasses or multiple focus points, such as distance, intermediate, and close-up.

Some critical referral and patient selection considerations include:

• Importance of detailed referral notes from long-term care providers
• Understanding patient personality and psychological readiness
• Previous experiences with mono vision in contacts can be predictive
• Hyperopic patients tend to adapt more easily to advanced lens technologies

As for patient expectation management, Ibach introduced the "Rule of 95", which refers to approximately 95% independence from glasses for most activities. The realistic expectation to set for patients is that some minor corrective wear might still be necessary. A red flag for Ibach to indicate that a patient may not be the best candidate for refractive surgery is those who claim they "never want to wear glasses again."

Additionally, technological advancements for patients include specialized, customizable lens technologies, the ability to match specific technologies to individual patient needs, and tailoring surgical approach based on the patient's unique characteristics.

Ibach's key takeaway from the presentation is that modern lens-based surgical options provide sophisticated, personalized vision correction strategies that can significantly reduce dependence on corrective eyewear while maintaining realistic patient expectations.