At this year’s Controversies in Modern Eye Care meeting, Neda Shamie, MD, passionately discussed the transformative potential of both refractive cataract surgery and refractive surgery. For Shamie, these procedures represent more than clinical advancements; they embody a modern, patient-centered approach to vision correction.
Refractive cataract surgery, she explained, is about leveraging today's technological innovations to reduce a patient’s dependence on glasses at the time of cataract surgery. “It’s a more contemporary, elevated approach,” she said, emphasizing the importance of engaging patients in conversations about their lifestyle and visual goals. With options like multifocal, toric, extended depth-of-focus, light-adjustable, and small-aperture IOLs, practitioners now have an expansive tool kit to match the right lens to the right patient.
Preoperative education is an opportunity for optometrists
Key takeaways for optometrists:
- Refractive cataract surgery is highly personalized: Use IOL technology to match lenses with lifestyle.
- Start conversations early: Educating patients pre-operatively is a key role for optometrists.
- Move beyond LASIK/PRK: Consider EVO ICL or RLE for patients who fall outside standard surgical criteria.
- Collaboration is essential: Strong co-management improves outcomes and deepens patient trust.
- Chair time is an investment: Personalized care pays off in satisfaction and surgical success.
Shamie encouraged optometrists to initiate these discussions early, educating patients on the variety of options available. While these conversations may lengthen chair time, she believes they significantly enhance the patient experience and ensure surgical success. “I spend the time with patients to really engage in what they like to do, what their visual needs are, and see if I can match-make them to the right lens,” she said.
Personalizing refractive surgery
The conversation extended to refractive surgery more broadly. While LASIK and photorefractive keratectomy remain excellent options, Shamie warned against a one-size-fits-all approach. “When you only offer those two, you tend to stretch the limits of safety,” she noted. Today’s refractive surgeon must also consider alternatives like the EVO ICL for non-LASIK candidates or refractive lens exchange for hyperopic or presbyopic patients.
Shamie highlighted the role of optometrists in identifying candidates for these alternatives, especially when patients express dissatisfaction with glasses or contact lenses. “It’s a wonderful way to really extend their trust in you,” she added.
Collaborative care is the foundation of optimal outcomes
Shamie closed with a reminder of the meeting’s founding purpose: promoting true collaboration between optometrists and ophthalmologists. Citing the vision of Robert Maloney, MD, MA, who began the conference nearly two decades ago, she reaffirmed her belief that optimal patient outcomes stem from seamless, respectful comanagement.
“The whole journey of vision recovery is optimized when there’s a clear and streamlined handoff,” she said. From preoperative education to ocular surface optimization, optometrists lay the foundation for surgical success.
