How OSD affects advanced technology IOLs

September 1, 2020

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Gretchyn Bailey, NCLC, FAAO: Hi, everybody. I am Gretchyn Bailey with Optometry Times®. And I have the pleasure of speaking now with Dr. Jake Lang from Minneapolis. Jake is talking to us about a lecture he is delivering at this year’s Twin Cities Ocular Surface Disease Symposium. Boy, that is a mouthful. And that meeting is all virtual this year. It is also combining with Dry Eye Boot Camp at the same time. Jake, first, thanks very much for talking with me. I really appreciate you taking the time.

Jake Lang, OD, FAAO: My pleasure. Thanks for having me here. And thanks to Everything Dry Eye, Dry Eye Boot Camp and Twin Cities OSD symposium for allowing me to speak to people about advanced technology, intraocular lenses (IOLs), and ocular surface disease.

We spoke a lot about advanced technology IOLs, where IOLS have come from, where they are going, new technology that is on the horizon, ways of correcting refractive error, ways of correcting presbyopia, and maybe ways of integrating technology into our IOLs in the future. We talked a lot about that and then how the ocular surface plays such a huge role in making these advanced technology lenses work. Without a healthy ocular surface, we just can’t get out of that technology what we want. I kind of did it a little analogy to having this great cell phone and having horrible service. You just can’t get out of your phone what you want. If you don’t have that, if you don’t have good WiFi, your Zoom meetings just don’t work that way.

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Bailey: And we have all experienced that lately, haven’t we?

Dr. Lang: We have, there has been a learning curve. We talked a lot about ocular surface, how it plays a role, things to look out for, things to do about ocular surface disease so that your patients are set up for success. We talked about different conditions that cause irregularities in the surface and ways to fix those, make those lenses work at their maximum. That was really the focus of the lecture today.

Bailey: I have a quick question for you about these advanced technology IOLs that many people are referring to as premium IOLs, many patients are paying more out of pocket for them. Are you finding that patients who do have some ocular surface disease challenges prior to having a premium IOL implanted, are they experiencing more problems afterward? Do you think, because they have higher expectations due to a premium IOL? Or would you say it is on par with a non-premium implant?

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Premium IOLs

Dr. Lang: No, I think the patients really expect success. Now more than ever, just because of our world of our generational changes, but also the technology that they are paying for, they want to work. If you buy a new computer or a new phone, you expect it to work and without that ocular surface disease being treated, it is not going to work. And so yeah, they are expecting: “You told me this is going to work. I paid for it. Why isn't it working?” And I do find these patients are more willing to do the treatments too, like, “Yes, this is what I want.”. So you know, they see the end and the goal in sight. They are more willing to adhere to your recommendations do what you want, because they have skin in the game too, right? They want this lens to work. They want this technology; they want this freedom from glasses. So, they are willing to jump in and do whatever it takes, and sometimes they are disappointed if that wasn’t brought up to them, beforehand. Why didn't you tell me this? I would have done this. I would have waited; I would have taken care of whatever I needed to take care of beforehand.

Bailey: You said that these patients are willing to put in the time and the effort prior to cataract surgery. Would you say that they are more compliant or more interested in achieving ocular surface success than say patients who are not opting for a premium IOL?

Dr. Lang: I think that varies with the patient to some degree because some patients are more concerned about their ocular health than others. I find the patients that want that extra level of vision is realizing that there are a lot of moving pieces and they will adhere and do whatever they need to do to get to that higher level of vision, especially in the preoperative period. I mean, they come in for X amount of measurements and all these extra appointments and have a lot of questions about the lens. They are engaged in setting themselves up for success.

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Treat early, treat often

Bailey: If you had 2 or 3 pearls to offer to your fellow ODs, about preparing the ocular surface for premium IOL patients, what would those be?

Dr. Lang: Yeah, treat early, treat often. Look, lift, pull, and push. That is an American Society of Cataract and Refractive Surgery (ASCRS) recommendation. Take that extra minute to look around a little bit more, recognize what you are seeing, explain it to the patient, take those extra minutes to explain and educate the patient about what is going on. And then on the back end, don’t necessarily mess it up with post-operative treatments either. These post-operative treatments need to be ocular surface friendly as well.

Bailey: Absolutely. I like don’t mess it up after. (Laughter) That is good advice.

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Dr. Lang: Well, the surgeons always tell me, “Don't mess up my work.”.

Bailey: Well, they’re not wrong.

Dr. Lang: I would agree.

Bailey: This was some great information. Jake, thank you very much for talking with me today and I will talk to you soon.

Dr. Lang: My pleasure. Thank you.

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