Care of the Premium IOL Patient
Optometrists should be very comfortable with management of the cataract patient. Premium IOLs add new aspects to their care. Premium IOLs come with increased expectations by our patients, and we can guide and counsel the patient to achieve optimal outcomes. Here are some important pearls on the management of premium IOL patients:
- Optometrists are often the gatekeepers for patient selection, IOL recommendation, and postoperative management of refractive cataract patients. Optometrists should be well versed in the different IOL options and the advantages and disadvantages of all the IOL types.
- The cornea is key to patient selection and management. Dry eye disease and blepharitis must be treated prior to cataract surgery. Patients expect a lot when they choose premium IOLs, and untreated ocular surface disease can significantly affect visual results and patient satisfaction. Punctal plugs, RESTASIS®, lid hygiene, Omega 3 supplementation, and AzaSite® can be utilized aggressively to treat these conditions within the scope of optometric care.
- Preoperative astigmatism is important for visual outcomes after cataract surgery, particularly when premium IOLs are used. Corneal astigmatism must be well managed in the premium IOL patient. Peri- and postoperative treatments may be necessary to handle postoperative astigmatism. Limbal relaxing incisions, astigmatic keratectomy, or laser vision correction may be used to fine-tune results.
- The endothelial layer is particularly important in the premium IOL patient, as edema is poorly tolerated by these patients postoperatively. Guttatae are best discovered preoperatively before cataract surgery, and never more so than when multifocal lenses are being considered, as these patients will do poorly otherwise.
- Comorbidities such as macular retinal disease (especially macular degeneration), epiretinal membrane, and macular edema or a history of uveitis may make the patient an unwise candidate for premium lenses. A careful preoperative history and dilated fundus exam is mandatory.
- Lastly, the patient’s family optometrist will likely know the patient’s special needs. As with laser vision correction, certain patients may not be suitable candidate’s due to unrealistic expectations or visual demands at work or at play.