Sharing of a unique cataract treatment case (Feature Interview with Dr. Tsui-Kang Hsu)
Video Source: Ophthalmology Community
Q1: Sharing of a unique cataract treatment case
Modern cataract surgery is very advanced, with small wounds and quick recovery. The artificial lens also has many functions, so more than 95% of patients are actually very satisfied. In clinical practice, however, we still encounter patients with limited postoperative visual improvement. It is true that a few patients experience little or no improvement in vision after cataract surgery. They should have been able to see clearly, but their vision remained blurry after surgery. In such cases, it is necessary to determine whether there are other causes of vision impairment besides cataracts. Sometimes, patients with poorly controlled diabetes mellitus may experience macular edema, macular ischemia, or even worsening of diabetic retinopathy after surgery, resulting in little improvement in visual acuity. In overripe cataracts, it is easy to cause corneal edema after surgery due to the high ultrasonic energy or long operation time, which prolongs the recovery time and affects visual acuity. In addition, severe postoperative dry eye often compromises visual quality and decreases patient satisfaction. Another special case is an accidental impact after surgery, such as when you are holding your grandchild and your grandchild bumps into your eye, causing dislocation of the intraocular lens (IOL), which can lead to vision loss. For postoperative IOL dislocation, a newer method is to use special wires (monofilament non-absorbable polypropylene suture, 6-0 prolene wire), one end of which is attached to the lens and the other end is cauterized and attached to the sclera, so that the IOL can be repositioned in a good position, allowing the patient to regain his or her vision.
Q2: How do you help your patients choose an IOL?
In the ophthalmology clinic, many patients require cataract surgery. During the surgery, the cataract is removed and a new IOL is implanted to replace the cataract. There are many different types of IOLs on the market today: There are blue light blocking lenses, aspheric lenses, astigmatism correcting lenses, extended focal length presbyopia correcting lenses, bifocal lenses, and trifocal lenses. With so many lenses available, how do I choose? The public needs to know a very important concept: The most expensive is not always the best. It is important to consider your eye condition, your lifestyle and the nature of your work. For example, if a patient spends most of his or her time at a computer working at intermediate to near distances, he or she does not necessarily need to see clearly at a distance and may choose to retain some degree of myopia. Or, if the patient spends most of his or her time outdoors instead of reading or using a tablet, a multifocal lens for intermediate to near won’t work. Current multifocal or extended focus IOLs use a beam splitter to solve the problem of seeing far and near. As a result, the intensity of light is scattered by the beam splitter, and the clarity of vision is not as good as that of monofocal lenses. Patients who need to drive at night should pay special attention to the choice of IOL and don’t always believe that the most expensive is the best. Sometimes multifocal lenses shift light, causing halos or glare when driving at night, which is not as clear as with monofocal lenses. Therefore, the use of multifocal IOLs is not recommended for patients who need to drive at night, just a reminder.