Cornea

The refractive cataract work-up

Part two of a seven-part corneal/anterior segment survival guide.

BY MARTHA C. TELLO, BGS, COMT, OSC

The rush of an ordinary clinic day should not impede an ophthalmic technician’s performance during a refractive cataract preliminary exam. Understanding the exam process helps to make the exam efficient for the physician and results in the optimal patient experience and outcome.

To improve the performance of ophthalmic technicians working with the refractive cataract surgeon, we offer the following best practices.

From the beginning

Start by defining cataracts for patients. Cataracts occur when the lens becomes cloudy and hard. They typically develop from normal aging or from eye trauma, previous eye surgery, or use of certain medications, such as oral steroids. Patients may present with complaints such as blurred vision, poor night vision, sensitivity to light and glare, ghost images, double vision, and/or decreased color sensitivity.

Ready for surgery?

At first, patients may come into the ophthalmologist’s office hoping new glasses will correct their eye problems. The thought of having surgery might not even cross their minds. The patient may not be able to target one specific visual complaint.

The ophthalmic technician must identify whether the patients are potential candidates for refractive cataract surgery. The problem: A complaint of blurry vision does not automatically indicate a cataract diagnosis.

If patients are frustrated with a deficit in their daily activities or notice a change in their daily functioning, an efficient ophthalmic technician should investigate whether symptoms interfere with quality of life.

Cortical cataract with pseudoexfoliation.IMAGES COURTESY ROSA LONG, CRA

For example, patients may complain of a change in their driving behaviors or a change in their hobbies, such as trouble seeing the golf ball, difficulty playing cards, or the need for more light while reading.

These practical changes in daily functioning may significantly impact their daily activities and result in frustration and possible depression. It’s the technician’s job to help them realize that surgery may be necessary to solve their visual issues.

Set the proper expectations

Once patients realize that removing their cataracts prevents severe vision loss, they typically have several questions. It is wise to touch upon traditional cataract surgery, monovision, and recent innovations in cataract surgery. This includes femtosecond lasers, premium IOLs, toric IOLs for astigmatic correction, and how technological advancements such as intraoperative aberrometry may improve outcomes. (See Refractive cataract surgery Q&A, right.)

Physicians value team members with diverse skills, so an ophthalmic technician should also be able to multitask and play the role of surgical coordinator. The surgical coordinator can readily answer questions about surgical clearance by the primary care doctor, pre-op and post-op eye drops, post-op restrictions, special testing, and lens options.

Martha C. Tello, BGS, COMT, OSC educates patients on premium IOLs.IMAGES COURTESY ROSA LONG, CRA

Understand the process

During the explanation of the cataract surgery process, be clear in emphasizing that every eye is different in terms of size, depth, and curvature of the cornea. This way, the patients understand the need for routine yet careful measurements, such as axial length, specular microscopy, and topography, to obtain accurate data.

It is important to make patients aware that traditional cataract surgery involves the use of a surgical blade to perform corneal incisions and anterior capsulotomies. Also, clearly share that a femtosecond laser performs four aspects of cataract surgery: corneal incisions, primary incision, paracentesis, and limbal relaxing incisions.

Moving forward

Our refractive cataract surgeon, Kendall Donaldson, MD, MS, has her own plan of pre-op and post-op drops. Drug combinations including Besivance, Vigamox, Pred Forte, Durezol, Ilevro, Ketorolac, and Nepafenac (among others) are frequently used. The combination of a steroid, nonsteroidal agent and antibiotic agent are standard post-operative protocol. Our refractive cataract surgeon tries to minimize the amount of drops used to avoid compliance issues and minimize ocular surface complaints. OP

Part three will detail refractometry in the cornea clinic.

	Kendall E. Donaldson, MD, MS, is associate professor of ophthalmology and medical director of Bascom Palmer Eye Institute in Plantation, Fla.
	Martha C. Tello, BGS, COMT, OSC, is an ophthalmic technologist and clinical research coordinator with Bascom Palmer Eye Institute in Plantation, Fla. She has a Bachelor’s Degree in Leadership and Communication from University of Miami.