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    Defining dysfunctional lens syndrome

    Clinical entity of DLS has been overlooked, inadequately characterised


    Part of the rationale behind the DLS terminology is to avoid the use of others, such as very early cataract or pre-cataract. These terms can seem dismissive, implying that a patient’s only option is to wait for the early cataract to ripen or for a pre-cataract to become a cataract, delaying surgery by 5 to 10 years.

    Prof George O Waring IV, of the University of South Carolina, USA, defines three stages of DLS:

    Stage 1 is defined by the onset of presbyopia and the subsequent progressive loss of accommodation.

    Stage 2 includes some opacification of the lens with the onset of aberrations or change of refraction.

    In stage 3, DLS is advanced--not yet meeting the insurance-based criteria for a cataract--but influencing the daily life of the patient. In stages 2 and 3, a lens-based procedure should be preferred to LASIK if the patient is demanding refractive surgical intervention.

    Cataract is a cataract, and DLS is a clinical entity that has been overlooked and inadequately characterised. In the perspective of the refractive surgeon, this new entity is important since it gives objective measures to decide between a cornea-based LASIK or a lens-based procedure, such as refractive lens exchange.

    Stein’s famous quotation might simplify things. There are always two sides to every story, and it is a question of perspective to reveal the tru behind what is called a fact.

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