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    Designer cataract surgery concept tailored to each case

    ‘Premium’ cataract surgery is not necessarily ‘custom’ cataract surgery


    The surgeon’s first consideration is determining the associated pathologies, ammetropias, past ocular surgical history, and visual dysfunctions of each patient and then choosing options from the available array of treatments (Gulani 3T system) to resolve all of each patient’s conditions during one surgery that they need anyway, i.e., cataract surgery.

    By not doing so, a surgeon will have missed out on the only opportunity that individual patients had for the rest of their lives.

    With such an outlook, I encourage colleagues to classify every cataract patient into four categories and then individually plan to address all of their correctable visual issues (bowling pins) using custom designed cataract surgery.

    The Gulani Cataract Category Classification comprises four categories:

    1. Cataracts with associated refractive errors (i.e., myopia, hyperopia, astigmatism, and presbyopia);
    2. Cataracts with a previous eye surgery (i.e., RK, LASIK, etc.);
    3. Cataracts with an associated pathology (i.e., Fuchs disease, corneal scar, keratoconus etc.) and
    4. Enhancement of a previous cataract surgery (i.e., residual ammetropia, haloes, glare, etc.)

    When all of these factors are considered for individual patients, the surgical plan unfolds clearly.

    For example, a Category 1 cataract patient may wear bifocal glasses for farsightedness, astigmatism, and presbyopia. Therefore, there are four visual factors affected—cataract, farsightedness, astigmatism, and presbyopia. Instead of considering such a patient as a routine case and rushing them through a cataract surgery assembly line, the surgeon should try to correct all of the patient’s visual problems during one cataract surgery.

    Category 2 patients who have undergone previous refractive surgeries such as LASIK and RK may present with either long-term side effects of those surgeries with gradually decreasing vision over time or a need for an enhancement. Their vision can be planned using cataract surgery with specific new technology lens implants including incision sealants and intraoperative calculation technology to be followed by staged, laser vision surgery for excellent visual outcomes.

    For Category 3 patients who have an associated pathology, such as keratoconus, corneal scars, or Fuchs dystrophy besides cataracts, the surgeon can plan for the visual endpoint by first manipulating the optics of the eye using new technology IOLs with cataract surgery to prepare for laser Corneoplastique techniques.

    Finally, Category 4 patients with previous cataract surgery may have the wrong IOL power/technology in place or a surgical complication or may want an enhancement of their cataract surgery. In such cases, the surgeon should plan to exchange the lens implant or piggyback or perform corneal refractive surgery to correct not only their resultant spectacle prescription but also resolution of the offending symptoms.

    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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