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    Designer cataract surgery concept tailored to each case

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


    Custom planning, customized vision

    This four-category classification allows surgeons to place practically every cataract case into a plan mode and then work toward the Gulani 3-T system: target, technology, and technique, when designing a customized cataract surgery plan.

    I spend extensive time with every patient determined to find my pins and to confirm their visual target. We can then work on how to deliver that target based on their clinical status from the 3-T system to the four-category classification to see how the plan unfolds.

    Target. The surgeon first determines the patient’s customized visual goals of monovision, blend, progressive, or accommodative vision and any professional requirements, for example, for pilots and night vision-dependent professions.

    Technology. The technologies to be considered are the type of lens implant: monofocal, multifocal, toric, accommodating, or dual IOLs; the cataract extraction technology: femtosecond laser/phacoemulsification; intraoperative aberrometry measurement systems, combinations such as LASIK laser vision surgery/diamond astigmatic incisions; and two- or three-dimensional visualization systems including the recently FDA-approved incision sealants.

    In addition, combined knowledge about the technologies and the optics of the eye allow measurement of higher order aberrations along with secondary refractive errors and optical zones with corneal asphericity, which are factors that affect vision beyond the three common refractive errors.

    Technique. The surgical technique could be based on cataract densitometry analysis, associated pathologies, and planned correctables dependent on incision site placement and energy applications.

    Armed with this information, the surgeon can then dedicate a plan personalized to each patient. Rather than being intimidated by technology or its indispensability, one can confidently pick the technology most applicable in each case from a shelf (in our mind) as we determine the target and technique for that case remembering all the time that for that particular patient this surgery will impact the rest of his or her life.

    Thus, rather than forcing a set technology and technique on all patients, imagine the fun of picking specific technologies such as femtosecond laser in cases of mature white cataracts or nystagmus, incision sealants in RK cases, toric or accommodative lens implants previous refractive or corneal irregularity cases, and then even combination technologies to design each case to achieve its best vision potential.

    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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