Dispelling myths about refractive lens exchange

This article was reviewed by Arjan Hura, MD

As IOL technologies continue to become more advanced and sophisticated in their ability to deliver sharp vision at a wide variety of ranges, modern cataract surgery has essentially become refractive lens surgery.

As each iteration and generation of new IOL technology continues to provide better and more consistent results, cataract surgeons are increasingly implanting more than just the standard monofocal lens.

Related: Macular OCT imaging is vital in work-up of cataract surgery patients

However, the acceptance of replacing a lens purely for refractive purposes, a procedure referred to as refractive lens exchange (RLE), remains controversial.

A previous widely held misconception was that ophthalmologists do not have LASIK performed on their own eyes, which was dispelled by 2 studies in 2014 and 2015.

Results of the first, led by Ron Krueger et al, showed that physicians that had LASIK had a 95.3% satisfaction rate with their results^,1 and the results from second study, led by Guy Kezirian, MD, and members of the Refractive Surgery Alliance (RSA), showed that refractive surgeons are 4 times more likely than the general population to undergo laser vision correction.²

Considering those results, Arjan Hura, MD, and Guy Kezirian, MD, MBA, FACS, decided to use the same approach to test impressions about RLE by asking surgeons about their own experiences with undergoing the procedure.

Related: Avoiding IOL refinements after presbyopia-correction surgery

Study design
Hura and Kezirian performed a prospective, randomized-survey study to determine the prevalence of RLE among active refractive surgeons, their recommendations to family members and friends to undergo the procedure, and the satisfaction rates among the ophthalmologists who underwent the procedure.

Five hundred ophthalmologists were selected randomly to receive the 29-question survey from among 2441 ophthalmologists who had used SurgiVision DataLink software products to plan refractive surgeries; specifically, they were asked about their personal experience with refractive surgery. The survey tool used was provided by the RSA.

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The main purpose of the study was to establish the prevalence of RLE among refractive surgeons, but the study also looked at whether those surgeons had recommended RLE to family and family members, and whether those family members undrgone RLE.

The study also sought to characterize the attitudes and satisfaction rates among refractive surgeons who undergone RLE.

The premise was that the prevalence rate of RLE among refractive surgeons may indicate the potential penetration of the procedure in the marketplace over time.

Related: For IOL placement, location is key

Results
Preliminary results presented at American Society of Cataract and Refractive Surgery 2020 were based off a 64.3% survey response rate.

Ninety-nine percent of the responders considered themselves refractive surgeons and 34% had undergone a laser vision correction themselves.

Almost 50% of those who underwent laser vision correction were in their 30s, 30% in their 40s, and 22% in their 20s at the time of surgery.

Of the survey responders, 8.5% reported having undergone a lens procedure for cataract (90%) and emmetropic presbyopia (10%).

Related: Femtosecond laser-assisted RLE offering better outcomes

An interesting finding was that 24% of the responders said they anticipate undergoing RLE for presbyopia; those who would not undergo the procedure were closer to the age of cataract surgery, wanted to wait for improved intraocular lens technologies, were concerned about potential complications, would not be able to tolerate multifocality, or reported the presence of a pre-existing ocular factor that would interfere with RLE, Hura said.

Based off the initial responses, the main study conclusions are the majority of refractive surgeons are performing RLE, almost one-third have recommended RLE to immediate family members, and almost a fifth have family members who have undergone RLE.

The investigators have no financial interest in this subject matter.

Read more by Lynda Charters

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Arjan Hura, MD
e:[email protected]
Hura is a third-year ophthalmology resident at the University of Cincinnati in Ohio. Dr Kezirian is the founder of the Refractive Surgery Alliance (RSA), and lives in Scottsdale, Arizona.

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References
1. Pasquali TA, Smadja D, Savetsky MJ, et al.Long-term follow-up after laser vision correction in physicians: quality of life and patient satisfaction. J Cataract Refract Surg. 2014;40(3):395-402. doi:10.1016/j.jcrs.2013.08.052

2. Kezirian GM, Parkhurst GD, Brinton JP, Norden RA. Prevalence of laser vision correction in ophthalmologists who perform refractive surgery. J Cataract Refract Surg. 2015;41(9):1826-1832. doi:10.1016/j.jcrs.2015.10.027