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Purpose of Review In this article, we review the latest research related to presbyopia management at the time of cataract surgery with attention focused on available options in the USA. Recent Findings With refractive cataract surgery, patient satisfaction is largely dependent on preoperative expectations with regard to spectacle independence and photic phenomena. Monovision with monofocal intraocular lenses have the highest rates of spectacle dependence but the lowest rate of photic phenomena. Extended depth of focus lenses provides excellent distance and intermediate vision, but patients often require glasses for near vision in addition to having mild glare and halos. Refractive multifocal lenses tend to have the highest rates of photic phenomena. Both diffractive and refractive multifocal lenses had excellent near and distance visual acuity but difficulty with intermediate vision. Trifocal lenses provided the most consistent vision at near, intermediate, and distance and only had moderate amounts of glare and halos with excellent patient satisfaction. Summary The current market of intraocular lenses provides patients with the opportunity to experience spectacle independence following refractive cataract surgery. Current options include monovision with monofocal lenses, multifocal intraocular lenses, extended depth of focus intraocular lenses, and pseudo-accomodative intraocular lenses. Future technology is focusing on accommodation, pinhole apertures, and improved multifocality.

Purpose of Review In this article, we review the impact of the COVID-19 pandemic on refractive surgery. Recent Findings COVID-19 infection frequently causes eye symptoms, most commonly conjunctivitis or mild irritation. While virus can be detected in tears of symptomatic patients, the risk of transmission via this route appears low. Summary Refractive surgery consultations were significantly reduced during the pandemic; however, volume is rebounding quickly likely due to a number of lifestyle, health, and financial factors. Laser refractive and intraocular surgery likely confer a low risk of virus spread, especially in asymptomatic patients. Screening prior to the refractive consultation and surface disinfection in the clinic and operating room can help reduce transmission risk further.

Background: To determine whether there is a significant saving of time when using a digital cataract workflow for digital data transfer compared to a manual approach of biometry assessment, data export, intraocular lens calculation, and surgery time. Methods: In total, 48 eyes of 24 patients were divided into two groups: 24 eyes were evaluated using a manual approach, whereas another 24 eyes underwent a full digital lens surgery workflow. The primary variables for comparison between both groups were the overall time as well as several time steps starting at optical biometry acquisition until the end of the surgical lens implantation. Other outcomes, such as toric intraocular lens misalignment, reduction of cylinder, surgically induced astigmatism, prediction error, and distance visual acuity were measured. Results: Overall, the total diagnostic and surgical time was reduced from 1364.1 ± 202.6 s in the manual group to 1125.8 ± 183.2 s in the digital group (p < 0.001). The complete time of surgery declined from 756.5 ± 82.3 s to 667.3 ± 56.3 (p < 0.0005). Compared to the manual approach of biometric data export and intraocular lens calculation (76.7 ± 12.3 s) as well as the manual export of the reference image to a portable external storage device (26.8 ± 5.5 s), a highly significant saving of time was achieved (p < 0.0001). Conclusions: Using a software-based digital approach to toric intraocular lens implantation is convenient, more efficient, and thus more economical than a manual workflow in surgery practice.

Purpose of review To report the visual, clinical, and surgical outcomes of cataract surgery following radiation therapy for uveal melanoma (UM) while reviewing the available literature discussing these outcomes. Recent Findings Patients were managed with cataract surgery after radiation for UM at the Bascom Palmer Eye Institute, between January 2014 and February 2021, with a minimum follow-up of 6 months. Only the radiated eye was included. Measured outcomes included BCVA (logMAR), and OCT measurement of macular thickness at 1, 3, 6, and 12 months postoperatively. Paired t-tests were used to compare pre- and postoperative variables. Forty-seven eyes from 47 patients were included. Their mean age was 67.0 ± 11.0 years old; 24 (51%) were male. Preoperatively, 21 (44.6%) had radiation-induced maculopathy, 8 (17%) exudative retinal detachment, and 4 (8.5%) iris synechiae. Cataract types included nuclear sclerosis (80.8%), posterior subcapsular (55.3%), cortical sclerosis (19.1%), and mixed-type (55.3%). Intraoperative events reported were synechialysis (4.2%), floppy iris syndrome (IFIS) (2.1%), sub-tenon’s corticosteroid injections (31.9%), and bevacizumab (21.2%). There were no complications. There was a significant improvement in best corrected visual acuity (BCVA) at the 1st month postoperatively (0.68), and up until the 12th month postoperatively (0.71) compared to baseline (1.14, p < 0.01). OCT measurements of the macular thickness showed a significant increase (363 µm) during the 6th postoperative month compared to baseline (327 µm; p < 0.01). Summary Cataract surgery is safe and effective in improving visual acuity in individuals with post-radiation cataracts. Routine macular thickness monitoring should be considered in order to optimize their visual outcome. In the treatment of these patients, a multidisciplinary approach and proper surgical planning are essential, with a focus on early, aggressive anti-inflammatory and anti-VEGF therapy. Setting Bascom Palmer Eye Institute, USA. Design Retrospective chart review. Methods Patients were managed with cataract surgery after radiation for UM at the Bascom Palmer Eye Institute, between January 2014 and February 2021, with a minimum follow-up of 6 months. Only the radiated eye was included. Measured outcomes included BCVA (logMAR) and OCT measurement of macular thickness at 1, 3, 6, and 12 months postoperatively. Paired t -tests were used to compare pre and postoperative variables. Results Forty-seven eyes from 47 patients were included. Their mean age was 67.0 ± 11.0 years old; 24 (51%) were male. Preoperatively, 21 (44.6%) had radiation-induced maculopathy, 8 (17%) exudative retinal detachment, and 4 (8.5%) iris synechiae. Cataract types included nuclear sclerosis (80.8%), posterior subcapsular (55.3%), cortical sclerosis (19.1%), and mixed-type (55.3%). Intraoperative events reported were synechialysis (4.2%), floppy iris syndrome (IFIS) (2.1%), sub-tenon’s corticosteroid injections (31.9%), and bevacizumab (21.2%). There were no complications. There was a significant improvement in best corrected visual acuity (BCVA) at the 1st month postoperatively (0.68) and up until the 12th month postoperatively (0.71) compared to baseline (1.14, p  < 0.01). OCT measurements of the macular thickness showed a significant increase (363 µm) during the 6th postoperative month compared to baseline (327 µm; p  < 0.01). Conclusion Cataract surgery is safe and effective in improving visual acuity in individuals with post-radiation cataracts. A multi-disciplinary approach, proper surgical planning, and postoperative anti-inflammatory care are paramount in the management of these individuals.

Purpose of review Vivity is a new class of extended range of focus IOL, and it is growing in terms of its use both in Europe and the USA. It is a new IOL using new technology and there is a paucity of peer-reviewed literature on this new IOL. The authors wanted to write a paper explaining the technology and sharing their experience and perspectives to provide new users with a better understanding and insights. Recent findings We review the current publications in the literature and provide our own collective experience and perspective as users of the Vivity IOL. A total of 30% of recipients of the Vivity IOL could read when emmetropia was achieved in both eyes while a much greater proportion could read up close (phones, books) with a modest amount of defocus in the near vision eye. Summary Our findings to date suggest that this IOL is indeed in a new category with a significant improvement in range of focus but with the same photic phenomena as a monofocal IOL.

Purpose of Review To explore the etiology and incidence of pseudophakic positive dysphotopsia (PD) and negative dysphotopsia (ND) and summarize strategies to prevent and treat its occurrence. Recent Findings PD is managed with intraocular lens (IOL) exchange for lower refractive index or treated edge lenses or by use of photochromic contact lenses. PD related to presbyopia-correcting IOL designs is prevented with patient screening and education and mitigated post-operatively by optimizing visual acuity, treating ocular surface disease, and facilitating neuroadaptation through virtual augmentation. Consider IOL exchange if these measures fail. ND is managed with manipulation of the optic and the anterior nasal capsule through multiple surgical and procedural techniques. New IOL design and peripheral ring contact lenses are promising treatments. Summary Pseudophakic PD and ND are unique entities presenting independently of one another and demanding individualized prevention and treatments. A multifaceted approach will cater itself to the best treatment per patient.

  Purpose of Review To review the latest articles or papers on the results of light-adjustable lens implantation after lens surgery. We know this IOL was approved by the FDA in 2017. Mexico and Europe have experience with the LAL since 2008. Recent Findings Despite more than 5 years of LAL approval in the market, there is only one paper that shows 7 years of folloAbstract_Paraw-up results after LAL implantation. There are also reports with visual results in special cases after cataract surgery in patients with prior LASIK and prior radial keratotomy. Summary Retinal safety, refractive accuracy, and management of refractive error following cataract surgery with implantation of a LAL have been well documented over the last 5 years. We found one published case with complications after LAL implantation and had to be explanted and changed for another IOL, 14 days after surgery, and one case reported with explantation 4 years after surgery because of persistent erythropsia. On the other hand, there are published papers with good results in visual acuity on difficult cases after refractive surgery or trauma with the LAL. Long-term reports from targeted refraction with the LAL were better than + / − 0.5 D in 98% of the cases at 6 months, with refractive stability at 1 year of 0.04 D, and a + / − 0.23 D range at 7 years. (3)

Purpose of Review Immediately sequential bilateral cataract surgery (ISBCS) has been gaining attention over the past decade as a more efficient way to address the growing need for cataract removal in an aging population, and yet delayed sequential bilateral cataract surgery (DSBCS) remains the standard of care in many ophthalmologic communities. This review discusses some of the reasons surgeons have been hesitant to adopt ISBCS and hopes to address both the pros and cons of the procedure in the current medical environment. Recent Findings Many of the current arguments against the practice of ISBCS involve potential bilateral surgical complications and worse refractive outcomes; however, the literature to date does not support these arguments. The risk of unilateral vision threatening complications appears similar to DSBCL, and no cases of bilateral complications have been reported when the currently recommended protocols have been obeyed. Additionally, refractive targets have been similar to DSBCS in current published studies. Summary ISBCS appears to be a more efficient and cost-saving procedure that remains safe and effective for improving visual functioning in patients with bilateral visually significant cataracts.

Purpose of Review Dealing with an unhappy patient is always an uncomfortable challenge and likely one of the most difficult aspects of our job as a surgeon because it stands in contrast to what our primary intentions are as physicians. Recent Findings The most common reasons for patient dissatisfaction include residual refractive error and incompletely treated ocular surface disease. Other common patient concerns include issues with quality or range of vision and shortcomings related to perceived expectations. Recent data show that personality profiling may assist us in determining candidacy for specific lens technology. Summary Here, we will review the most common reasons and remedies for patient dissatisfaction after cataract surgery.

Purpose of Review To provide current overview of surgical options available to a vitreoretinal surgeon in a rapidly changing landscape of techniques for secondary IOL placement, and IOL exchanges. Recent Findings In the past several years, there has been a substantial expansion of surgical approaches for IOL fixation in the absences of zonular support. Novel sutured and sutureless transconjunctival methods have been developed and more efficient, safer modifications of old techniques have been also introduced. Summary Today’s vitreoretinal surgeon needs to be skilled at performing secondary IOL placement and exchanges, as demands for these procedures are increasing due to population aging. Familiarity with a variety of approaches is warranted to be able to choose the most appropriate technique for a particular patient to achieve the best outcomes.