The Pursuit of Postop Happiness

On the heels of the 250th anniversary of our country and in reviewing this issue’s content, we were reminded of this quote from founding father Benjamin Franklin, “By failing to prepare, you are preparing to fail.” Let us explain.

Cataract and refractive surgery have never been more precise. Femtosecond lasers, advanced biometry, and a growing menu of premium IOLs have pushed outcomes closer to perfection with every passing year. Yet, one of the greatest predictors of a patient’s satisfaction after surgery often has to do with what happens in the exam chair beforehand—and that is squarely the optometrist’s domain. So, when we fail to prepare, we are preparing to fail these preoperative patients.

Identifying and managing dry eye disease (DED) is an area of patient preparation that is crucial to satisfactory postoperative outcomes. Let’s remember that it is now widely recognized that an unstable tear film is among the most common causes of inaccurate biometry, compromised refractive outcomes, and patient postoperative dissatisfaction.

Let’s also keep in mind that ODs are uniquely positioned to both diagnose and treat DED, as they are typically the first eyecare providers to see these patients.

In this issue of Modern Optometry, you’ll see a common through line: the importance of identifying and managing an unhealthy ocular surface before either surgery is performed. In “A Review on Identifying and Explaining Cataracts,” by optometrist Nicholas J. Bruns, he notes that DED is considered when patients complain of glare, a common symptom of cataracts. Also, in “Identifying Ideal Candidates for Refractive Surgery,” optometrist Ranjani Panda mentions how DED is a contraindication. And, in “Prepping the Ocular Surface for Cataract and Refractive Surgery,” optometrist Sean W. Smolyenak discusses the specific action steps he follows for an optimal postsurgical outcome.

Equally crucial in patient preparation is the OD’s role in managing postoperative expectations. Optometrists Gabrielle Anderson, Mitch Ibach, and Patrick Shultz discuss this in their articles, “Establishing a Practical Collaborative Care Protocol” and “Educating Patients on IOL Options,” respectively. In the former, the authors say they explain to patients the potential risks and complications. In the latter, Dr. Shultz provides patient-facing scripts on the purpose of each IOL and the expected compromises.

The bottom line is that ODs who take the time to explain what “spectacle independence” realistically means, who counsel patients on the likelihood of needing glasses for some tasks, and who prepare patients for a neuroadaptation period after advanced IOL implantation are directly reducing the incidence of postsurgical dissatisfaction and unnecessary IOL exchanges.

As this issue covers cataract and refractive surgery, we think it’s worth stressing that technology is only half of the outcome equation. The other half is the OD’s role in diagnosis, education and intervention (see “Cataract Surgery: Identifying Postoperative Adverse Events,” by optometrist Samantha Rivet), all of which are connected to preparation!