Editorial From Oliver Findl, MD, MBA, FEBO

How do you know which IOL to use?

Oliver Findl

Posted: Friday, February 1, 2019

Oliver Findl MD

I am very pleased to be invited to write this editorial for EuroTimes, which has a special focus this month on IOLs.

As my colleague Soosan Jacob points out in this issue, deciding on the choice of IOL to implant can sometimes be a difficult task, not only for the patient but also often for the surgeon who counsels the patient. The numerous types of available IOLs as well as relative advantages and disadvantages of each can be challenging.

As a surgeon, my advice to younger colleagues is always to use the lens that you are most comfortable with, but also the one that you think is best suited to the individual patient.

As we are all aware, as more exciting technologies come on the market our patients may have higher expectations of the improvement in vision that can result after a lens is implanted.

In my opinion, when talking to our patients before we enter the operating theatre, we must always stress that we can never guarantee perfect vision or a dramatic improvement in vision after a lens is implanted. We must always be honest with our patients and advise them that while we will always do our best for them, there is no such thing as the perfect procedure. We should follow the motto “underpromise and overdeliver”.

As ophthalmologists, we are always looking for the next big innovation and with that in mind, I was also very interested to read Howard Larkin’s report from the Ophthalmology Futures Forum held in Vienna in September 2018.

At this forum, Julian Stevens said that designing successful accommodating IOLs remains daunting and he noted that several mechanical and flexible gel lens IOL designs have lost accommodative range over time due to capsule fibrosis. He also pointed out that lens mineralisation has developed as much as five years after implant. My personal experience with the so-called accommodating IOLs has been very disappointing, I do not use them at all. Even though electronic accommodating IOLs still appear futuristic, prolonged battery life may make them realistic sooner than expected.

This is a discussion that we will return to in the future, and as always part of the excitement of being an ophthalmologist is looking forward to what lies ahead and to see the benefits that years of research can bring in real life situations in our daily surgeries.