Which intraocular lens would ophthalmologists choose for themselves?

Abstract

Purpose: Contemporary cataract surgery is increasingly customizable with the advent of presbyopia-correcting intraocular lenses (IOLs) and the femtosecond laser. The purpose of this study was to determine the types of IOLs ophthalmologists choose for themselves and whether demographic characteristics, surgical experience, and attitudes of ophthalmologists might influence their decision-making. Additional goals included evaluating the use of femtosecond laser use in cataract surgery and investigating surgeon IOL preferences for their patients.

Methods: We distributed a 29-question Survey Monkey survey to senior ophthalmology residents and practicing ophthalmologists and received 347 responses during a 1-month period. We analyzed 328 surveys using chi-square tests and Fisher's exact tests.

Results: Main outcome measures included surgeons' personal preferences for choice of IOL, femtosecond laser-assisted cataract surgery, and IOL preference for patients. In the setting of no astigmatism, 61.3% of respondents would choose a monofocal IOL set for either distance or monovision for their own surgery. For corneal astigmatism >1.25 D, 60.3% of respondents would choose a toric monofocal lens and only 6.9% would want a femtosecond laser or manual LRI for their own surgery. Of the respondents, 34.6% perform femtosecond laser-assisted cataract surgery, but only 15.3% would want femtosecond cataract surgery performed on themselves. Also, 67.7% implant presbyopia-correcting IOLs (diffractive echelette, multifocal, or accommodative). When correcting for patients' corneal astigmatism >1.25 D, 65.7% of respondents preferred a toric monofocal IOL.

Conclusion: Ophthalmologists value quality of vision and are risk averse. Overall, a surgeons' personal preference for their own surgery is correlated with past surgical experience with patients.

Fig. 1

Surgeon personal intraocular lens choice for both eyes assuming minimal astigmatism. Bar graph showing which option surgeons would choose for their own surgery assuming they had minimal astigmatism

Fig. 2

Surgeon personal intraocular lens (IOL) choice assuming corneal astigmatism >1.25 D. Bar graphs showing which IOL option surgeons choose for themselves assuming they had >1.25 D of corneal astigmatism

Fig. 3

Bar graph showing surgeon intraocular lens choice for patients with corneal astigmatism >1.25 D