Report on Custom Matching Intraocular Lenses (IOLs) in Lens-Based Surgeries with Emphasis on Sustainable Development Goals (SDGs)

Introduction

The evolving needs of patients serve as a significant catalyst for innovation and the adoption of advanced solutions in ophthalmology, particularly in the selection of intraocular lenses (IOLs) for lens-based surgeries. This report highlights the importance of patient-centered care aligned with Sustainable Development Goals (SDGs), focusing on quality health and well-being (SDG 3), innovation (SDG 9), and reduced inequalities (SDG 10).

Patient Expectations and Custom Matching Approach

Patients today are well-informed and have high expectations for vision correction, seeking spectacle-free lives with excellent vision across all distances, minimal visual disturbances, and solutions compatible with their active lifestyles. Addressing these expectations requires a personalized approach to IOL selection.

Since 1998, the concept of custom matching IOLs has been advocated to optimize surgical outcomes. This approach involves tailoring IOL choices to individual patient needs rather than applying a universal solution, thereby promoting inclusive and equitable healthcare (SDG 10).

Assessment and Selection Process

Optimizing outcomes begins with a comprehensive assessment of the patient’s ocular history, health status, visual goals, lifestyle, personality, profession, and hobbies. This holistic evaluation supports SDG 3 by enhancing health outcomes through personalized care.

The meticulous selection process includes objective assessment of ocular characteristics such as:

1. Corneal astigmatism
2. Health of the ocular surface
3. Angle kappa/alpha
4. Pupil size
5. History of previous LASIK, higher-order aberrations (HOA), and other ocular comorbidities

Preoperative Patient Counselling

Effective preoperative counselling is critical to managing patient expectations and ensuring informed consent. Discussions cover:

• Details of the surgical procedure and anesthesia
• Recovery process and postoperative care
• Benefits and impact on quality of life
• Potential side effects such as halos and glare
• Risks and possible complications

This transparent communication supports SDG 3 by promoting patient well-being and empowerment.

Case Study: Custom Match Approach

A 56-year-old female patient desiring spectacle independence underwent a custom matched IOL implantation based on her preoperative refraction and ocular assessment:

• Dominant eye (OD): Implanted with Vivity Toric, a non-diffractive extended depth-of-focus (EDOF) lens correcting presbyopia and astigmatism
• Non-dominant eye (OS): Implanted with Clareon PanOptix, a trifocal lens providing spectacle independence with enhanced vision at all distances

Postoperative outcomes demonstrated excellent visual acuity:

• Uncorrected distance visual acuity (UCDVA) both eyes: 20/20
• Uncorrected intermediate visual acuity at 60 cm: 20/25
• Uncorrected near visual acuity at 40 cm: 20/20

This personalized surgical strategy exemplifies innovation (SDG 9) and contributes to improved quality of life (SDG 3).

Criteria for Excluding Custom Match Approach

While the custom match approach yields high success rates, certain patient conditions contraindicate its use, including:

• Irregular cornea or higher-order aberrations greater than 0.3
• Severe dry eye disease unresponsive to treatment
• Retinal pathologies such as age-related macular degeneration
• Contraindications for trifocal lenses
• Sensitivity to halos
• Angle kappa larger than 500 µm, especially post-LASIK
• Pupil size outside the 3.5 mm to 4.5 mm range
• Decentered ablations in post-LASIK patients

Appropriate patient selection ensures equitable access to effective treatments, aligning with SDG 10.

Conclusion

The custom match approach to IOL implantation represents a superior strategy to meet the diverse and exacting demands of modern patients. It enhances visual outcomes, reduces adverse effects such as glare and halos, and supports patient satisfaction. This approach embodies the principles of sustainable healthcare by promoting innovation, quality health, and equitable patient-centered care consistent with the Sustainable Development Goals.

References

1. Kruger JA. Avoiding and managing patient dissatisfaction after intraocular lens implantation after cataract surgery. In: Buratto L, Apple DJ, Werner L, Zanini M, eds. Phacoemulsification: Principles and Techniques. 2nd ed. Slack Incorporated; 2003.
2. Yeu E, Cuozzo S. Matching the patient to the intraocular lens: preoperative considerations to optimize surgical outcomes. Ophthalmology. 2021;128(11):e132-e141. doi:10.1016/j.ophtha.2020.08.025

Author Information

Johann Krüger, MD | E: drkruger@eyelaserclinic.co.za

Dr. Krüger is an internationally renowned eye surgeon practicing in Cape Town for over 32 years. He is a fellow of the College of Ophthalmology South Africa, the Royal College of Surgeons Edinburgh, and a founding member of the World College of Refractive Surgery and Visual Sciences.

1. Sustainable Development Goals (SDGs) Addressed or Connected

1. SDG 3: Good Health and Well-being
   • The article focuses on improving eye health through advanced intraocular lens (IOL) selection and surgeries, directly contributing to ensuring healthy lives and promoting well-being for all ages.
2. SDG 9: Industry, Innovation and Infrastructure
   • The article discusses innovation in medical technology and personalized surgical approaches, highlighting the role of innovation in healthcare infrastructure and services.
3. SDG 10: Reduced Inequalities
   • By emphasizing personalized patient care and informed consent, the article indirectly supports reducing inequalities in healthcare access and outcomes.

2. Specific Targets Under the Identified SDGs

1. SDG 3: Good Health and Well-being
   • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and access to safe, effective, quality, and affordable essential medicines and vaccines for all.
   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
2. SDG 9: Industry, Innovation and Infrastructure
   • Target 9.5: Enhance scientific research, upgrade the technological capabilities of industrial sectors, including health technologies.
3. SDG 10: Reduced Inequalities
   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.

3. Indicators Mentioned or Implied to Measure Progress

1. Health Outcome Indicators
   • Uncorrected distance visual acuity (UCDVA) measurements (e.g., 20/20 vision post-surgery) as a direct indicator of surgical success and patient health outcomes.
   • Patient satisfaction and quality of life improvements post-surgery, including spectacle independence and reduction of dysphotopsias (halos and glare).
2. Innovation and Technology Indicators
   • Use of advanced diagnostic tools such as iTrace for surgical planning and personalized IOL selection.
   • Adoption rates of new IOL technologies (e.g., EDOF and trifocal lenses) in clinical practice.
3. Equity and Access Indicators
   • Extent of preoperative patient counselling and informed consent processes ensuring patient understanding and inclusion.
   • Customization of treatment plans based on individual patient characteristics, reflecting equitable healthcare delivery.

4. Table of SDGs, Targets, and Indicators

Source: europe.ophthalmologytimes.com