This content is for healthcare professionals only.

This activity is funded by an independent medical education grant from Alcon Vision, LLC.

The activity is jointly provided by USF Health and touchIME.

Faculty & Disclosures

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    Faculty & Disclosures
    Dr John Hovanesian

    University of California, Los Angeles, Jules Stein Eye Institute, California, USA

    Dr John Hovanesian is a board-certified ophthalmologist, a faculty member at the University of California, Los Angeles, Jules Stein Eye Institute, CA, USA, and an internationally recognized leader in corneal, cataract, refractive and laser surgery. read more

    Dr Hovanesian has published two eye surgery textbooks — one on the subject of refractive cataract surgery and one on pterygium surgery. Dr Hovanesian has lectured all over the world, authored dozens of peer-reviewed articles, and produced surgical teaching videos that have won the “Best Teaching” award at the prestigious American Society of Cataract and Refractive Surgery Film Festival.

    Dr John Hovanesian discloses: Consultancy fees from: Acufocus,Inc., Aerie Pharmaceuticals, Alcon, Allergan, Apellis Pharmaceuticals, Avellino Lab USA, Inc., Azura Ophthalmics, BlephExTM, Bruder Healthcare Company, BVI Medical, Centricity Vision, Inc., Cloudbreak Pharma, Cord LLC, Dompé, Eyedetec Medical, Inc., EyePoint Pharmaceuticals, Glaukos Corp, GlaxoSmithKline (GSK), Glint Pharma, Gobiquity, Hasa Optix, Horizon Therapeutics, Hoya Lens UK, ImprimisRX, Johnson & Johnson Vision, Kala Pharmaceuticals, Inc., Novartis, Ocular Therapeutix, Oculis Holding AG, Omeros, On Point Vision, Inc., Orasis Pharmaceuticals Ltd, Oyster Point Pharma, Rayner Surgical Group Ltd, Research Insight LLC, Sensimed SA, Sight Life, Sun Pharmaceuticals Industries Ltd, Tarsus Pharmaceuticals, TearLab Corporation, Thea Pharmaceuticals, Trefoil Therapeutics, Vindico Medical Education, Visus Therapeutics and Zeiss. Advisory board fees from: Apellis Pharmaceuticals, Bausch + Lomb, BlephExTM, Bruder Healthcare Company, BVI Medical, Cord LLC, Dompé, Eyedetec Medical, Inc., EyePoint Pharmaceuticals, Glaukos Corp, Glint Pharma, Hasa Optix, Horizon Therapeutics, Hoya Lens UK, Novartis, Ocular Therapeutix, Omeros, Orasis Pharmaceuticals Ltd, Rayner Surgical Group Ltd, Sight Life, Sight Sciences, Sun Pharmaceuticals Industries Ltd, Trefoil Therapeutics, Visus Therapeutics and Zeiss. Other Financial or Material Support (royalties, patent, etc.): Alcon, Alicia Surgery Center, Allegro Ophthalmics, Allergan, Cloudbreak Pharma, Cord LLC, CorneaGen, CRISPR therapeutics, Eyedetec Medical, Inc., Gobiquity, Inc., Guardion Health Sciences, Harvard Eye Associates, Johnson & Johnson Vision, Novartis, Ocular Therapeutix, Orasis Pharmaceuticals Ltd, Research Insight, LLC., RxSight, Sight Sciences, Sight Life, Tarsus Pharmaceuticals, TearClear, Versant Ventures and Visionary Ventures. Research fees from: Acufocus, Inc., Aerie Pharmaceuticals, Alcon, Allergan, Bausch + Lomb, Cord LLC, EyePoint Pharmaceuticals, Glaukos Corp, ImprimisRx, Johnson & Johnson Vision, Novartis, Ocular Therapeutix, Omeros, On Point Vision, Inc., Research Insight, LLC., Sight Sciences, Sun Pharmaceuticals Industries Ltd and Zeiss. 
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    touchOPHTHALMOLOGY touchOPHTHALMOLOGY
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    Focus Questions
    How is lens power best determined before cataract surgery?
    How is lens power best determined before cataract surgery?
    What methods do you use to obtain true corneal power after refractive surgery?
    What methods do you use to obtain true corneal power after refractive surgery?
    How do you decide which intraocular lens formula to use?
    How do you decide which intraocular lens formula to use?
    What recent advances have changed practice for intraocular lens calculations in challenging eyes?
    What recent advances have changed practice for intraocular lens calculations in challenging eyes?
    How do you approach a patient that has irregular corneal astigmatism after surgery?
    How do you approach a patient that has irregular corneal astigmatism after surgery?
    How do you think recent approvals in advanced-technology intraocular lenses will improve patient outcomes?
    How do you think recent approvals in advanced-technology intraocular lenses will improve patient outcomes?
    What new data on intraocular lens technologies were presented at the American Academy of Ophthalmology (AAO) 2023 annual meeting?
    What new data on intraocular lens technologies were presented at the American Academy of Ophthalmology (AAO) 2023 annual meeting?
    How is artificial intelligence set to change clinical practice and selection of intraocular lenses for individual patients?
    How is artificial intelligence set to change clinical practice and selection of intraocular lenses for individual patients?
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    Cataract Surgery CE/CME accredited

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    Quickfire Q&A with expert faculty. Close

    Advances in IOL technology and power calculations: Updates and innovations

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    Dr John Hovanesian is a board-certified ophthalmologist, a faculty member at the University of California, Los Angeles, Jules Stein Eye Institute, CA, USA, and an internationally recognized leader in corneal, cataract, refractive and laser surgery. read more

    Dr Hovanesian has published two eye surgery textbooks — one on the subject of refractive cataract surgery and one on pterygium surgery. Dr Hovanesian has lectured all over the world, authored dozens of peer-reviewed articles, and produced surgical teaching videos that have won the “Best Teaching” award at the prestigious American Society of Cataract and Refractive Surgery Film Festival.

    Learning Objectives

    After watching this activity, participants should be better able to:

    • Identify appropriate IOL power calculations, for preoperative assessment and after refractive surgery
    • Describe new advancements in IOL technology for patients with cataracts
    Overview

    In this interview, Dr John Hovanesian answers a series of questions focused on how to effectively manage patients prior to cataract surgery and ensure the most appropriate intraocular lens (IOL) formula is used, including his views on recent advances in IOL technology. 

    This activity is funded by an independent medical education grant from Alcon Vision, LLC, and is jointly provided by USF Health and touchIME. read more

    Target Audience

    Ophthalmologists, including cataract and refractive surgeons, involved in the management of patients with cataracts.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Dr John Hovanesian discloses: Consultancy fees from: Acufocus,Inc., Aerie Pharmaceuticals, Alcon, Allergan, Apellis Pharmaceuticals, Avellino Lab USA, Inc., Azura Ophthalmics, BlephExTM, Bruder Healthcare Company, BVI Medical, Centricity Vision, Inc., Cloudbreak Pharma, Cord LLC, Dompé, Eyedetec Medical, Inc., EyePoint Pharmaceuticals, Glaukos Corp, GlaxoSmithKline (GSK), Glint Pharma, Gobiquity, Hasa Optix, Horizon Therapeutics, Hoya Lens UK, ImprimisRX, Johnson & Johnson Vision, Kala Pharmaceuticals, Inc., Novartis, Ocular Therapeutix, Oculis Holding AG, Omeros, On Point Vision, Inc., Orasis Pharmaceuticals Ltd, Oyster Point Pharma, Rayner Surgical Group Ltd, Research Insight LLC, Sensimed SA, Sight Life, Sun Pharmaceuticals Industries Ltd, Tarsus Pharmaceuticals, TearLab Corporation, Thea Pharmaceuticals, Trefoil Therapeutics, Visus Therapeutics and Zeiss. Advisory board fees from: Apellis Pharmaceuticals, Bausch + Lomb, BlephExTM, Bruder Healthcare Company, BVI Medical, Cord LLC, Dompé, Eyedetec Medical, Inc., EyePoint Pharmaceuticals, Glaukos Corp, Glint Pharma, Hasa Optix, Horizon Therapeutics, Hoya Lens UK, Novartis, Ocular Therapeutix, Omeros, Orasis Pharmaceuticals Ltd, Rayner Surgical Group Ltd, Sight Life, Sight Sciences, Sun Pharmaceuticals Industries Ltd, Trefoil Therapeutics, Visus Therapeutics and Zeiss. Other Financial or Material Support (royalties, patent, etc.): Alcon, Alicia Surgery Center, Allegro Ophthalmics, Allergan, Cloudbreak Pharma, Cord LLC, CorneaGen, CRISPR therapeutics, Eyedetec Medical, Inc., Gobiquity, Inc., Guardion Health Sciences, Harvard Eye Associates, Johnson & Johnson Vision, Novartis, Ocular Therapeutix, Orasis Pharmaceuticals Ltd, Research Insight, LLC., RxSight, Sight Sciences, Sight Life, Tarsus Pharmaceuticals, TearClear, Versant Ventures and Visionary Ventures. Research fees from: Acufocus,Inc., Aerie Pharmaceuticals, Alcon, Allergan, Bausch + Lomb, Cord LLC, EyePoint Pharmaceuticals, Glaukos Corp, ImprimisRx, Johnson & Johnson Vision, Novartis, Ocular Therapeutix, Omeros, On Point Vision, Inc., Research Insight, LLC., Sight Sciences, Sun Pharmaceuticals Industries Ltd and Zeiss. 

    Content Reviewer

    John Steven Jarstad, M.D., FAAO, FRSM-UK has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Adriano Boasso has no financial interests/relationships or affiliations in relation to this activity.

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.5 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.5 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 14 December 2023. Date credits expire: 14 December 2024

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Cataract Surgery
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    This activity is funded by:

    An independent medical education grant from Alcon Vision, LLC, and is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 14 December 2023. Date credits expire: 14 December 2024.

    Claim Credit
    touchFOCUS
    Advances in IOL technology and power calculations: Updates and innovations
    0.5 CE/CME credit
    Question 1/5
    Which of the following pre-existing conditions is the most common cause of suboptimal cataract surgery?

    Pre-existing ocular surface disease is the most common cause of suboptimal cataract surgery outcomes, and is highly prevalent in patients with cataracts.1 The Prospective Health Assessment of Cataract Patients’ Ocular Surface (PHACO) study evaluating patients presenting for cataract surgery (N=136) found that 77% of eyes scheduled for surgery had corneal staining (50% had central staining) noted in their preoperative assessment, and 62.9% had a tear break-up time of 5 seconds or less.2 Ocular surface irregularities can compromise the accuracy of presurgical biometry and corneal topography/tomography, resulting in inaccurate IOL calculations, suboptimal postoperative outcomes and patient dissatisfaction.3

    Abbreviation

    IOL, intraocular lens.

    References

    1. Dierker D. 2019. Available at: https://collaborativeeye.com/articles/mar-19/the-importance-of-the-ocular-surface-in-cataract-surgery/# (accessed 21 November 2023).
    2. Trattler WB, et al. Clin Ophthalmol. 2017;11:1423–30.
    3. Hovanesian JA, et al. Clin Ophthalmol. 2021;15:3679–86
    Question 2/5
    Your 63-year-old female patient who had LASIK eye surgery 4 years ago is now in need of cataract surgery. To determine optimal intraocular lens power, what would you need to be aware of?

    LASIK, laser-assisted in situ keratomileusis.

    Laser refractive surgery such as LASIK alters the anterior corneal contour and leads to remodelling of the corneal epithelium.1 A history of previous corneal refractive surgery makes it challenging for standard keratometry or corneal topography/tomography to accurately measure the anterior corneal curvature, and therefore difficult to determine IOL power.2 

    Abbreviations

    IOL, intraocular lens; LASIK, laser-assisted in situ keratomileusis.

    References

    1. Tang M, et al. J Opthalmol. 2015;2015:860313.
    2. Wang L, et al. Taiwan J Opthalmol. 2022;12:22–31.
    Question 3/5
    On assessment of your 71-year-old male patient who is due to undergo cataract surgery, you find irregularity of the ocular surface due to dry eye disease. What do you do next to achieve an accurate refractive outcome?

    VEGF, vascular endothelial growth factor.

    After the diagnosis of DED is made, there are a variety of available treatment options that can be utilized in the preoperative and postoperative periods to maintain a healthy ocular surface.1 Prescription options for DED treatment include cyclosporine or lifitegrast.1 In a study by Hovanesian and colleagues, patients with dry eye who were prescribed topical cyclosporine 0.09% BID for 28 days pre-cataract surgery showed a statistically significant improvement in the prediction error of the spherical equivalent outcome of surgery, thus improving patient outcomes.2

    Abbreviations

    BID, two times a day; DED, dry eye disease.

    References

    1. Venkateswaran N, et al. Saudi J Ophthalmol. 2022;36:142–8.
    2. Hovanesian JA, et al. Clin Ophthalmol. 2021;15:3679–86.
    Question 4/5
    When talking with your patient about potential IOLs, how would you describe the Light Adjustable Lens?

    IOL, intraocular lens; LAL, light adjustable lens.

    An LAL is an IOL that enables correction of refractive error and vision customization postoperatively once ocular healing has occurred. The LAL is made of a special photosensitive material (macromers) that can be adjusted in response to UV light through a series of non-invasive treatments using a light-delivery device in the weeks following IOL implantation.

    Abbreviations

    IOL, intraocular lens; LAL, Light Adjustable Lens; UV, ultraviolet.

    Reference

    Folden DV, Wong JR. Clin Ophthalmol. 2022;16:2413–20.

    Question 5/5
    Your 59-year-old female patient is due to undergo cataract surgery, but during her preoperative assessment you identify corneal irregularities that could lead to higher-order aberrations influencing the outcomes in terms of IOL selection and visual acuity. What recently approved IOL do you choose for this patient to reduce the impact of irregular astigmatism that is not amenable to spherocylindrical correction?

    EDOF, extended depth of focus; IOL, intraocular lens.

    The small-aperture IOL is a recently introduced IOL that can provide favourable central visual acuity in patients with irregular corneas. In addition to providing an enhanced depth of focus, the small-aperture IOL can also compensate for higher-order aberrations present in the cornea and provide improved central visual acuity. This has contributed to the appeal of the small-aperture IOL in patients with irregular corneas, such as post-penetrating keratoplasty, post-radial keratotomy and keratoconus.

    Abbreviation

    IOL, intraocular lens.

    Reference

    Vander Zee BL, et al. JCRS Online Case Reports. 2023;11:e00101.

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    This activity is funded by:

    An independent medical education grant from Alcon Vision, LLC, and is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 14 December 2023. Date credits expire: 14 December 2024.

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