Approaching the macula from the premium cataract surgeon perspective

Premium cataract surgeons face the daily decision of whether to offer cataract surgery patients the option of multifocal IOL or other advanced IOL technology, which could contribute to current and/or future potential undesirable visual aberrations postoperatively. Patients may present at their initial cataract evaluation with a pristine macula or early pathology such as an epiretinal membrane or mild macular degeneration. Even with a normal macula, the potential for macular pathology in the future is essentially unknown without specialized diagnostic approaches to improve our detection and/or prediction odds. The decision to go with monofocal IOL technology with zero aberrations, such as the hydrophobic acrylic enVista MX60 from Bausch + Lomb, is much easier in patients with moderate or severe macular pathology.The prevalence of AMD is 9.2 million Americans, occurring in seven out of every 100 adults older than 40 years, one out of eight older than 60 years, and one out of three older than 75 years. AREDS2 nutritional supplementation can lower the risk of progression by 25%, and certain behavior modifications such as less smoking, better cardiovascular status, increased exercise and improved diet can also lessen the risk of progression. Obviously, as premium cataract surgeons we cannot control compliance for our patients with such options, and so utilizing current and other upcoming diagnostic and therapeutic technologies described below can only improve the odds.