Most people can manage a task when they’re simply allowed to focus on the task itself, with no extenuating circumstances. For instance, for anyone who’s done it for even just a couple of years, driving a car becomes an “overlearned” skill in which doing it precisely becomes almost second-nature (as anyone who’s eaten a sandwich, changed the radio station and driven at the same time will tell you—not that I endorse such behavior).

However, change the driving environment from a sunny May day to an ice storm in January and suddenly the easy task of cruising down the boulevard becomes fraught with danger. You’ve now got multiple hazards to track: Limited visibility; other drivers; the road conditions. By some estimates, stopping distance can go from 60 feet on a dry road to as much as 600 feet when driving on ice. Your degree of difficulty just shot way up. (That sandwich can wait till you get home.)

Though much more complex than operating a car, cataract surgery is one of the most successful, effective surgeries known to medicine. Ophthalmologists have honed their skills to the point that both anatomical and visual results are uniformly excellent. 

However, like driving on an icy road the addition of ocular co-morbidities can take a procedure that may have been routine and turn it into a much more challenging proposition. It’s these challenging cases that surgeons discuss in two of our features this month. 

In the first article (p. 26), both corneal specialists and expert cataract surgeons explain how to handle patients with co-existing corneal problems. These can range from the fairly garden-variety ocular surface disease to Fuchs’ dystrophy and complex post-transplant eyes. The physicians provide valuable tips on such aspects as whether to proceed with sequential or simulataneous cornea and cataract procedures, and how to make sure you get the best IOL calculations in patients with irregular corneas.

In the other article exploring ocular co-morbidities and cataract surgery, experts tackle the question of how to get the best possible results—especially when it comes to selecting an intraocular lens—for patients with glaucoma. For surgeons who like to offer their patients the latest in presbyopia-correcting lenses, surgeons say the good news is that it’s still possible, at least in some patients. “Patients who have ocular hypertension, glaucoma suspects or those with very mild, pre-perimetric glaucoma are going to be great candidates if they’re also well-controlled and if their visual fields have very minimal peripheral defects,” says Constance O. Okeke, MD, MSCE, of Norfolk, Virginia. “These are the patients you should consider pushing the envelope to offer them multifocals or extended depth of focus IOLs.” 

We hope the advice offered by the surgeons in this month's features helps you stay on course when the road gets rocky.




— Walter Bethke
Editor in Chief