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This activity is funded by an independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc.

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    Faculty & Disclosures
    Dr Jennifer Loh

    Loh Ophthalmology Associates, Miami, FL, USA

    Jennifer Loh is a board-certified ophthalmologist practising in Miami, FL, USA, with a focus on cataract and refractive surgery and dry eye disease. She is founder and medical director of her practice, Loh Ophthalmology Associates, and a clinical and surgical attending physician for the Larkin Hospital Ophthalmology Residency programme. read more

    Dr Loh has been active in speaking at national ophthalmology meetings and in publishing articles in ophthalmology trade journals. She also served as the 2019 president of Cedars-Aspens, an anterior segment group comprising some of the country’s top key opinion leaders, and is a member of the American-European Congress of Ophthalmic Surgery and the Refractive Surgery Alliance.

    Dr Loh was recipient of the 2018 Rising Star Award from OWL (Ophthalmic World Leaders), The Ophthalmologist Power List Rising Star Award in 2017, and the Alcon Outstanding Female Leader Award in 2016.

    Dr Jennifer Loh discloses: Advisory board or panel membership for: Alcon, Allergan, Beaver Visitec, Bausch and Lomb, Centricity Vision, Dompe, Horizon Therapeutics, Johnson and Johnson, LensAr, Novartis, Novabay, Ocular Science, Orasis Pharmaceuticals, Oyster Point, Sight Sciences, Sun Ophthalmics Tarsus, Visus and Zeiss. Grants/research support from: Sight Sciences. Speaker’s bureau membership for: Alcon, Allergan (Relationship Terminated), Bausch & Lomb, Sun Pharma and Sight Sciences.
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    Cataract surgery and ocular comorbidities: Key considerations for IOL choice

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    Jennifer Loh is a board-certified ophthalmologist practising in Miami, FL, USA, with a focus on cataract and refractive surgery and dry eye disease. She is founder and medical director of her practice, Loh Ophthalmology Associates, and a clinical and surgical attending physician for the Larkin Hospital Ophthalmology Residency programme. read more

    Dr Loh has been active in speaking at national ophthalmology meetings and in publishing articles in ophthalmology trade journals. She also served as the 2019 president of Cedars-Aspens, an anterior segment group comprising some of the country’s top key opinion leaders, and is a member of the American-European Congress of Ophthalmic Surgery and the Refractive Surgery Alliance.

    Dr Loh was recipient of the 2018 Rising Star Award from OWL (Ophthalmic World Leaders), The Ophthalmologist Power List Rising Star Award in 2017, and the Alcon Outstanding Female Leader Award in 2016.

    Dr Jennifer Loh discloses: Advisory board or panel membership for: Alcon, Allergan, Beaver Visitec, Bausch and Lomb, Centricity Vision, Dompe, Horizon Therapeutics, Johnson and Johnson, LensAr, Novartis, Novabay, Ocular Science, Orasis Pharmaceuticals, Oyster Point, Sight Sciences, Sun Ophthalmics Tarsus, Visus and Zeiss. Grants/research support from: Sight Sciences. Speaker’s bureau membership for: Alcon, Allergan (Relationship Terminated), Bausch & Lomb, Sun Pharma and Sight Sciences.

    Take CE/CME Test

    Jennifer Loh is a board-certified ophthalmologist practising in Miami, FL, USA, with a focus on cataract and refractive surgery and dry eye disease. She is founder and medical director of her practice, Loh Ophthalmology Associates, and a clinical and surgical attending physician for the Larkin Hospital Ophthalmology Residency programme. read more

    Dr Loh has been active in speaking at national ophthalmology meetings and in publishing articles in ophthalmology trade journals. She also served as the 2019 president of Cedars-Aspens, an anterior segment group comprising some of the country’s top key opinion leaders, and is a member of the American-European Congress of Ophthalmic Surgery and the Refractive Surgery Alliance.

    Dr Loh was recipient of the 2018 Rising Star Award from OWL (Ophthalmic World Leaders), The Ophthalmologist Power List Rising Star Award in 2017, and the Alcon Outstanding Female Leader Award in 2016.

    Dr Jennifer Loh discloses: Advisory board or panel membership for: Alcon, Allergan, Beaver Visitec, Bausch and Lomb, Centricity Vision, Dompe, Horizon Therapeutics, Johnson and Johnson, LensAr, Novartis, Novabay, Ocular Science, Orasis Pharmaceuticals, Oyster Point, Sight Sciences, Sun Ophthalmics Tarsus, Visus and Zeiss. Grants/research support from: Sight Sciences. Speaker’s bureau membership for: Alcon, Allergan (Relationship Terminated), Bausch & Lomb, Sun Pharma and Sight Sciences.

    Take CE/CME Test

    Jennifer Loh is a board-certified ophthalmologist practising in Miami, FL, USA, with a focus on cataract and refractive surgery and dry eye disease. She is founder and medical director of her practice, Loh Ophthalmology Associates, and a clinical and surgical attending physician for the Larkin Hospital Ophthalmology Residency programme. read more

    Dr Loh has been active in speaking at national ophthalmology meetings and in publishing articles in ophthalmology trade journals. She also served as the 2019 president of Cedars-Aspens, an anterior segment group comprising some of the country’s top key opinion leaders, and is a member of the American-European Congress of Ophthalmic Surgery and the Refractive Surgery Alliance.

    Dr Loh was recipient of the 2018 Rising Star Award from OWL (Ophthalmic World Leaders), The Ophthalmologist Power List Rising Star Award in 2017, and the Alcon Outstanding Female Leader Award in 2016.

    Dr Jennifer Loh discloses: Advisory board or panel membership for: Alcon, Allergan, Beaver Visitec, Bausch and Lomb, Centricity Vision, Dompe, Horizon Therapeutics, Johnson and Johnson, LensAr, Novartis, Novabay, Ocular Science, Orasis Pharmaceuticals, Oyster Point, Sight Sciences, Sun Ophthalmics Tarsus, Visus and Zeiss. Grants/research support from: Sight Sciences. Speaker’s bureau membership for: Alcon, Allergan (Relationship Terminated), Bausch & Lomb, Sun Pharma and Sight Sciences.

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    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

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

    • Describe common ocular comorbidities with cataract that may adversely affect the outcomes of cataract surgery
    • Explain how comorbidities, such as glaucoma, AMD and diabetic retinopathy, should be managed ahead of cataract surgery
    • Discuss factors affecting IOL choice in patients with cataracts and ocular comorbidities
    Overview

    In this activity, Dr Jennifer Loh explains the key considerations for intraocular lens selection and management of patients with cataracts and ocular comorbidities, including glaucoma, age-related macular degeneration and diabetic retinopathy.

    This activity is funded by an independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc., 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 Jennifer Loh discloses: Advisory board or panel membership for: Alcon, Allergan, Beaver Visitec, Bausch and Lomb, Centricity Vision, Dompe, Horizon Therapeutics, Johnson and Johnson, LensAr, Novartis, Novabay, Ocular Science, Orasis Pharmaceuticals, Oyster Point, Sight Sciences, Sun Ophthalmics Tarsus, Visus and Zeiss. Grants/research support from: Sight Sciences. Speaker’s bureau membership for: Alcon, Allergan (Relationship Terminated), Bausch & Lomb, Sun Pharma and Sight Sciences.

    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 0.75 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 0.75 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: 04 December 2023. Date credits expire: 04 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 / Anterior Segment / Refractive Surgery
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    This Activity Is Funded By:

    An independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc., 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: 04 December 2023. Date credits expire: 04 December 2024.

    Claim Credit
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    Cataract surgery and ocular comorbidities: Key considerations for IOL choice
    0.75 CE/CME credit
    Question 1/5
    Which of the following is a key symptom of neovascular AMD?

    AMD, age-related macular degeneration.

    Neovascular AMD is the most aggressive form of AMD. The underlying pathophysiology includes the growth of abnormal, fragile blood vessels under the retina that can leak fluid and blood, which in turn can damage the macula. Changes to central vision are often sudden and severe.

    Abbreviation

    AMD, age-related macular degeneration.

    Reference

    Macular Disease Foundation Australia. Available at: www.mdfoundation.com.au/about-macular-disease/age-related-macular-degeneration/stages-of-amd/ (accessed 18 October 2023).

    Question 2/5
    Which of the following is common among patients with glaucoma and must be treated prior to cataract surgery?

    Dry eye and ocular surface disease can be common in patients with glaucoma, especially in those taking multiple medications containing preservatives. Comorbid dry eye disease and ocular surface and lid conditions should be treated preoperatively to enable accurate biometry measurement and IOL power selection, and to ensure optimal postoperative IOL performance.

    Abbreviation

    IOL, intraocular lens.

    Reference

    Kerr N. 2022. Available at: www.mieducation.com/pages/iol-selection-in-patients-with-glaucoma (accessed 2 November 2023).

    Question 3/5
    Your patient has cataracts with comorbid moderate non-proliferative diabetic retinopathy and good glycaemic control. You perform a preoperative ocular examination that reveals suspected non-centre-involving macular oedema. What would you do next?

    VEGF, vascular endothelial growth factor.

    Patients with diabetes, with or without diabetic retinopathy, are at increased risk of developing macular oedema after cataract surgery,1 even following an uncomplicated procedure.2 Any pre-existing macular oedema should be controlled prior to surgery to maximize visual outcome.3 As such, patients are often referred to a retina specialist for evaluation prior to cataract surgery to ensure any necessary pre-treatment, such as anti-VEGF therapy, steroids or laser photocoagulation, is received.2,4

    Abbreviation

    VEGF, vascular endothelial growth factor. 

    References

    1. Chu CJ, et al. Ophthalmology. 2016;123:316–23.
    2. Hovland PG. Ophthalmol Retina. 2020;4:349–50.
    3. Kelkar A, et al. Indian J Ophthalmol. 2018;66:1401–10.
    4. Mukamal R. 2021. Available at: www.aao.org/eye-health/tips-prevention/diabetes-vision-eye-exam-care-cataract-glaucoma (accessed 8 November 2023).
    Question 4/5
    Your 45-year-old patient has cataracts and comorbid diabetes. Following a comprehensive dilated eye exam, there is currently no evidence of diabetic retinopathy or other macular disease. During discussions before cataract surgery, how would you counsel your patient regarding intraocular lens selection?

    DR, diabetic retinopathy; IOL, intraocular lens.

    People with diabetes have a relative impairment of the blood–aqueous barrier, irrespective of evidence of DR, which confers an increased risk of inflammation and macular oedema after cataract surgery.1 Consequently, cataract surgery may accelerate the progression of pre-existing DR, induce rubeosis, or precipitate or initiate DMO.1 IOLs contraindicated for macular pathology, such as multifocal lenses, may still be used in patients with diabetes who do not present with DR at the time; however, the potential for experiencing vision compromises later in life needs to be communicated.2 Silicone IOLs are contraindicated in the management of patients with diabetes regardless of DR status because silicone oils, which condense on silicone IOLs, may be used at some point for the surgical management of severe DR.2

    Abbreviations

    DMO, diabetic macular oedema; DR, diabetic retinopathy; IOL, intraocular lens.

    References

    1. Amoaku WM, et al. Eye. 2020;34:1–51.
    2. Bixler JE. 2019. Available at: www.ncbi.nlm.nih.gov/books/NBK544518/ (accessed 19 October 2023).
    Question 5/5
    Your patient has cataracts with comorbid glaucoma, manifesting as central field defects, and is at high risk for disease progression. There is no evidence for astigmatism. Which intraocular lens would you recommend for this patient?

    Monofocal IOLs are an option for all stages of glaucoma.1 Multifocal or extended depth of focus lenses are generally contraindicated in patients with moderate or severe glaucoma due to the risk of further reducing contrast sensitivity and/or compromising vision quality, especially in low light.1,2 Multifocal or extended depth of focus lenses may also cause undesirable visual symptoms and compromise vision quality if the disease progresses after implantation and are therefore not advised for patients at risk of disease progression.1 Toric IOLs may be used in patients with glaucoma to reduce astigmatism.1

    Abbreviation

    IOL, intraocular lens.

    References

    1. Kerr N. 2022. Available at: www.mieducation.com/pages/iol-selection-in-patients-with-glaucoma (accessed 2 November 2023).
    2. Yeu E, Cuozzo S. Ophthalmology. 2021;128:e132–41.
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    This Activity Is Funded By:

    An independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc., 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: 04 December 2023. Date credits expire: 04 December 2024.

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