ASRS 2023: Tracking trends in secondary IOL surgery among vitreoretinal surgeons

Matthew R. Starr, MD, sat down with Sheryl Stevenson, Group Editorial Director, Modern Retina®, to discuss his ASRS presentation on how secondary lens techniques have changed.

Video transcript

Editor’s note: This transcript has been edited for clarity.

Sheryl Stevenson: We're joined today by Dr. Matthew Starr, who will be presenting at this year's ASRS [meeting] in Seattle. Welcome to you, Dr. Starr. We're delighted to have you join us. We're curious about hearing more about your talk [about] trends in secondary IOLs. Can you tell us more about that in regard to surgery for vitreoretinal surgeons?

Matthew (Matt) R. Starr, MD: Yeah, thanks so much, Sheryl, for having me. As you said, my name is Matt Starr. I'm coming from the Mayo Clinic, and on behalf of my coauthors, Nick Boucher, BS, and Chakshu Sharma, MS, from Vestrum Health, and then Gabe Kaufmann, BS, a medical student at the University of Chicago, who is now going to be an intern at Cleveland Clinic.

We actually looked at the Vestrum database, which is a predominantly private practice database of vitreoretinal surgeons, and looked at the number of secondary lens surgeries that were being performed by vitreoretinal surgeons from 2015 to 2021. Seven years' worth of data. We had approximately 2000 eyes in this study. What we really wanted to do is...what are vitreoretinal surgeons doing. As we all know, vitreoretinal surgeons are more and more commonly doing these types of surgeries [if] most of us feel that they [patients] need a full pars plana vitrectomy. Often these will be done with one surgeon sometimes.

What we saw early on in our study was that the majority (almost 90% of the cases) were being done with an anterior chamber intraocular lens [AC IOLs]; specifically, it was 93% in 2015. Interestingly, the scleral-fixated intraocular lenses and scleral sutured lenses were about 3% to 4%....And over time, it decreased for the AC IOLs from 93% to 36% in 2021, and scleral-fixated increased from 3% to 34%, and scleral-sutured increased from 4% to 30%.

It was an interesting kind of paradigm shift in the way that vitreoretinal surgeons are performing these types of surgeries. We looked at complication rates, vision outcomes, and things and there wasn't really a large difference in vision. The anterior chamber lenses perhaps had a slightly less gain in vision compared to the other two types of lenses. And those lenses actually were as we all know associated with increased corneal edema. We didn't see any rates of suture erosion, scleral haptic loss, or erosion. There were no differences in the number of surgeries needed afterwards or in the retinal detachment rate between all of these different types of surgeries.

In the end, we kind of concluded that scleral fixated, scleral sutured lenses are becoming a much more popular technique, and anterior chamber lenses are becoming less and less frequently performed by vitreoretinal surgeons. Still, at the end of our study, they were the most commonly performed type when you looked at all three of them individually, but that was only in 36% of the cases. So 65% of the time, a surgeon is going to do either a fixated or scleral sutureed lens and really no one surgeon does one or the other type of lens.

Stevenson: Definitely some interesting data there. Is there anything else that you'd like to add that we have not even touched upon regarding the trends in your study?

Starr: It was interesting to see early on, there was a slight...the higher rate of retinal detachments and the scleral fixated, scleral lenses. When you looked at the study as a whole, there was no difference in the rates of retinal detachments following these surgeries and so there might have been a learning curve early on in 2015 where surgeons were doing kind of adjusting their techniques and things like that. Overall, it was anywhere from 3% to 4%, depending on the type of lens that was seen in our database.

And another interesting point, when we looked at the types of lenses that surgeons are doing, most vitreoretinal surgeons will either do one or probably two or three of the different types of surgeries. Most of us feel comfortable kind of handling any type of secondary lens. Interestingly though, the number of surgeons only doing one type of lens were only doing AC IOLs. You're seeing that as more and more time goes on, I think more of us are doing different types of secondary lenses, but there's still a large cohort of vitreoretinal surgeons that are just doing the tried-and-true anterior chamber lens.

Stevenson: Well, certainly fascinating. Again, Dr. Starr, thank you so much for your insights. We really appreciate it.