SHINING A SPOTLIGHT ON SURGERY TERMINOLOGY

A call to standardize cataract and refractive surgery terminology and eliminate barriers between ophthalmologists and their patients.

BY E. CEREN YESILKAYA, MD, AND DAGNY ZHU, MD

One of Buddha’s famous teachings says, “Whatever words we utter should be chosen with care, for people will hear them and be influenced by them for good or ill.” This quote emphasizes the importance of mindful speech and reminds us to be responsible for our words and to use them as a force. It is crucial to acknowledge that words do matter and hold significance and influence our thoughts. In the medical field, this especially holds true as the use of incomprehensible technical jargon can create a barrier between doctors and patients.

It is our duty as refractive surgeons to carefully select the language we employ when communicating with patients. When multiple terms are used to describe a single procedure, it can lead to confusion, anxiety and diminished confidence. We should not rely on manufacturers to determine the terminology; instead, it falls upon us to educate patients and drive progress within our field.

To address this, the Refractive Surgery Alliance (RSA) Terminology Committee was formed. The committee aimed to standardize terminology in three areas:

1. The replacement of the crystalline lens for the treatment of refractive error and/or presbyopia.
2. Procedures involving the extraction of cornea stromal lenticules.
3. The occurrence of transient hyperesthesia with ocular surface issues following ocular surgery.

Throughout committee deliberations, three fundamental aspects were prioritized: patient understanding, accuracy and an impartial standpoint free from any brand bias.

Here, we present the recommendations formulated by the RSA Terminology Committee, accompanied by the underlying rationale.

1. LENS REPLACEMENT

Lens replacement is a highly beneficial procedure using advanced technology IOLs. It is ideal for patients with presbyopia and cataracts who desire reduced reliance on eyeglasses and contact lenses.

The committee considered various terms, some of which are already used in daily practice (eg, refractive lens exchange, clear lens exchange, laser/lifestyle lens upgrade and lens implant focusing enhancement) but settled on “lens replacement” (LR). This choice was based on simplicity and the familiarity patients have with the concept of replacement procedures, such as knee and hip replacements. Additionally, individual physicians can add prefixes such as custom, precision or dysfunctional as needed.

2. LASER-ASSISTED LENTICULE EXTRACTION

Different lenticule-based procedures worldwide, such as small incision lenticule extraction (SMILE), femtosecond lenticule extraction (RELEX and FLEX), cornea lenticule extraction for advanced refractive correction (CLEAR), small-incision lenticule keratomileusis (SILK) and SmartSight, employ femtosecond lasers of different brand manufacturers to create a refractive lenticule inside the cornea that is subsequently extracted. To avoid confusion and provide a standardized term, the committee chose “laser-assisted lenticule extraction” (LALEX) as the preferred umbrella terminology.

3. SURGICAL TEMPORARY OCULAR DISCOMFORT SYNDROME

Patients may experience ocular discomfort due to various factors, including corneal nerve disruption, inflammation or dry eye disease after eye surgery. The committee aimed to develop a term that acknowledges and validates patients’ discomfort while emphasizing its temporary nature and subsequent resolution without tying it to a specific procedure or pathogenesis. “Surgical Temporary Ocular Discomfort Syndrome” (STODS) was chosen to encompass this broad array of postoperative symptoms to promote better understanding among patients and health-care professionals.

CONCLUSION

The RSA Terminology Committee hopes that the usage of LR, LALEX and STODS becomes widespread in medical literature and gains acceptance. By adhering to these standardized terms, we can enhance patient understanding, promote precision and advance our field in an unbiased and professional manner. OM

The RSA Terminology Committee, led by Dr. Tanya Trinh, MBBS, FRANZCO, and composed of additional members (Balamurali Ambati, MD, PhD; Dagny Zhu, MD; Lance Kugler, MD; R. Luke Rebenitsch, MD; Guy Kezirian, MD, FACS; Arthur B. Cummings, MMed(Ophth), FCS(SA), FRCSEd; and Brett Mueller, DO, PhD), consulted with RSA members, comprising nearly 500 refractive surgeons worldwide.

‘DIGITAL TRANSFORMATIONS’ TAKE CENTER STAGE

Panelists at OWL meeting discussed how digital technology and AI are revolutionizing ophthalmology.

In June, Ophthalmic World Leaders (OWL) held its first SoCal Chapter event of the year in Newport Beach, Calif., which focused on the impact of digital technology and artificial intelligence (AI) in the ophthalmology space. The panelists included moderator Kate Fehlhaber, PhD, The Fundingsland Group, Dagny Zhu, MD, NVISION Eye Centers, Rowland Heights, Calif., Flora Azucena, Alchemy Vision, and Linda A. Lam, MD, MBA, FASRS, Keck School of Medicine of USC, Los Angeles.

OWL, a non-profit organization, provides professional and personal development and creates opportunities for collaboration within ophthalmology. Its vision is to promote and develop diverse leadership to advance ophthalmic innovation and patient care. The organization hosts events at most of the larger ophthalmology meetings, like ASCRS and AAO, as well as select local chapters.

“This was the first in-person event we’ve done in Southern California since COVID — the turnout was great and the feedback from attendees was really positive,” says Dr. Fehlhaber. “I think people are really excited about the future of AI, especially ChatGPT, a generative AI chatbot, which has been the most accessible use of AI recently.”

Part of the discussion revolved around how AI will be part of the future workflow for ophthalmology, with the goal of helping to streamline processes and increase efficiency for doctors.

The panelists’ discussions included topics such as social media and AI, using AI to help doctor-patient relationships, AI tools in education and how AI should be embraced instead of feared.

SHORT TALKS

Embrace social media

In her talk, Dr. Zhu stressed the importance of making sure that the industry is helping to spread evidence-based medicine online to combat misinformation. She pointed out that misinformation is especially rampant on TikTok in ophthalmology and said that less than 20% of ophthalmology content on TikTok is created by ophthalmologists. The rest is from non-ophthalmologists portraying information as education.

Using AI to help doctor-patient relationships

In her talk, Dr. Lam provided some insights from a paper she co-authored, “Digital Technology, Telemedicine and Artificial Intelligence in Ophthalmology: A Global Perspective.” Dr. Lam explained that innovation across the industry using digital technology will help with the doctor-patient relationship, with telemedicine as an example. Dr. Lam noted that AI will help to provide patients with access to care through telemedicine. In addition, at USC, Dr. Lam says she and her team are looking at developing an AI platform and placing that in primary care clinics to screen patients who have diabetes for diabetic retinopathy.

Using AI tools in education

From the education side, Ms. Azucena emphasized the importance of training technicians in practices by using engaging, quick lessons that are easily accessible — this is especially important for capturing the attention span of the younger generation of digital natives. She also pointed out how AI tools will be used to help bring education forward. In addition, she explained how language models like ChatGPT and Google’s PaLM and Meta’s LLaMA function are going to continue to grow.

Don’t fear AI

One of Dr. Fehlhaber’s key takeaways from the meeting was that ophthalmologists should not fear AI.

“It’s scary to think about robots taking over the world,” she says, “but the outcome of our conversation was that we need to embrace AI and take a step back from that fear factor and think about how it’s going to have a positive impact in your work, whether that’s clinical or industry.”

After the panel discussion, the conversation continued with networking, which Dr. Fehlhaber says is always one of the biggest benefits of OWL.

COMING UP NEXT FOR OWL

The OWL Leadership Summit will take place on Sept. 21 in Austin, Texas. OWL will also host an event at the European Society of Cataract and Refractive Surgeons in Vienna on Sept. 10. During AAO, OWL’s Signature Event & Awards Ceremony will take place on Nov. 5 from 5:30-7:00 p.m. at the Intercontinental in San Francisco.

For more information about OWL as well as its programs, visit its website (www.owlsite.org ). OM

OCULAR VASCULAR EVENTS FOUND WITH COVID-19 VACCINE

Recent studies suggest that ophthalmologists should be aware of a possible correlation between the COVID-19 vaccine and an increased risk of blindness.

One study, “Ocular vascular events following COVID-19 vaccines: A systematic review” (bit.ly/3puZAro ), was a systemic review of 49 case reports and series, which found 130 ocular vascular events following COVID-19 vaccination in 23 countries. Of these cases, venous occlusive events were the most common events (54.3%), which mostly occurred following the first dose (46.2%) and within the first 5 days following vaccination (46.2%). Vascular events occurred more with the Pfizer and AstraZeneca vaccines (81.6%) and mostly presented unilaterally (73.8%). The most frequently reported treatment was intravitreal anti-VEGF (n = 39, 30.4%). The majority of patients (90.1%) demonstrated either improvement (p = 0.321) or persistence (p = 0.414) in the final BCVA. The study notes that the issue of ocular vascular events as a consequence of COVID-19 vaccination is an important cause of blindness for patients that deserves more attention. However, the authors noted that these adverse events are still considered rare based on the millions of vaccine doses administered worldwide and that the benefits of vaccination still far outweigh the associated risks.

Another study, “Risk assessment of retinal vascular occlusion after COVID-19 vaccination” (bit.ly/3raWvgl ), addressed the concern of emerging cases of retinal vascular occlusion (RVO) in outpatient settings. This retrospective cohort study used the TriNetX global network and compared individuals who were vaccinated with COVID-19 vaccines with those who were unvaccinated. The cumulative incidence of RVO was higher in the vaccinated cohort compared to the unvaccinated cohort, 2 years and 12 weeks after vaccination. The risk of RVO increased during the first 2 weeks after vaccination and persisted for 12 weeks. The study excluded individuals who had tested positive for COVID-19, those with a history of RVO and those who used any systemic medication that could potentially affect blood coagulation prior to vaccination. The authors also noted several limitations of the study, and that the data should be evaluated critically and cautiously owing to the retrospective nature of the investigation.

The AAO’s EyeWiki page (bit.ly/3JMPpoJ ) provides summaries of various ocular adverse events following COVID-19 vaccination reported in peer-reviewed literature. These include ocular inflammatory diseases, optic neuropathy and various anterior segment conditions. The AAO recommends carefully monitoring patients with pre-existing conditions associated with the development of ophthalmologic side effects. OM