Cataract & Refractive 360: Fundamentals, Techniques & Technology; Volume 4, Number 2

1.25 CME
$0 FEE
Cataract & Refractive 360: Fundamentals, Techniques & Technology


Provider Statement

This continuing medical education activity is provided by Vindico Medical Education.

Support Statement

This activity is supported by educational grants from Alcon Vision, LLC; Carl Zeiss Meditec, Inc.; and J&J Vision.

Activity Description

Successful cataract surgery involves a multifactorial process that relies on numerous interconnected assessments, planning, and execution procedures. Phacodynamics, which is the effects of the equipment used to perform a cataract procedure on the internal environment of the eye, must be thoroughly understood to maintain a stable anterior chamber and to minimize damage from the heat produced by ultrasonic energy during phacoemulsification. New technologies, such as optical coherence tomography and femtosecond (FS) laser, can be applied to several diagnostic and procedural components of the surgery. Astigmatism can now be corrected during cataract surgery, using peripheral corneal relaxing incisions or toric intraocular lens implantation. The surgeon can select from a growing range of intraocular lenses to achieve the refractive outcomes desired by the patient. In refractive surgery, FS laser is also used to correct astigmatism, and it can be employed for high-precision cutting of LASIK flaps. New applications for FS laser, such as softening of the lens to improve accommodation, are under investigation. The educational goals of this publication series are widespread, encompassing multiple facets of both cataract and refractive surgery. This issue focuses on the management of postoperative refractive surprise in the cataract patient, the surgical management of patients with presbyopia, techniques and tips for managing the soft cataract, perioperative medication options for cataract surgery, and the management of the unhappy multifocal lens patient.

Target Audience

The intended audience for this activity is ophthalmologists and other health care professionals involved in the management of patients undergoing cataract surgery.

Learning Objective(s)

Upon successful completion of this publication series, participants should be better able to:

  • Review the role of fluidics and ultrasound in cataract surgery and how the risk of associated complications may be minimized during their use.
  • Evaluate advances in presurgical/surgical diagnostics and intraoperative guidance systems and their impact on improved refractive outcomes.
  • List the benefits and limitations of femtosecond laser in cataract surgery.
  • Investigate the surgical techniques necessary to optimize outcomes in complex cases.
  • Review the impact on refractive outcomes of cataract surgery-induced and preexisting astigmatism.
  • Explore diagnostic and surgical techniques that can be used to correct astigmatism before, during, and after cataract removal.
  • Compare the available types of intraocular lenses and determine their influence on visual outcomes.
  • Assess the importance of presurgical screening and discussion with the patient for intraocular lens selection to ensure patient satisfaction with outcomes.
  • Summarize the need for presurgical planning prior to refractive procedures.
  • Compare advanced techniques and technology for guiding refractive surgery to reduce complications and achieve better visual outcomes.
  • Evaluate the evidence supporting the use of femtosecond laser in refractive surgery.

Chief Medical Editor

Terry Kim, MD
Professor of Ophthalmology
Duke University School of Medicine
Chief, Cornea and External Disease Division 
Director, Refractive Surgery Service 
Duke University Eye Center 
Durham, NC

Editorial Board

Nicole R. Fram, MD*
Partner, Advanced Vision Care
Clinical Instructor of Ophthalmology
Stein Eye Institute
Los Angeles, CA

Sumit (Sam) Garg, MD
Vice Chair of Clinical Ophthalmology
Medical Director
Associate Professor – Corneal, Cataract, and Refractive Surgery 
Gavin Herbert Eye Institute 
University of California 
Irvine, CA

Elizabeth Yeu, MD
Assistant Professor of Ophthalmology
Eastern Virginia Medical School
Partner, Virginia Eye Consultants
Cornea, Cataract, Anterior Segment, and Refractive Surgery Specialist 
Norfolk, VA

*Faculty Contributor also for this issue.


Kendall E. Donaldson, MD, MS
Professor of Ophthalmology, Medical Director 
Bascom Palmer Plantation 
Bascom Palmer Eye Institute 
University of Miami 
Miller School of Medicine 
Miami, FL

Larissa Gouvea, MD
Cornea Research Fellow
Storm Eye Institute
Medical University of South Carolina
Charleston, SC

John A. Hovanesian, MD, FACS
Harvard Eye Associates
Laguna Hills, CA

Raphael Penatti, MD
Clinical Research Fellow
Waring Vision Institute
Mount Pleasant, SC

Leela V. Raju, MD
Associate Professor, Department of Ophthalmology 
Director of International Ophthalmology 
NYU Langone Health 
New York, NY

George O. Waring IV, MD, FACS
Founder and Medical Director
Waring Vision Institute
Mount Pleasant, SC

Medical Writer

Valerie Zimmerman, PhD


Ronald A. Codario, MD, EMBA, FACP, FNLA, RPVI, CHCP


Vindico Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Credit Designation

Vindico Medical Education designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

This enduring material is approved for 1 year from the date of original release, November 25, 2019, through November 25, 2020.

How to Participate in This Activity and Obtain CME Credit

To participate in this CME activity, you must read the objectives, answer the pretest questions, read the articles, and complete the posttest and evaluation. Provide only one (1) correct answer for the questions. A satisfactory score is defined as answering 70% of the posttest questions correctly. Upon receipt of the completed materials, if a satisfactory score on the posttest is achieved, Vindico Medical Education will issue an AMA PRA Category 1 Credit(s)™ Certificate.


In accordance with the Accreditation Council for Continuing Medical Education’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of the planners, teachers, and authors involved in the development of CME content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the past 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control.

The authors disclose that they do have significant financial interests in any products or class of products discussed directly or indirectly in this activity, including research support.

Chief Medical Editor, Editorial Board, and Faculty report the following relationship(s):

Kendall E. Donaldson, MD, MS
Consulting Fee: Alcon, Allergan, Bausch + Lomb, Bio-Tissue, Eyevance, J&J Vision, Kala, Omeros, Sun, Zeiss

Nicole R. Fram, MD
Consulting Fee: Aerie, Alcon, Allergan, CorneaGen, J&J Vision, Ocular Science, W.L. Gore, Zeiss 
Speakers Bureau: Alcon, Bausch + Lomb, Dompè, J&J Vision, Novartis, Shire, Sun 
Contracted Research: Alcon, Allergan 
Ownership Interest: CorneaGen, Ocular Science

Sumit (Sam) Garg, MD
Consulting Fee: Avedro, CorneaGen, EyePoint, Eyevance, J&J Vision, Kala, Katena, Takeda, Verana Health, VisionCare, Zeiss
Speakers Bureau: J&J Vision, Takeda
Ownership Interest: Equinox, Expert Opinion, LensGen, Ocutrx, RPS

Larissa Gouvea, MD
No relevant financial relationships to disclose.

John A. Hovanesian, MD, FACS
Royalty: Slack Incorporated, TLC Laser Eye Centers
Consulting Fee: 1-800-DOCTORS, Abbott Medical Optics, AcuFocus, Aerie, Alcon, Allegro Ophthalmics, Allergan, BlephEx, Eyedetec, Glaukos, Guardion Health Sciences, IOP/ Katena, Ivantis, Kala, Novartis, Ocular Therapeutix, Omeros, ReVision Optics, Sarentis Ophthalmics, Sensimed, Shire, Tear Film Innovations, Tearlab, Valeant, Veracity
Contracted Research: Abbott Medical Optics, AcuFocus, Aerie, Alcon, Allergan, Cloudbreak Therapeutics, Cord LLC, Eyedetec, Glaukos, IngenoEye, IOP/ Katena, Novartis, Ocular Therapeutix, Omeros, ReVision Optics, Shire, Tear Film Innovations, Valeant 
Ownership Interest: Alcon, Alicia Surgery Center, Allegro Ophthalmics, Allergan, BlephEX, Eyedetec, Glaukos, Guardion Health Sciences, Harvard Eye Associates, Harvard Hearing, IngenoEye, MDbackline, Novartis, Ocular Therapeutix, RxSight, Sarentis Ophthalmics, Sight Sciences, Tear Film Innovations 
Medical Advisory Board: 1-800-DOCTORS, Abbott Medical Optics, Aerie, BlephEx, Cord LLC, Eyedetec, Glaukos, Guardion Health Sciences, IngenoEye, IOP/Katena, Ivantis, Kala Pharma, MDbackline, Ocular Therapeutix, Omeros, ReVision Optics, Shire, Sight Sciences, Tear Film Innovations, TearLab, Valeant, Veracity

Terry Kim, MD
Consulting Fee: Aerie, Alcon/Novartis, Allergan/Actavis, Avedro, Avellino Labs, Bausch + Lomb/Valeant, BlephEx, CoDa/Ocunexus Therapeutics, Kala, NovaBay, Ocular Therapeutix, Omeros, PowerVision, Presbyopia Therapies, Shire, Simple Contacts, TearLab, Zeiss 
Ownership Interest: Avellino Labs, CorneaGen, Kala, NovaBay, Ocular Therapeutix, Omeros, Simple Contacts

Raphael Penatti, MD
No relevant financial relationships to disclose.

Leela V. Raju, MD
Consulting Fee: Allergan
Ownership Interest: RPS

George O. Waring IV, MD, FACS
Consulting Fee: Ace Vision, AcuFocus, Alcon, Allergan, Bausch + Lomb, GlassesOff, Ivantis, J&J Vision, Oculus, Omeros, Perfect Lens, Riechert Technologies, SRD Vision, Visiometrics, Zepto

Elizabeth Yeu, MD
Consulting Fee: Alcon, Allergan, ArcScan, Aurea Medical, Avedro, Bausch + Lomb, Bio-Tissue, BVI, EyePoint, Expert Opinion, Glaukos, i-Optics, J&J Vision, Kala, LENSAR, Merck, Mynosys, Novartis, Ocular Science, Ocular Therapeutix, OCuSOFT, Oyster Point, Science Based Health, Shire, Sun, TearLab, Veracity, Zeiss
Speakers Bureau: Alcon, Allergan, BioTissue, J&J Vision, Ocular Therapeutix, Omeros, Shire, TearLab
Contracted Research: Alcon, Allergan, Bausch + Lomb, Bio-Tissue, i-Optics, Kala, Topcon
Ownership Interest: ArcScan, CorneaGen, Modernizing Medicine, Ocular Science, Oyster Point, Strathspey Crown

Medical Writer reports the following relationship(s):

Valerie Zimmerman, PhD
No relevant financial relationships to disclose.

Reviewer reports the following relationship(s):

Ronald A. Codario, MD, EMBA, FACP, FNLA, RPVI, CHCP
No relevant financial relationships to disclose.

Vindico Medical Education staff report the following relationship(s):

No relevant financial relationships to disclose.

Signed disclosures are on file at Vindico Medical Education, Office of Medical Affairs and Compliance.

Unlabeled and Investigational Usage

The audience is advised that this continuing medical education activity may contain references to unlabeled uses of US Food and Drug Administration (FDA)-approved products or to products not approved by the FDA for use in the United States. The faculty members have been made aware of their obligation to disclose such usage. All activity participants will be informed if any speakers/authors intend to discuss either non–FDA-approved or investigational use of products/devices.

Copyright Statement

Created and published by Vindico Medical Education, 6900 Grove Road, Building 100, Thorofare, NJ 08086-9447. Telephone: 856-994-9400; Fax: 856-384-6680. Printed in the USA. Copyright © 2019 Vindico Medical Education. All rights reserved. No part of this publication may be reproduced without written permission from the publisher. The material presented at or in any of Vindico Medical Education continuing medical education activities does not necessarily reflect the views and opinions of Vindico Medical Education. Neither Vindico Medical Education nor the faculty endorse or recommend any techniques, commercial products, or manufacturers. The faculty/authors may discuss the use of materials and/or products that have not yet been approved by the US Food and Drug Administration. All readers and continuing education participants should verify all information before treating patients or utilizing any product.

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