Verifying refractive outcomes and ensuring long-term reliability

Clinical Challenge

Increasing patient expectations for long-term reliable outcomes

As the average age of cataract patients is declining1, surgeons need to cater to increasing patient expectations and provide long-term solutions.2

Yet, particularly after the removal of hard cataracts, higher rates of inflammation and edema can be experienced.3 In the long-run, dislocated IOLs or dysphotopsias4 may cause headaches - both to the surgeon and the patient.

traumatic coloboma of the iris
Clinical Solution

Reliability in post-op check up and long-term refractive outcomes

As the extraction of hard cataracts is associated with higher post-op complications, thorough post-operative diagnostics are vital.3 Trusted technologies are slitlamp and OCT. To ensure life-long tolerability of the implant as well as an excellent patient outcome, an optimal IOL needs to be chosen. Hydrophilic IOLs have a great biocompatibility which is especially important in eyes with a damaged blood-aqueous barrier (from uveitis, glaucoma, diabetes).5

Additionally, inflammatory cells accumulate less easily on hydrophilic IOLs than hydrophobic IOLs. Dysphotopsias also occur less in hydrophilic lenses, as they have a lower refractive index compared to hydrophobic IOLs. 6 Specifically IOLs with a 4-point haptic design are a trusted platform for excellent centration and stability in the bag.7

ZEISS Solution

Premium optical quality – ZEISS SL 800

The SL 800 slit lamp from ZEISS equips you with an all round setup for the observation of anterior and posterior segments.

ZEISS SL 800 and SL Imaging Solution

  • The VarioLight cold white feature benefits scattering and helps to identify irregularities within the anterior segment
  • High-quality images and video captures can be added to exam reports to offer you the ability to compare and document cases


ZEISS VERACITY Surgical provides post-op automated analytics and a-constant optimization.

Dense cataract workflow challenges


A dense cataract is, by its very nature, difficult to penetrate. This makes pre-op cataract evaluation a challenge. Both precise biometric measurement as well as screening for macular pathologies are key to avoid refractive surprises.8,9,10


Lens fragmentation of a dense cataract requires a lot more phaco energy to emulsify the hard nucleus. More energy increases the risk of damage to corneal endothelial cells, which, in turn, can cause post-operative complications.8,11

Webinar trilogy: Treating dense cataracts – when routine becomes a challenge

Dr. Don Pek, Dr. Ruth Lapid-Gortzak, Dr. Nino Hirnschall, Dr. Sartaj Grewal & Dr. Franco Spedale

March 2021

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  • 1 Marketscope 2016.
  • 2 .
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  • 4 Randall J. Olson, MD, Salt Lake City, Review of Ophtalmology, PUBLISHED15 JANUARY 2005 Demystifying Dysphotopsia.
  • 5 A New-Generation Hydrophilic Acrylic IOL, STEVEN D. VOLD, MD CRSTEurope, 2011; Abela-Formanek C, Amon M, Schild G, Schauersberger J, Heinze G, Kruger A. Uveal and capsular biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses. J Cataract Refract Surg. 2002;28(1):50-61; Abela-Formanek C, Amon M, Kahraman G, Schauersberger J, Dunavoelgyi R. Biocompatibility of hydrophilic acrylic, hydrophobic acrylic, and silicone intraocular lenses in eyes with uveitis having cataract surgery: Long-term follow-up. J Cataract Refract Surg.2011;37(1):104-12.
  • 6 Randall J. Olson, MD, Salt Lake City, Review of Ophtalmology, PUBLISHED15 JANUARY 2005 Demystifying Dysphotopsia J. T. Holladay and M. J. Simpson, “Negative dysphotopsia: Causes and rationale for prevention and treatment,” J. Cataract Refract. Surg., 2017.
  • 7 Ganesh and Brar, 2017. Long-term visual outcomes and patient satisfaction following bilateral implantation of trifocal intraocular lenses. Clinical Ophthalmology. 2017:11 1453-1459 ** P. Mojzis et. al.: Implantation of a diffractive trifocal intraocular lens: One-year follow-up. Journal of Cataract and Refractive Surgery; August 2015. Volume 41, Issue 8, Pages 1623-1630.
  • 8 U. Devgan, Dense brunescent cataracts present surgical challenges, Ocular Surgery News 2011,
  • 9 S.Garg, Surgeons meet challenges of removing rock-hard cataracts, Ocular Surgery News 2018,
  • 10 A.Brissette, OCT Is Indispensable for Pre-op Cataract Evaluation, Opthalmology Management 2019,
  • 11 M. Colvard, Phacoemulsification of the rock hard cataract, Eyeworld 2012,