Carlos Ruiz Lapuente is an experienced surgeon in combined procedures of cataract, glaucoma, and vitreoretinal diseases. Researcher, patent holder, and former Head of Department of Ophthalmology, Dr. Lapuente is now developing ophthalmic technology and is also the director of a private clinic in Barcelona.
At the ESCRS 2022 Congress in Milan, we had an opportunity to sit down and talk to Dr. Lapuente about dealing with complex cases, potential drug treatment for cataract, and his current research.
1) What do you think about the current trifocal lenses in the market? As a cataract surgeon yourself, what do you think needs to improve?
Trifocal lenses are here to stay. After a big expansion five or six years ago it became clear that they were not for everyone. Complaints about glare, haloes, night driving performance and light dependence limited their success while doctors had to face a significant percentage of unsatisfied patients that we didn’t have with monofocal lenses. Then an intermediate category of EDOFs merged to bridge the gap between trifocals and their quality of vision issues and monofocals with the intermediate to near vision limitations.
But former LASIK patients now in their late forties are pushing the surgeons to the limit of the EDOF themselves with tend to fall short of their expectations on the near distance vision. As a consequence while trifocals are constantly improving regarding the optical performance and reducing complaints of quality of vision new lenses need to include specific solutions for subgroups of patients such as myopic LASIK and other excluded groups like the mild Epiretinal Membranes, a common finding prior to surgery.
2) As a surgeon, you mostly deal with complex cases such as cataract patients with glaucoma. What are some important points to be considered in these types of cases?
In the case of glaucoma and the need for cataract surgery we need to evaluate the visual function and the status of the optic nerve and ocular surface. Principles to be applied are the careful selection of the intraocular lenses to get the best visual performance adapted to the patient needs with the less invasive procedure for the maintenance of long term Intraocular pressure control with no additional topical treatment, if possible.
MIGS provide us with different solutions that can be applied at the time of the cataract surgery or that can be adjusted to enhance a further IOP reduction of the surgery. More physiological approaches with the elegant proposal of canaloplasty will gain acceptance as implant-free options. Also procedures of ciclodestruction with either micropulsed lasers or Ultrasound energy have become a safe and effective option to achieve the target IOP.
3) You are also a great researcher as far as I know. Is there any research that you are focused on right now?
My research links are focused on deepening our knowledge of the factors limiting the success of multifocal intraocular lenses regarding non-ocular surface-related diseases, such as unilateral early glaucoma or epiretinal membrane and the influence of surface design on the diffractive edges, be they sinusoidal or not, with the objective support of aberrometry. This interest is motivated by the clinical impression that surgeons have been able to have a better visualization the epiretinal membranes in cases of EDOFs and sinusoidal multifocals when compared to previous generations of multifocal lenses. Other ongoing research is related to devices for office-based intraocular surgery with the highest standards of air quality.
4) Do you think cataract treatment with drugs can soon become a reality?
Reversion of a cataract with drugs might be a topic for research meetings in the future. As a researcher, I have seen that it has been considered a holy grail for too many decades and from time to time it has given rise to expectations that in the end were not fulfilled. But now I am quite sure that the research underway shows the value of these experiments and will provide us with a better understanding of the aging process of the crystalline lens, cataract formation, and presbyopia. We will see again pharmacological proposals aimed at slowing the progression of both cataract and presbyopia. In the meantime, we need to provide our patients with the most up-to-date solutions for today’s needs.
5) What advice would you give to young ophthalmologists?
Enjoy this very rewarding profession and take advantage of the accessibility of the best resources and to the most prestigious experts that will help you with the decision-making process in complex cases. Do not rush to the operating room without a skilled and planned surgical strategy. Experts are there to help you prior to action, not only when results fall below expectations.