Happy Patients, Higher Volumes

Doctors strive to make their patients happy, but a happy patient may not be a sign of a perfect surgery, according to Andrea Janekova MD.

“Like an iceberg, only 10% of the whole volume is visible, with many steps that need to be done, hiding underneath,” she said during the Customized Patient Planning IME Symposium at the 2025 ESCRS Annual Congress in Copenhagen. “Any kind of mistake and any wrong measurement can damage an otherwise great result.”

As an example, many parameters during biometry can give wrong values if not performed correctly, thus inserting a mistake into the very beginning of a long process. For this reason, said Dr Janekova, patient flow is very important in clinical practice.

Across different kinds of clinical settings, time is the common denominator, especially time spent with patients. Adjusting to technology can be time consuming, but in the long run this leads to simplification of procedures and workflow and therefore better outcomes.

Digital biometry plays a key role in this process. Dr Janekova noted that in the past she had to perform measurements manually, but it is now possible to measure cataracts with biometers with a higher level of accuracy. It also saves time, as digital biometry can be integrated with advanced IOL formulas.

Corneal imaging is also a very important part of the workflow, Dr Janekova said. An inaccurate keratometry is a major source of postoperative refractive error, and therefore the precision of a digital measurement can be essential to producing correct IOL power calculations. Moreover, corneal imaging allows a thorough evaluation of the regularity of the corneal surface, allowing detections of keratoconus, ectasia, and corneal scarring that would otherwise jeopardise surgical outcomes. Finally, corneal imaging can help in detecting corneal pathologies, finding the subtle or subclinical signs of corneal conditions that would be essential for the correct choice of IOL.

Dr Janekova presented the case of a 50-year-old woman with scutellar posterior cataract in both eyes and slight hypermetropia. The patient wanted spectacle independence due to her many daily activities that required near and intermediate vision. Dr Janekova chose the AT ELANA 841P lens thanks to its trifocal design

The preoperative planning needs to start even before the patient enters the clinic, Dr Janekova said. There is a non-medical aspect that needs to be considered—the communication between the patient, the receptionist, and the nurses. This can make an impact on patient satisfaction even before they reach the examination phase.

In her practice, Dr Janekova makes sure all measurements, such as tear film and visual acuity, are carefully taken before surgery. The patient is sent to a consulting phase and interviewed about their needs, their work, and other daily life activities. Remote access workflow is also greatly appreciated, offering the possibility of obtaining biometric data even if the surgeon is not in the clinic.

According to Dr Janekova, all the digital planning and diagnostics are advantageous and save time. “This is something that can make your everyday life much easier, especially when dealing with higher volumes of patients,” she said.

Andrea Janekova MD, FEBO, FEBOS-CR is Head Physician of Cataract, Refractive, and Vitreoretinal Surgery, Prague Eye Centre, Czech Republic.