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Up Front | Aug 2003

5 Questions With Robert Cionni, MD

Dr. Cionni shares his bright vision for the future of cataract surgery techniques and technology.

Who were your mentors in ophthalmology and why?
My father was, and still is, my model of a caring physician. He and my mother showed me, through example, how to be compassionate. I credit Dr. Arthur Keeney at the University of Louisville for teaching me the joy of being an ophthalmologist (and how to spell it). He was a wonderful mentor and helped me through those difficult years of residency. At the Cincinnati Eye Institute, Dr. Robert Osher trained me in cataract and anterior segment surgery. My goal when I began my fellowship was to achieve postoperative results similar to his. His insight and attention to detail helped me to develop the skills I needed to become a better surgeon.

What is the current focus of your research? I am working with Alcon on several investigational IOLs. Additionally, I continually try to improve physicians' ability to manage patients with zonular compromise and hope to see capsular tension rings available in the US soon. Finally, I am working on devices to help reduce postocclusion surge during phacoemulsification.

What will the future of cataract surgery look like?
I believe that we will continue to move toward smaller incisions and IOLs that can be placed through them. Some surgeons are already moving to microincisional phaco techniques in preparation for these lenses. We are seeing new lens removal modalities such as AquaLase that may help decrease surgical complications and make clear lensectomy a safer, more viable option. As our patients become more demanding and technology improves (eg, multifocal, accomodative, pseudoaccomodative, and toric IOLs), we will see a sharp increase in the number of patients electing to have refractive lens exchanges. There will be a shift away from LASIK to this procedure. This will mean that many patients will have their crystalline lenses removed before cataracts develop and perhaps we will see a leveling off of cataract surgeries as these patients get older, which will lessen the burden on Medicare. There is a growing body of evidence that chronic exposure to blue-wavelength light may increase the risk for degenerative macular disease, and studies with the recently approved AcrySof Natural have shown that this blue-light–blocking IOL does not negatively affect vision, so there is no risk in providing this better protection. I firmly believe that blue-light–blocking IOLs will become the standard for the future.

What new or future technologies are you most excited about?
I am most excited about the recent pseudo-accomodative IOL technology brought out in the ReStore IOL. By decreasing the percentage of light focused at near with increasing optical zones of the lens, the effect of “light-splitting” on contrast sensitivity and induced glare or halos should be minimized. My personal results with these patients, without the need for careful selection based on age, pupil size, or night driving, has been nothing short of phenomenal. The next generation of phaco machines also promise to be much more reliable, predictable, versatile, and safe with decreased surge potential, even at high vacuum and flow rates.

What do you find most challenging in ophthalmology today?
Without a doubt, the most challenging part of ophthalmology today is managing a practice. Patient care is a breeze compared with the brutal world of the business of medicine.

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