编者按：近年来，白内障手术技术不断进步和发展，手术效果越来越好。但即便如此，仍未能完全满足白内障患者的视觉需求。在第39届世界眼科大会（WOC2024）上，欧洲白内障与屈光外科医师学会（ESCRS）主席Filomena Ribeiro教授与会分享了功能性视觉相关讲题，《国际眼科时讯》特邀Filomena Ribeiro教授进行专访，就白内障手术人工晶状体（IOL）度数计算、功能性视觉的评估方法、老视矫正等热点话题分享看法，共探白内障手术精进之道。

《国际眼科时讯》：IOL度数计算对于白内障手术的效果至关重要，您认为应该如何提升IOL度数计算的精确度？

Filomena Ribeiro教授

IOL度数计算在白内障手术中至关重要，如今老视矫正型IOL已问世，更需要精准计算IOL的度数。现在有一些新的计算公式可以提供精准的计算结果，这些公式即便应用于极端的远视眼或近视眼，其表现也十分出色，眼科医师只需应用这些公式进行计算即可。ESCRS推出了IOL度数计算器，任何人都可以免费使用，只需在ESCRS网站输入一次数据，即可得到所有可靠的新公式的计算结果，快速又简便，现在该计算器也可计算复曲面人工晶状体（Toric IOL）的度数。我们会在今年的ESCRS大会上推出圆锥角膜病例和屈光手术后病例的计算器，这是一款非常实用的在线工具，任何人都可以访问，希望大家可以尝试一下。

Yes, that is a crucial issue. Moreso now that we have presbyopia correction IOLs, we need to be very precise with our calculation of the IOL power. Right now, we have several new formulae that can provide very good results, at least for the average cases with the average biometric values of the eyes. These new formulae have also performed very well in extreme eyes with hyperopia or myopia. What we need to do is have quick access to these ways to do the calculations. Right now, we have the IOL power calculator from the European Society of Cataract and Refractive Surgeons (ESCRS). It is free for everyone to use. You just need to go to the website for the ESCRS and input the data once, and you will have the results from all the new formulas that perform well, so in a very fast way and without the problem of transcription errors, because you only input the data once, you can get the results for every new formula. It is a very good way to do it. Right now, we also have the ability to do the toric calculations with this calculator. And very soon, in two weeks, we will have the ESCRS Congress in Barcelona, so we will launch the calculator for keratoconus cases and post-refractive cases also. It is a very good instrument, and I encourage everyone to try it. It is all online and accessible for everyone.

《国际眼科时讯》：现在眼科医师越来越重视功能性视觉，您认为原因是什么？

Filomena Ribeiro教授

众所周知，白内障手术是一种成功率很高的手术，其可帮助患者恢复视觉功能。现在我们需要更深入地探讨功能性视觉，为使患者可以更好地生活和工作，眼科医师需要关注不同的视物距离，要使IOL光学设计与患者的需求和个性相匹配。如果眼科医师能够做好这方面的工作，即可在患者不戴镜的情况下满足其在各种不同距离下的视觉需求，这是真正需要眼科医师为白内障手术患者和老视矫正方案选择提供帮助之处。

Cataract surgery provides a very good outcome. We know that it is the surgery in medicine with the big chance of success, because it retrieves visual function. But we can now address the funcional vision. We know that for people to perform on a daily basis, we need to focus on different distances. Today, we can provide this to our patients. Of course, we need to make a good match of the IOL optic design with the needs and personality of the patient. If we do it properly, our patients really can perform well at different distances without the need for glasses. That is something where we need to have a sense of value for what we are really providing for our patients with cataract surgery and also the choice of presbyopia correction.

《国际眼科时讯》：目前老视矫正方案似乎都不完美，您认为如何才能更好地矫正老视？

Filomena Ribeiro教授

现在多种不同的光学设计为老视矫正提供了个性化方案来满足患者的视觉需求。我们希望在不久的将来能拥有与天然晶状体相同的方式提供屈光调节的IOL，目前该领域已经取得一定进展，我相信未来这一梦想一定会实现。不过放眼现在，多种不同的光学设计已经可以为老视患者提供非常好的解决方案了。

Right now, the truth is that we have several different optical designs that provide us with very good solutions to address the needs of our patients. But of course, there is not only one solution for every patient - we need to match the needs of the patient. Our expectations are always, in the near future, to have an accommodating IOL that can provide in the exact same way as the natural crystalline lens. There are some developments in this regard. I believe that in the future we will get it, but right now, we have so many options that I think we can provide very good solutions for all of our patients.

《国际眼科时讯》：您认为现在白内障患者还有哪些未被满足的需求？

Filomena Ribeiro教授

首先要确保IOL度数计算的精确性，眼科医师需要谨慎进行所有测量以获取患者的生物特征数据。目前此方面存在的一个问题是干眼，干眼与IOL度数计算相关，如果患者有干眼，眼科医师需要在进行生物特征测量之前解决干眼问题。另外，散光也需要矫正，现在Toric IOL的效果非常好，如果要植入Toric IOL的患者有散光，眼科医师应该解决散光的问题。评估患者和IOL计算所需的测量需要更多时间，但这样做可以提升患者的满意度。最后是老视矫正问题，老视的矫正不仅意味着脱镜，而且意味着患者可以在脱镜情况下在不同距离都能有很好的视觉体验。

The first thing is to really provide a very good IOL power calculation. That is the first step, and for that we need to be very careful with all the measurements we take to get the biometric data of the patient. Something that is an issue right now, for instance, is dry eye. Dry eye is also a problem related to the the IOL power calculation. That is something that is mandatory to do in the evaluation of our patients. If they have dry eye, we need to address it before any biometric measurements are taken. Then we need to correct astigmatism, of course. Right now, the toric IOLs give very good results. If we have a case with astigmatism, we should address it. It takes more time in evaluating the patient and for the measurements we need for the calculations, but it provides a very high level of satisfaction for our patients. The last one is really correcting the presbyopia issues. It is not only about being free from wearing glasses, but also to perform well at different distances without the need for a pair of glasses. If we can do it now, we should do it.

《国际眼科时讯》：您认为在植入Toric IOL时，多大程度的散光需要矫正？

Filomena Ribeiro教授

这取决于使用的IOL类型，每种IOL的情况都不同。我们知道焦深延长型（EDOF）IOL对小度数散光的耐受性更强，如果计划植入三焦点IOL，眼科医师需要确保最终散光度数小于0.75D至0.5D。如果使用EDOF IOL，也许会对散光更宽容一些，但也永远不会出现1.0D的情况。对于单焦点IOL，有时候少量散光能够改善近视，眼科医师也可以尝试一下。

It really depends also on the type of IOL we are using. We know, for instance, that EDOF IOLs are more tolerant of small degrees of astigmatism. If we plan to implant a trifocal IOL, we need to make sure that we end up with <0.75 diopter to 0.5 diopter. What we need to consider is that we need to achieve this post-op target - <0.5 diopter is the way to go with trifocal IOLs. If we have an EDOF IOL, maybe they can be a bit more tolerant, but of course, we should never end up with a residual error of 1.0 diopter. For monofocal IOLs, sometimes a little bit of astigmatism can provide a way of getting improvement on near vision, so we can play with this. It is not equal for every kind of IOL.

Filomena Ribeiro教授最后谈到，第43届欧洲白内障与屈光外科医师学会年会（ESCRS 2025）将于2025年9月12~16日在丹麦哥本哈根举行。2024年在巴塞罗那举办的ESCRS 2024取得了巨大成功，出席人数创下历史新高。ESCRS 2025将来到哥本哈根，这座城市融合了传统和创新，是一个具有多样性和包容性的城市。2025年，期待与大家在美丽而热情的哥本哈根举行的ESCRS 2025大会上再次相聚！

ESCRS 2025会议信息：https://congress.escrs.org/

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