EyeWorld Asia-Pacific September 2015 Issue

40 EWAP REFRACTIVE September 2015 Role of refractive lens exchange and management of unhappy refractive patients by Ellen Stodola EyeWorld Staff Writer AT A GLANCE • Improperly set patient expectations and poor patient selection are two factors that can lead to unhappy refractive patients. • Refractive lens exchange is a good option, although not always the go-to option in a practice. • Screening tools like topography, optical biometry, and OCT are extremely valuable for refractive patients. Before a refractive procedure, it’s important to know what factors can cause unhappy patients, the best tools, and how a refractive lens exchange may be valuable A lthough a refractive lens exchange (RLE) may not be the first choice for many surgeons, it can have value in the refractive practice. It’s important to know its role and to be able to evaluate refractive patient expectations ahead of time to eliminate some of the unhappiness and complications that can occur. Screening tools can help with this, as can a thorough discussion with the patient prior to surgery. Richard S. Hoffman, MD , clinical associate professor, Casey Eye Institute, Oregon Health & Science University, Portland, Ore., and John Berdahl, MD , Vance Thompson Vision, Sioux Falls, SD, discussed when they When screening refractive patients, it’s important to rule out conditions such as anterior basement membrane dystrophy. Poor patient selection is one of the leading causes of an unhappy patient. Source: John Berdahl, MD use refractive lens exchange and other guidelines for patients in the modern cataract refractive practice. The role of refractive lens exchange RLE is an important but not essential part of a modern cataract refractive practice, Dr. Hoffman said. “It is essential to offer this if you are a refractive surgeon, but a cataract surgeon can elect to refer these out to someone else,” he said. “Surgeons who perform these procedures should be proficient in the use of toric IOLs, LRIs, and multifocal IOLs.” Surgeons using refractive lens exchange should be able to fine-tune the refractive results with corneal refractive surgeries, like LASIK or PRK. Those with a high complication rate or whose postoperative refractive results are not at least 85% +/–0.50 D may not be the best individuals to perform RLE, Dr. Hoffman said. “This, however, is mostly dependent on the expectations of patients within their particular market.” “Refractive lens exchange is an option that should be on the table,” Dr. Berdahl said. “In our practice it’s a good option, but it’s not our primary go-to option except in select circumstances.” A refractive lens exchange may be particularly beneficial for those around 50 years of age who are hyperopic, he said. With modern cataract surgery and a number of new technologies, surgeons can address the problem of presbyopia better than they were able to before, but it’s still not perfect, and the new technology does come with a price. Unhappy refractive patients “The most likely reason for unhappiness is improperly set expectations,” Dr. Berdahl said. Surgeons need to be certain that patients understand what they’re going to get and what they’re not. Don’t gloss over potential side effects, he said. It’s important to