EyeWorld Asia-Pacific September 2015 Issue

43 EWAP REFRACTIVE September 2015 According to Dr. Blanton, surgeons should not underestimate the importance of an accurate preop refraction. He recommends obtaining a patient’s aberrometry measurement prior to doing the refraction. “We use the WaveScan aberrometer [Abbott Medical Optics, Abbott Park, Ill.] and place this in the phoropter, which gives us a fogging refraction,” he said. “We do a WaveScan-guided manifest refraction, taking our patients as far down the eye chart as possible. When designing the treatment plan, we do a nomogram- adjusted treatment to accommodate different surgical techniques and environmental conditions that each surgeon will find.” If you don’t hit the target, what next? If a patient is unhappy with his or her vision postop, first make sure that it is a surgical issue and not one of unfulfilled expectations. “My go-to strategy for patients who have suboptimal results is to first acknowledge their unhappiness—it is crucial to not try to convince them of how great they are seeing if they are unhappy,” Dr. Reilly said. “If they have an unrealistic expectation that I did not understand prior to surgery, that is a failure on my part to spend enough time to understand their expectations.” Once you’ve determined that the issue is a surgical one, make sure to give those patients extra attention. “You want to realize that 1–2% of people with modern surgery are going to need more follow-up and more effort than the rest, and that 2% has to become your most important patients,” Dr. Durrie said. “They need your undivided attention. That’s the first thing that the patient really respects. Then you go through and explain to them why they aren’t on target.” Taking the time to make sure that the patients who are disappointed with their initial results end up happy is smart for your practice, he said—in his experience, those patients end up being the best referrals. “If you spend extra time with a patient, they’re more likely to send family and friends in, so it’s well worth the effort,” he said. “The ones that we spend the extra time with, they’re the ones that send in the most patients to our practice.” If there is residual astigmatism, myopia or hyperopia, go back through your calculations and see why they have that residual refractive error before considering an enhancement procedure. “Sometimes it’s just wound healing, and they either over heal or under heal, but you need to know that going into [an enhancement] procedure to get the second procedure accurate,” Dr. Durrie said. “If they have something else going on—usually something to do with the ocular surface—find out what it is and treat it if you can.” Don’t forget about PRK Most patients choose LASIK over PRK because the recovery is shorter and less painful, but surface ablation still has a role to play in a modern refractive practice. “There are patients who are clearly non-candidates for LASIK based on topography, pachymetry, refractive error, and occupational considerations,” Dr. Blanton said. “For those patients, surface ablation is an excellent procedure.” “With advanced surface ablation, you can achieve similar levels of satisfaction if you prepare the patient for what is expected after surgery,” Dr. Reilly said. “In fact, when they don’t experience as much pain as you prepare them for, their satisfaction is even higher. “After I explain the benefits of both procedures I am continuously surprised by the number of patients who elect surface ablation,” he continued. “Giving patients a choice and some control over their care really enhances their confidence in the surgical procedure.” PRK has a role not only as a primary procedure in a refractive practice but also for enhancing previous LASIK, radial keratotomy, and premium IOL patients, Dr. Reilly added. “Overall, surface ablation’s role not only in laser vision correction but in any refractive practice is robust and will continue to be integral for years to come.” EWAP Editors’ note: Dr. Blanton has financial interests with Abbott Medical Optics. Drs. Durrie and Reilly have no financial interests related to this article. Contact information Blanton : blanton007@aol.com Durrie : ddurrie@durrievision.com Reilly : cdreillymd@gmail.com