EyeWorld Asia-Pacific September 2018 Issue

September 2018 EWAP FEATURE 15 future lens changes on the surgery you did.” Dr. Durrie will have this same educational conversation with pa- tients in their 20s and 30s, just so they’re aware of the changes that will happen decades down the road. It doesn’t keep them from choosing to have surgery, he said. The amblyopic patient who wants refractive surgery Another challenging case is the patient with amblyopia who comes in seeking refractive sur- gery. Dr. Durrie said he sees about one of these patients a week. “People who have had poor vision throughout their life are more likely to come in, so we see patients with amblyopia at a high- er percentage than the general ophthalmologist or optometrist would,” he said. Patients who are 20/15 or better in their dominant eye and have mild amblyopia of 20/25 or 20/30 best corrected in their nondominant eye can benefit tremendously from surgery, Dr. Durrie said. With these patients, he explains what a lazy eye is— how their brain learned to favor the good eye—and that refractive surgery will not fix that aspect of their vision. It’s expectation set- ting, he said. “You’re telling them they can have a surgery, but we can’t change the brain,” he said, adding that he’ll see these patients twice before surgery to make sure their prescription is stable. Another category is the patients whose amblyopia was missed or untreated in childhood and they are 20/200–20/400 best corrected. “They’ve been hoping all their life that someone could fix their lazy eye. This is a more impor- tant educational process because they’re not going to get a lot of benefit out of surgery,” Dr. Durrie said. While their myopia, hypero- pia, and astigmatism can be cor- rected, they’re still likely to be no better after surgery. “It’s a real disappointment to them … but it’s important to help them understand that they’ve got- ten along well and functioning to this stage; it’s something they’ve adapted to,” Dr. Durrie said. If they really want refractive surgery in their good, dominant eye, Dr. Durrie said this presents a dilemma because they only have one eye for functional vision. He proceeds with extreme caution in these cases and might even per- form surgery on the amblyopic eye as a trial run, discounted or free of charge, before proceeding with the other eye. Finally, there are patients with strabismus with a lazy eye. Dr. Durrie said these patients’ stra- bismus can often get better with refractive surgery due to better vision getting them to hold their eye in a more regular position, but he’ll have them consult with an adult strabismus specialist before surgery because some patients can have an increase in their deviation. The patient with disguised ocular surface disease When a woman in her 40s came to Dr. Desai’s office seeking LASIK, she didn’t complain of dry eye symptoms. Careful examina- tion, however, revealed not only dry eye but more serious ocular surface disease. This patient was a moderate myope but only correct- ed to 20/30 with glasses, which Dr. Desai said was a red flag when “ The goal of refractive surgery is to be able to rehabili- tate patients with normal corneas and abnormal corneas as well. ” - Eric Donnenfeld, MD Crosslinking can halt the progression of keratoconus and can be combined with excimer laser treatment to then regularize the cornea. Source: Eric Donnenfeld, MD continued on page 16