EyeWorld Asia-Pacific December 2019 Issue

EWAP DECEMBER 2019 9 FEATURE importance his clinic places on bringing another family member to preoperative counseling for both monocular and binocular patients. It not only helps with the patient’s decision making but it provides another set of ears for setting appropriate postoperative expectations. In terms of lens choice, the doctors were split on whether they would implant a multifocal or accommodating lens in a monocular patient, but all said they would offer torics. Dr. Gimbel said he would advise against a multifocal due to degraded quality of optics. He also said monocular patients are often encouraged to wear shatterproof glasses anyway for protection, reducing this Li˜iwÌ œv > “Տ̈vœV> œÀ accommodating lens. Dr. Osher said he would not put in a multifocal or accommodating lens unless the patient insisted. Dr. Vasavada said he would consider a multifocal or accommodating lens for a monocular patient if they desired spectacle independence and were otherwise suitable and healthy enough for a multifocal. If a patient was a long-time diabetic, for example, Dr. Vasavada said he would caution against these lenses due to the increased likelihood of degradation of vision associated with that disease. Dr. Lindstrom said he has implanted premium lenses in monocular patients. “The decision-making process for me remains the same as in the binocular patient, except that customized matching with different IOLs in each of two eyes is not available,” he said. One aspect Dr. Osher does differently with monocular patients is he prescribes an extended preoperative antibiotic regimen. Instead of ordering 1 day of a preop antibiotic, he has monocular patients on it for 3–4 days preop. Most said the surgical procedure itself is the same. Dr. Osher said he doesn’t have anesthesia provide retrobulbar injections, opting for peribulbar or topical in these cases. Following surgery, Dr. Osher said he always gives 125 mg of acetazolamide to avoid “a really rare, ridiculous pressure spike.” “Your surgery has to be meticulous, you can’t be rushed. It should be like your very best preparation,” Dr. Osher said. “I used to coach a lot of baseball. … I always say throw your best pitch, and that’s what you’ve got to do with not just your one- eyed patients but everyone.” Dr. Lindstrom said you have to be honest with yourself and your experience level in these cases. If you’re faced with a small pupil, pseudoexfoliation with loose zonules, corneal guttata, glaucoma, epiretinal membrane, and the patient is on tamsulosin—which he said often present together in monocular patients who had complicated ÃÕÀ}iÀÞ ˆ˜ ̅iˆÀ wÀÃÌ iÞipÞœÕ might need to refer this case. “You will sleep much better and you will not notice losing one or two cases a year to a colleague,” he said. “When a surgeon experiences a major sight-threatening complication in an only eye, and I speak from experience, it is never forgotten. Some of us have trained to be put in that position as consultative ophthalmologists, but not every ophthalmic surgeon has to suffer the experience of a poor outcome in an only eye. At a minimum, get a second opinion and, when appropriate, a retina consult preoperatively if the patient has retinal disease or is a high myope.” EWAP Editors’ note: Dr. Gimbel is professor at Loma Linda University, Calgary, Canada. Dr. Lindstrom is founder and attending surgeon at Minnesota Eye Consultants, Minneapolis. Dr. Osher is professor of ophthalmology at the University of Cincinnati and medical director emeritus at the Cincinnati Eye Institute. Dr. Vasavada is founder and director of Raghudeep Eye Clinic, Ahmedabad, India. None of the doctors declared any ƂPCPEKCN KPVGTGUVU TGNCVGF VQ VJG VQRKE B I OME C H AN I C S ME E T S T OMO G R A P H Y HEY CORVIS ST I just took a look at the tomography. These values call for caution. I don’t think I would operate. HI PENTACAM The biomechanics looks good, though. The cornea is very stable. I don’t see any problem with operating. O.K. TOGETHER NOW Tomography and corneal biomechanics together make the decision easier: Surgery could be an option. Corvis ® ST meets Pentacam ® : Combined measurement results for a safe decision on surgery OCULUS Asia Ltd. info@oculus.hk www.corneal-biomechanics.com www.pentacam.com