EyeWorld Asia-Pacific June 2019 Issue

48 EWAP JUNE 2019 CATARACT À° œ`i˜]…œÜiÛiÀ] >ۜˆ`à complicated eyes altogether. Once the patient has paid for the upgrade, he said, their expectations are set for the superior vision they thought they ºLœÕ}…Ì°» º Ì Ãii“à ̅>Ì ˜œ amount of preop discussion can alleviate this tendency,” he said. EDOF and refractive lens exchange Drs. Chang, Wong, and Yeu ÕÃi " " à vœÀ ÀivÀ>V̈Ûi i˜Ã iÝV…>˜}i , ®° º Ãii i˜Ã pathology to be a continuum of progression from a young healthy lens to a dysfunctional lens to a cataractous lens,” Dr. Chang said. “Regardless of the condition of the phakic lens prior to removal, the patient will have the same potential vision postoperatively. Therefore, >à œ˜} >à iÝ«iVÌ Ì…>Ì Ì…i patient will be happy with the relative functional gains in their uncorrected vision acuity after ÃÕÀ}iÀÞ] `œ ˜œÌ…iÈÌ>Ìi ̜ œvviÀ " " à >à >˜ œ«Ìˆœ˜°» Dr. Yeu, however, only performs , ˆ˜…Þ«iÀœ«ˆV «>̈i˜Ìà œÛiÀ ̅i age of 45; she will not perform , ˆ˜ “Þœ«ˆV «>̈i˜Ìà ՘̈ >Ì least the age of 58. À° œ`i˜ ˆÃ “œÀi V>ṎœÕð “Although refractive lensectomy works, it comes with trade-offs,” …i Ã>ˆ`° º ˜ “Þ œ«ˆ˜ˆœ˜ ̅iÀi is currently no product that can fully satisfy the patient who has preop BCVA of 20/15 with spectacles or contact lenses. Glare, halos, starbursts, spider webs, loss of contrast, and range of vision all remain issues. Take great care in interviewing your patient and setting expectations preop.” Unhappy patients No procedure is perfect, and as in all cases, preparation is iÛiÀÞ̅ˆ˜}° º Ì ˆÃ iÝVii`ˆ˜}Þ `ˆvwVÕÌ Ìœ…>˜`i >˜ ՘…>««Þ " " «>̈i˜Ì ܅œ Ü>à not properly counseled preoperatively,” Dr. Chang said. “The two primary areas of `ˆÃÃ>̈Ãv>V̈œ˜ ܈̅" " à are (1) not enough uncorrected near visual acuity and (2) unsatisfactory dysphotopsias or night vision symptoms.” -ޓvœ˜Þ] w˜i ÃÌ>ÀLÕÀÃÌà ܈̅ “Տ̈«i w˜i…>œÃ]»…i Ã>ˆ`° i asks about their satisfaction with regard to uncorrected distance and night vision at one day and at one week after receiving ̅i " ˆ˜ ̅i wÀÃÌ iÞi° º v ̅iÞ >Ài ՘…>««Þ ܈̅iˆÌ…iÀ] ܈ address the issue before working on the contralateral eye. “Before surgery and continuing postoperatively, it is important to evaluate and treat the ocular surface and macula,” he continued. “Postoperatively, uncorrected refractive error and «œÃÌiÀˆœÀ V>«ÃՏ>À œ«>VˆwV>̈œ˜ they will see a night halo/ spider web with 100% certainty and that they will need glasses some of the time for some activities. …We do not promise perfection and get the patient’s buy-in on realistic expectations before they choose to have surgery. Preoperative counseling—medical and psychological—is mandatory for all patients.” For unhappy patients, Dr. Wong offers keratorefractive surgery for refractive misses, lens exchanges, and the full spectrum of refractive surgery. “An unhappy EDOF patient is like any other unhappy refractive cataract surgery patient [and should be handled as such]—with extra special V>Ài]» À° 9iÕ Ã>ˆ`° º-«iVˆwV>Þ] manage the ocular surface carefully, reserve performing any posterior capsulotomy if there is any concern that ̅i " ܜՏ` ˜ii` ̜ Li exchanged, address residual refractive errors, and see them more frequently than not until ̅i ˆÃÃÕi V>˜ Li Ài܏Ûi`° `œ not move on to the second eye surgery until some resolution ˆÃ Ài>V…i` ܈̅̅i wÀÃÌ iÞi° Besides greater near vision being achieved with binocular summation, the quality of vision œv ̅ˆÃ " ˆÃ Ü }œœ` ̅>Ì ˆv ̅iÀi ˆÃ > Vœ˜ViÀ˜ ܈̅̅i " itself, it is generally not a quality of visual acuity issue in the long term from any permanent waxiness, but from night vision- related concerns or the need for some reading glasses for near vision. Preoperative chair He tells all patients being œvviÀi` >˜ " " ] LÕÌ especially low myopes, that they may still need readers for small print, particularly in dim ˆ}…Ì° ºƂ``ˆÌˆœ˜>Þ] ˜œÌ œ˜Þ tell them that they will likely have night vision symptoms, >Ãœ `iÃVÀˆLi ̜ ̅i“ ̅i ëiVˆwV Ãޓ«Ìœ“à ̅>Ì Ì…iÞ Üˆ be having—in the case of the can be sources of unhappiness. V…iVŽ vœÀ ̅iÃi >}}ÀiÃÈÛiÞ >˜` i“«…>Èâi…>ۈ˜} > }œœ` postoperative refraction, being careful not to over-minus EDOF " «>̈i˜Ìð 7…i˜ ÃÌ>Li] œvviÀ laser vision correct and/or YAG laser capsulotomy as needed.” “Preoperative counseling is key,” Dr. Wong agreed. “We advise EDOF patients that Slit lamp photo of a Tecnis Symfony EDOF IOL. Source: Daniel Chang, MD