FEATURE 14 EWAP JUNE 2022 skate on the other. … Everything is off because they need to have the other eye done,” he said. “We educate them on the front end and let them know they’re not going to love [the time] between eyes.” Other issues include glare and halo in the early postop period. Dr. Williamson said patients need to be reminded that it can take 3–4 months for them to neuroadapt. Another issue could be that the patient doesn’t love their near vision. They might like it but not love it, Dr. Williamson said. The same issue could happen with distance. It might be a case where mixing and matching IOLs could help. Dr. Williamson said he doesn’t think of these as complaints from patients but rather observations. He said he listens to these observations and often uses them to inform what the best course of action is for the second eye. Douglas och, MD, discussed the challenge of cataract surgery in patients who have had prior refractive surgery. These patients elected for spectacle independence with initial refractive surgery, so they might have the same expectation after cataract surgery, if they’re opting for a presbyopia-correcting IO . Dr. och said that these patients often have multifocal corneas whose depth of focus can compensate in part for residual refractive error, but it’s not uncommon for them to be off target, and residual refractive error is more problematic with most EDOF and multifocal IOLs. It’s especially important that these patients be educated about the added challenge their prior refractive surgery poses for hitting the post-cataract surgery refractive target, Dr. och said. e thinks that the Tecnis Symfony lens (Johnson & Johnson Vision), with its large “landing zone,” is more forgiving in this regard, and in his practice he largely avoids other EDOF and multifocal IOLs in post-refractive eyes. If the needed postop correction is small, Dr. och said he½ll propose PR . 1sually A-I is not feasible, but sometimes he will do a yap recut and lift, if the cornea is amendable to further yap surgery. or residual refractive error of –2 or more or +1.5 or more, he prefers IOL exchange. As for taking lessons learned from the first eye and applying them to the second, Dr. och said it’s more nuanced in postrefractive surgery patients. “If they½ve had a modest A-I , you could probably learn something from the first eye, but if they½ve had a large A-I correction, and especially in post-R eyes, one cannot rely as much on the outcome of the first eye when calculating the IOL for the second one,” he said. Dr. Williamson said that patients who are unhappy with their refractive outcome want to be heard and confident that their surgeon is understanding and has a plan for them. He said the staff often has an accurate pulse on just how unhappy a patient might be (e.g., the patient might be more honest with the staff than the physician). Dr. Williamson said it’s important to remind the patient with a presbyopia-correcting IOL of what they do have—“awesome near vision”—and at 3 months postop consider more significant action if they’re still not happy, such as a 9A capsulotomy (don½t 9A too early, Dr. Williamson cautioned) or explant. “Never do [an explant] before a month unless it was a refractive miss,” he said. “If you hit the refractive target … but the patient is unhappy with side effects, give it at least a month, then get it out and refund.” EWAP Editors’ note: Dr. Koch is in practice at tJe &eRartOent QH 1RJtJalOQlQI[ %Wllen '[e +nstitWte $a[lQr %QlleIe QH /eFicine *QWstQn 6eZas anF Jas interests YitJ #lcQn %arl <eiss /eFitec and Johnson & Johnson Vision. Dr. Raviv is in Rractice at tJe '[e %enter QH 0eY York, New York, New York, and has interests with Johnson & Johnson Vision. &r. 9illiaOsQn Rractices at 9illiaOsQn Eye, Baton Rouge, Louisiana, and has interests with Johnson & Johnson Vision. routine postop drops have usually stopped around this time, he said, and many patients with dysphotopsia will see it resolve after several months as well. For those with problems that still persist, Dr. Basti again stressed that there is the possibility of surgically exchanging the lens. “For someone unhappy with the outcome, convey to them that you will continue to monitor and get them to a good place,» he said. ºProviding that reassurance is key here.” EWAP 'FitQrso nQte &r. $asti is &irectQr QH tJe %ataract 5erXice &eRartOent QH 1RJtJalOQlQI[ 0QrtJYestern 7niXersit[ %JicaIQ +llinQis anF Jas interests with Johnson & Johnson Vision. &r. %JanI is %ataract anF 4eHractiXe 5WrIeQn 'ORire '[e anF .aser %enter $aMersfielF %aliHQrnia anF Jas interests with AcuFocus and Johnson & Johnson Vision. Unhappy patients - from page 11
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