REFRACTIVE EWAP JUNE 2022 1 Contact information Lee: bryan@bryanlee.pro Rebenitsch: Dr.Luke@ClearSight.com Wiley: wiley@cle2020.com W hen choosing a refractive procedure, there is a lot of information for surgeons to go over with patients, and the possibility of needing implant surgery in the future is one point for discussion. Bryan Lee, MD, JD, Luke Rebenitsch, MD, and William Wiley, MD, shared how they counsel patients, specific considerations, and how changing technology has had an impact on this and may open more options in the future. Technology is changing so quickly, Dr. Rebenitsch said, and the procedures of today are not the procedures of 20 years ago. or eÝample, A-I is very different today than it was 15–20 years ago. “We have better ablation patterns and larger optical zones, which do not necessarily preclude a patient from having a multifocal or advanced technology IO in the future,” he said. Dr. Rebenitsch said that all patients under 40 are counseled that their crystalline lens is going to change, and there are options for when they develop presbyopia. -etting eÝpectations is a win for patients and practices, he said. In cases of hyperopic ablations, Dr. Rebenitsch advised caution and said that he might be more likely to How refractive procedures impact future implant choices by Ellen Stodola Editorial Co-Director recommend a refractive lens eÝchange earlier because even with modern technology, hyperopic ablations are more likely to prevent patients from having certain advanced technology IO s. ºWhat½s changed over time is we’re doing lenses earlier, especially for hyperopic patients,” he said Dr. Rebenitsch added that treatment for a –6 to –8 myope is usually when higher order aberrations increase with modern ablation profiles, so he may be more likely to place a phakic IO , like the -TAAR -urgical I , to allow them to have better vision now as well as more options in the future. Additionally, he highlighted the benefits of the -MI E procedure in these cases because it leaves more of the surface of the cornea untouched. Any time you do a refractive procedure, it does make calculations more difficult for enhancement/lenses in the future, Dr. Rebenitsch added. But he noted that you can still do a A-I yap over -MI E rather than doing PRK or lifting an old A-I yap to enhance. Dr. Rebenitsch also mentioned how a discussion on presbyopia plays into patient counseling. “From a refractive standpoint, it’s important to make patients happy now, but you also have to look at what’s This article originally appeared in the April 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. best for them in the future,” he said. or eÝample, for someone who is +3 and in their early 40s, Dr. Rebenitsch would not choose to do A-I . Dr. Lee said he never uses a trifocal or multifocal IO in someone who has had corneal refractive surgery and he takes that into consideration if a patient has a cataract or has significant presbyopia. ºIn those situations, I mention that lasering the cornea now makes IO power selection more difficult and may limit IO options in the future,» he said. ºIf it merits more than ust a passing mention, that is an indication that refractive lens eÝchange may be the better surgical option.” A patient’s age may also play into this discussion. If someone has a clear lens and is in their 20s or 30s, Dr. Lee said he does not usually address future IO issues, especially given the availability of the Light Adustable ens ( A , RÝ-ight). ºI am confident that in the future, adustability will eÝtend to presbyopia-correcting IO s as well,” he said. However, he noted that he recommends a preoperative monovision trial for laser vision correction candidates who have symptomatic presbyopia and who have not tried it. ºIf they do not like monovision, they might
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