Clinical pearls for TECNIS SynergyTM: Patient selection and preoperative counselling The experts noted that most patients adapt well with mild and non-disruptive glare and halos following TECNIS SynergyTM implantation. However, surgeons may encounter a patient who reports less than perfect distance vision and experiences glare and halos. Therefore, Dr Fam believed that good preoperative informed consent and managing patient expectations are crucial. Dr Rojanapongpun advocated patient counselling on their visual goals i.e., perfect clarity versus spectacle independence and prioritization of visual tasks i.e., high contrast versus high comfort. “Patients should be allowed time to discuss with their family and make clear decisions based on their visual task priority,” said Dr Rojanapongpun. Surgeons should understand patients’ expectations and different visual requirements depending on their lifestyle and work.3 According to Dr Rojanapongpun, patient satisfaction equals outcome minus expectations. “To achieve high patient satisfaction and ensure positive postoperative outcomes, assessment of ocular pathology of the cornea, macula and optic nerve head is important,” added Dr Rojanapongpun. He explained that an evaluation of whether the surgery can offer valuable changes to the patient is the key – “if the cataract is too mild, I would recommend my patient to defer the surgery.” A detailed preoperative ocular evaluation can help patients achieve positive outcomes as successful presbyopia-corrections are often based on eye health.3 To achieve best refractive outcomes, surgeons should minimize postoperative residual astigmatic error to ≤0.75 D and consider posterior corneal astigmatism (PCA) as well as surgically induced astigmatism (SIA) in surgical planning.14 Ocular surface conditions such as dry eye disease should also be managed as part of the preoperative assessment. Surgeons should also ensure that patients are aware of the tradeoffs associated with various IOLs. It is important to educate patients on the “give and take” of IOL implantation and that there is always a compromise between multifocality and spectacle independence. Copyright 2022 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. All other trademarks are the intellectual property of their respective owners. © Johnson & Johnson Surgical Vision, Inc. 2022 PP2022CT4024 Figure 3. Stepwise approach of preoperative assessment Supported by Step 1 Examine the ocular surface Treat tear film or ocular surface disorders. Step 2 Consider residual refractive error Aim for minimal residual refractive error. Select the lens option closest to plano, and if the first plus and first minus lens are equidistant, then select the first plus lens option (i.e., slight hyperopia). Step 3 Assess capsule and retina Rule out tilted lens position, zonular loss, poor capsular clarity and retina pathology. Step 4 Manage patient expectations Counsel patients on postoperative expectations. Avoid aggressive recommendation of TECNIS SynergyTM to patients who are poor adaptors and those with type A personality.
RkJQdWJsaXNoZXIy Njk2NTg0