REFRACTIVE EWAP SEPTEMBER 2023 25 Contact information Ling: josephjling@gmail.com Loden: lodenmd@icloud.com When performing one of the many refractive procedures available today, the surgical experience doesn’t end when the surgery is over. Surgeons often have to follow up with patients, helping them through the postop experience, and sometimes providing touch-ups. Two physicians discussed how they handle the refractive postop experience, how to manage patient expectations, and diagnostic tools that help them. The postop experience begins right at the end of the surgery, said James Loden, MD. The doctor should be communicating with the patient that the procedure went well, if it did. If it didn’t, you need to share that as well, he said. “Part of setting the preliminary postop experience is by saying ‘You did Making Practice Perfect – The refractive postop experience by Ellen Stodola Editorial Co - Director great’ or ‘We did have a little complication, but we fixed it,’ or in those rare cases, ‘We broke a capsule and we’re going to have to do a second surgery.’” Being very communicative is key, he said. The second step is providing instructions before the patient leaves the surgery center, Dr. Loden said. It’s important to give clear and concise instructions of expectations and what the patient will experience over the next 2–3 hours and what they experience the next morning when coming in for the day 1 visit. The postop visit depends on the procedure, and Dr. Loden said he won’t always see each patient immediately after surgery, though he does prefer the chance to see the patient and set expectations. He added that it’s also important to identify if the patient may be harder to satisfy. In those cases, you can have them see the operating surgeon and set the expectations and timelines to get the patient happier quicker. With LASIK, he said that almost every patient is 20/20 on the day 1 postop exam, but it’s still important to set expectations for the next week. There could be a little glare or halo, but those will usually go away. Joseph Ling, MD, said he likes to see most patients 1 day after a refractive procedure because there are many things that can occur over the day after surgery. For LASIK specifically, he said it’s important to ensure that the flap isn’t mispositioned, and for LASIK, PRK, and SMILE, he said you want to make sure that the interface is clear. DLK can occur in the first 24 hours when there’s a lot of inflammation, he said. These are things that can easily be treated early on, but if you don’t see patients at 1 day out, these can get worse. For ICLs, he said it’s important to make sure the pressure looks good the day after surgery. It’s an intraocular surgery, so he’s concerned about inflammation, TASS, and infection, he said, adding that these are things the surgeon would want to catch early. “The sooner you see it, the sooner you can treat it, and the better the outcome,” he said. Most of these patients are quite functional the next day, Dr. Ling said, so it’s also a good This article originally appeared under the title “The refractive postop experience” in the July 2023 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. With proper expectation setting and handling of surprises in a confident and methodical manner, the patient and surgeon can benefit greatly from modern vision correction. Source: Joseph Ling, MD
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