EyeWorld India December 2017 Issue

residual astigmatism. It also deter- mines the amount of rotation nec- essary and calculates the expected residual refraction. He explained that rotating an IOL within the first few months after surgery is relatively easy, as IOLs do not tend to fixate right away. He occasionally needs to free up IOL haptics, depending on the IOL type. “You will never have to rotate the Trulign lens [Bausch + Lomb, Bridgewater, New Jersey] because it has phenomenal rotational stability. To rotate, we use balanced salt solution to inflate the bag and sometimes simply a cannula to move the lens into place. Sometimes it is that easy, but we have to be careful about the zonules so we don’t stretch them too much,” he said. “PRK and LASIK are most ef- fective for smaller errors, while IOL exchanges should only be considered for larger errors, to jus- tify the risk of reoperating. Most- ly, however, I recommend not waiting for patients to bring up the topic. Find out what’s wrong before patients come to you,” Dr. Hovanesian. “Using a software application like MDbackline, you can reach out to all post-surgical patients, but especially the un- happy ones, and get their feed- back. Every patient in our office who undergoes cataract surgery is contacted by email a month after surgery with a questionnaire that explores their surgical outcome and rate of satisfaction. Fortu- nately, most patients are happy, and for those who aren’t we want to know about it and do what it takes to get their refractive error improved. This software allows you to survey your patients, find out if they are unhappy, and ad- dress the problem. Only through feedback and being proactive will you get patients to that state of bliss where they are going to be telling their friends about your practice and the great toric lens they got.” Dr. Hovanesian thinks that patient feedback is crucial, as surgeons may not be aware of patient dissatisfaction. “It is hard to refine results without knowing what the results are. Our goals as surgeons include excellent visual acuity, patient satisfaction, and the reduction or elimination of astigmatic error, which are all se- verely impacted by residual error that needs to be promptly reduced or eliminated,” he said. EWAP Reference 1. Hovanesian J. Satisfaction and spectacle independence with accommodating IOLs versus multifocal IOLs 2 years after surgery. First presented at the 2016 ASCRS•ASOA Symposium & Congress. Editors’ note: Dr. Hovanesian is founder of MDbackline. Contact information Hovanesian: drhovanesian@ harvardeye.com 58 EWAP CATARACT/IOL December 2017 Cornea 2020 Ad Toric IOLs – from page 57