EyeWorld India March 2021 Issue

NEWS & OPINION 54 EWAP MAR C H 2021 result in a refractive surprise. In this situation, give the patient hope. These errors are usually rectified by a simple additional surgery, Dr. Parker said. Dr. Osher discussed this situation in his interview with EyeWorld . He explains to the patient that IOLs “are made in steps, for example, +21, +22, and +23. You may need a +22.6 for perfect vision, which isn’t made. Therefore, we err up or down to the nearest available lens, which may leave a touch of nearsightedness, farsightedness, or astigmatism,” he said. In addition, Dr. Osher explains to patients that everyone heals differently and how this can influence the outcome. “I always tell the patient that he or she may need a thin pair of glasses after surgery. It’s better to under promise and over deliver,” he said. “I will finish by saying something reassuring … always try to end on a high note,” he said, such as, “I’m confident that you will be seeing much better after your surgery.” “I always try to show each patient that I sincerely care and that I plan on doing my best,” Dr. Osher added. Unhappy patient Even if the surgery went perfectly and the outcome, by quantifiable measurements, was a success, patients can still be unhappy with the result. Dr. Osher reiterated the importance of giving the patient time, reassurance, and an honest explanation. He likes to compare unaided vision in the operated eye to the other; if that isn’t impressive enough, he shows the patient the preoperative and postoperative lines on the Snellen vision chart for their comparison. Leaving a patient without a lens Dr. Parker thinks this is an important conversation to prepare for, especially for those early in their career. When the capsular bag is compromised, surgeons have three options: put the lens in the bag with a sometimes technically complicated fixation technique; use an AC IOL, which he said can have problems later; or leave the patient without a lens. “Most surgeons don’t want to have to explain to the patient why they didn’t put a lens in … and instead put the worst lens in the worst location, and it ends up causing problems for the patient down the line,” Dr. Parker said. Instead, he advised preparing for this type of conversation ahead of time so the patient can be referred to a doctor more experienced in performing the fixation techniques for IOLs in these situations. The number one mistake Dr. Osher thinks doctors make when there is a complication is that they distance themselves from the patient. “It should be the exact opposite,” Dr. Osher said. It is the complicated patient who should receive personal calls to see how they’re doing, the one who should be offered genuine concern and reassurance. “This is the patient you want to shower with attention. … The patient knows I really care. That goes a long way,” he said. Some of these conversations can also be made easier if the preoperative discussion is handled differently. “For example, if patients who have undergone previous refractive surgery are told ahead of time that they will probably need a thin pair of glasses following surgery, it becomes an expectation and not a complication,” Dr. Osher said. EWAP Editors’ note: Dr. Osher is Professor of Ophthalmology, University of Cincinnati, and Medical Director Emeritus, Cincinnati Eye Institute, Cincinnati, Ohio. Dr. Parker practices at Parker Cornea, Birmingham, Alabama. Neither declared any relevant financial interests.