FEATURE 12 EWAP JUNE 2022 by Liz Hillman Editorial Co-Director An algorithm for ‘Getting to Happy’ after cataract surgery A patient comes in for a postop visit unhappy with their vision after they’ve received a presbyopia-correcting IOL—now what? Tal Raviv, MD, said that his practice is doing more presbyopia-correcting IOL surgeries than ever before with the latest generation of lenses. While many patients are pleased with their outcomes postop, not every patient is thrilled. “We needed a way for all of our doctors to be able to compassionately and effectively treat any patient who needed extra care,” Dr. Raviv said. So he created an algorithm— the Raviv º etting to appy» Post-IO Algorithmpto help Contact information Koch: dkoch@bcm.edu Raviv: talraviv@eyecenterofny.com Williamson: blakewilliamson@weceye.com 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. guide physicians through the process of managing a patient who is unhappy with their presbyopia-correcting IOL. “I would estimate about 10% of premium IOL patients have some issue, with about three quarters of those able to be resolved medically or by choosing another IOL in the fellow eye and the rest needing some form of enhancement, such as PR É A-I or IO exchange,” Dr. Raviv said. He added that he tells presbyopia-correcting IOL patients that about 3–4% will need an enhancement. “I see a number of unhappy post-refractive patients who are coming in for a second opinion following surgery elsewhere.” Dr. Raviv’s algorithm starts at the postop visit with a well-centered IOL in the bag. From there, refract the patient and follow the paths based on the outcome of the refraction and subsequent testing. In general, Dr. Raviv said it’s critical to teach patients interested in presbyopia- correcting IOLs preop that “even with the most exacting surgery and latest generation of customized IOLs, there is a small likelihood of needing an enhancement procedure.” “There are some patients who tell us preoperatively that they don’t ever want a second surgery, and in those we rule out a multifocal IOL,” Dr. Raviv continued. “Our profession still The Raviv “Getting to Happy” Post-IOL Algorithm. Source: Tal Raviv, MD
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