Eyeworld

I N FOCUS 48 | EYEWORLD | AUGUST 2019 CATARACT SURGERY POST-LVC Contact information Miller: kmiller@ucla.edu Rebenitsch: Dr.Luke@ClearSight.com Schallhorn: jschallhorn@gmail.com Walton: drwalton@visiontexas.com by Ellen Stodola EyeWorld Senior Staff Writer/ Meetings Editor topography, or photos of their staining pattern, can help get patient buy-in, which is crucial to successful treatment of dryness. Luke Rebenitsch, MD, said he generally sees patients at 1 day, 1 week, 1 month, and 3 months postop. Having a little SPK at 1 week is normal, he said. He treats conservatively at first with artificial tears. If there is any meibomian gland dysfunction, he may add omega-3s. He also likes to use the AcuTarget HD (Visiometrics) to look at the objective scatter index (OSI). This is mainly to be able to follow ocular surface disease and tear film over time, he said. LVC touch-ups after cataract surgery When determining how long to wait to offer LVC, Dr. Miller said there needs to be refrac- tive stability, and the earliest he would do this is about 3 months after surgery. In the cataract age group, Dr. Miller said he usually chooses PRK because he thinks LASIK causes more dry eye problems. "There's more pain for the patient postoperatively, but I think we dodge the dry eye bullet more often when we do PRK," he said. Julie Schallhorn, MD, said she usually waits 3 months before a touch-up because she wants the refraction to be completely stabilized first. "If there is any hint of PCO forming, I will do a YAG before a touch-up refractive procedure, as PCO can affect your refraction," she said. As the magnitude of refractive error is generally low, either LASIK or PRK would be good op- tions, Dr. Schallhorn said, and the decision be- tween them is based on patient-specific factors. According to Dr. Walton, two conditions must be met before an LVC touch-up. First, the patient must have healed into new, stable, baseline vision, and he prefers to wait until 3 months. Second, the patient must like the projected refractive change, Dr. Walton said. Happiness in a trial frame before LVC indicates both that refractive error is addressing their residual problem and that LVC enhancement of a myopic result will not disappoint them. He noted that it's important patients visually F ollowing a cataract or refractive proce- dure, a patient may still need touch-ups or further procedures to obtain the desired outcome. Surgeons discussed postoperative considerations, when to consider a laser vision correction (LVC) touch-up, new technologies, and when an exchange may be necessary. SPK after bilateral presbyopia IOLs Kevin M. Miller, MD, said he "hand holds" pa- tients during the first week after surgery as long as they don't have any major issues. If patients aren't happy, they might have some superficial punctate keratopathy (SPK), he said, but gen- erally Dr. Miller examines them, talks to them, and tells them it's still early. Usually at 1 week, Dr. Miller will stop antibiotics but keep patients on steroids. If someone is on NSAIDs and it's bad, he might consider taking them off, he said. If SPK is a problem, at 1 week he'll put them back on lubricating eye drops. Patients are usually off artificial tears for the first week be- cause of the increased risk of endophthalmitis, but at 1 week, the risk is very low, he said. Dr. Miller usually sees his patients at 1 day and 2 weeks after surgery. If they're having issues at 2 weeks, he starts doing evaluations. Bennett Walton, MD, said he classifies presbyopic IOL candidates into three categories with respect to dry eye and the ocular surface: good candidates, poor candidates who should not receive a presbyopic IOL, and those who deserve a chance at presbyopic correction but need to know the importance of dryness with their vision. Dr. Walton added that at 1 week postop, patients still fluctuate quite a bit, and if a patient responds well to reassurance and the refractive target has been hit, he may simply show a slit lamp photo of their staining pattern. "I have found photos a valuable tool for patient edu- cation and buy-in," he said. "I also like the HD Analyzer's [Visiometrics] tear film optical analy- sis." In his experience, having objective mea- surements, whether through the HD Analyzer, Optimizing outcomes post-surgery At a glance • When enhancing a patient with previous LASIK, surgeons should be careful lifting the flap, as epithelial ingrowth is possible. • Generally, in the immediate postop period, patients are still adjusting. Many surgeons wait up to 3 months before offering enhancements. • The Light Adjustable Lens is one new technology that may have indications for post-refractive patients in the future, offering the opportunity for adjustments after surgery.

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