Eyeworld

DECEMBER 2019 | EYEWORLD | 37 R Contact information Chang: dchang@empireeyeandlaser.com Donnenfeld: ericdonnenfeld@gmail.com Maloney: info@maloneyshamie.com Solomon: Kerry.solomon@carolinaeyecare. com Thompson: vance.thompson@ vancethompsonvision.com Vukich: javukich@gmail.com Waring: georgewaringiv@gmail.com Wiley: drwiley@clevelandeye- clinic.com than I do laser vision correction because as long as the spherical equivalent is close to plano, a limbal relaxing incision is very simple proce- dure to perform and well-tolerated by patients. Once I get up to over a diopter of cylinder, I'll go to laser vision correction for astigmatism. For spherical equivalent problems, then you do an IOL exchange, piggyback lens, or you can do an excimer laser photoablation. I feel I'm best with a laser vision correction. I do LASIK on these patients very commonly unless I see loose epithelium. In general, I aim to do laser vision correction for residual myopic spherical equivalent, but when I have a hyperopic residual refractive error, I will go to an IOL exchange or a piggyback lens, because I feel that a hyperopic correction requires a larger flap and is not as forgiving as a myopic treatment. Dr. Thompson: We have been investigators in the Light Adjustable Lens clinical trial and have been doing it commercially for 6 months. It is amazing how precision monovision through adjusting the optic at 3 weeks postop is so pow- erful…and the patients love it. I do believe we will see growth in monovision because of light adjustable implant technology. In general I have found it more appealing to patients to have their optic adusted post- operatively versus their cornea, though both have a place in premium cataract surgery. Dr. Vukich: One thing that we've incorporated into our practice is emphasizing that the first refractive surface— the tear film—isn't the culprit. You can have a small refractive error, but often it's the quality of vision that is affected by the ocular health and the tear film. Dr. Vukich: How do you enhance your pa- tients' vision when they have a refractive error that is close but not exactly what they need for optimal vision? What methods do you use and how do you approach them? Dr. Chang: The first thing I do is to make sure that the enhancement will help. If it's not obvi- ous that correcting the small refractive error will make the patient happy, I'll first have them try out the prescription in glasses or contact lenses to see if they like the improvement. If I'm pretty sure that the correction of their residual refractive error will make them happy, then I offer them laser vision correction with PRK. I like to take my time and wait for stability—ide- ally at least 3 months unless there is a significant refractive error. If the patient is very unhappy I offer it to them earlier. Either way, I make it clear that I am happy to continue working with them until they are happy. In general, none of us enjoy doing enhancements, but I make it a point to the patient that I am on their side and am willing to do whatever it (reasonably) takes to get them the great outcome they deserve. Dr. Donnenfeld Performing enhancements is vital. I do many more limbal relaxing incisions Premium Cataract Surgery: Relevant financial interests Chang: None Donnenfeld: Alcon, Johnson & Johnson Vision Maloney: Johnson & Johnson Vision Solomon: Alcon, Allergan, Bausch + Lomb, Johnson & Johnson Vision, Carl Zeiss Meditec Thompson: Alcon, Bausch + Lomb, Johnson & Johnson, RxSight Vukich: Johnson & Johnson Vision, Carl Zeiss Meditec Waring: None Wiley: None continued on page 39 George Waring IV, MD

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