Eyeworld

DECEMBER 2020 | EYEWORLD | 83 R by Liz Hillman Editorial Co-Director If not, then lens exchange or LASIK/PRK touch- up could be needed. "The surgery to use will depend on multiple factors, such as the time since surgery; the IOL type and the patient's satisfaction with it; the patient's preferred time frame for resolution; and intraoperative observations such as zonu- lopathy during phaco," Dr. Lee said. Dr. Wiley said if he's going to do LASIK or PRK, he will perform a YAG capsulotomy first. He explained that if the patient were to get a refractive procedure and later develop PCO that required a YAG, the refractive prescription could change. Though he prefers to get the refrac- tion to its most final point before treating, he cautioned that a YAG shouldn't be taken lightly. If a patient has a multifocal lens and they're not happy with the quality of vision due to the multifocality, you might want to avoid a YAG W hether astigmatic correction was targeted in cataract surgery or not, there is always a risk for residual astigmatism postop. When to address this astigma- tism—and how—depends on several factors, including patient perception, healing time, trust in measurements, and more. John Berdahl, MD, Bryan Lee, MD, JD, Deborah Ristvedt, DO, Russell Swan, MD, and William Wiley, MD, continued their discussion with EyeWorld to round out the topic of astig- matism management in cataract surgery (see page 74). The first thing to do when assessing for residual astigmatism is to make sure the cornea is well healed, which the doctors said is about 3–4 weeks postop. After that, you need to take the patient's personality into account, Dr. Wiley said. "Some patients come in with a diopter of astigmatism with the rule but they're ecstatic … maybe in their eye the astigmatism is helping them," he said. "If the patient is happy, I don't care what the residual astigmatism is. I don't want to fix what's not broken." To Dr. Wiley, ophthalmologists should get used to thinking about it as "managing astigma- tism" rather than "eliminating astigmatism." If a postop patient comes in and is symp- tomatic with residual astigmatism, it's some- thing that needs to be addressed. "I tell patients there are three options: We can treat it surgically, we can treat it with glass- es, or we can treat it with contact lenses," Dr. Wiley said, noting that some patients are happy to have it treated with the latter two options. Those with their heart set on spectacle and contact lens independence have a few surgical options. Many of the doctors interviewed said they would use astigmatismfix.com, if they used a toric lens, to determine if the residual astig- matism could be corrected with a lens rotation. Residual astigmatism: What to do about it continued on page 84 About the doctors John Berdahl, MD Vance Thompson Vision Sioux Falls, South Dakota Bryan Lee, MD, JD Altos Eye Physicians Los Altos, California Deborah Ristvedt, DO Vance Thompson Vision Alexandria, Minnesota Russell Swan, MD Vance Thompson Vision Bozeman, Montana William Wiley, MD Cleveland Eye Clinic Division of Midwest Vision Partners Relevant disclosures Berdahl: Alcon, Bausch + Lomb, Johnson & Johnson Vision, RxSight Lee: Carl Zeiss Meditec Ristvedt: None Swan: None Wiley: Alcon, Johnson & Johnson Vision, RxSight, Carl Zeiss Meditec "Some patients come in with a diopter of astigmatism with the rule but they're ecstatic … maybe in their eye the astigmatism is helping them. If the patient is happy, I don't care what the residual astigmatism is. I don't want to fix what's not broken." —William Wiley, MD

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