Eyeworld

DECEMBER 2021 | EYEWORLD | 53 R Contact Clinch: Thomas.Clinch@edow.com Faktorovich: ella@pacificvision.org Nikpoor: drneda@alohalaser.com Reference 1. Eydelman M, et al. Symptoms and satisfaction of patients in the Patient-Reported Outcomes With Laser In Situ Keratomileusis (PROWL) studies. JAMA Ophthal- mol. 2017;135:13–22. Relevant disclosures Clinch: Alcon Faktorovich: None Nikpoor: None "If they don't understand, it could be up- setting. If they do, they are reassured. If there is a plan of action to maintain a good healing process, that's even better. Some symptoms are a normal part of the postoperative healing. With modern screening, techniques, and technolo- gies, they are unlikely to persist. Be supportive, systematic, caring," she said. Dr. Nikpoor agreed and shared a particu- larly challenging case. She had a patient with severe neuropathic pain after PRK and saw her frequently for several months. "I reiterated at every visit that her pain was real and that I was committed to helping her get through this. She joined a Facebook support group and thanked me for taking her pain seriously. She shared that many members of the group were frustrated by their experience with their surgeons who dismissed them," she said. What do you do? If you do find an unhappy post-LASIK patient in your chair, Dr. Nikpoor said she starts with a data collecting phase where she's trying to fig- ure out what they're happy and unhappy about with their vision. "I repeat back what I hear to make sure I'm understanding them correctly. Then I'll go through the possible solutions for each thing they're unhappy about," she said. "At the end of that conversation I'll ask, 'If you did this again, would you make the same decision?' A lot of times they say, 'Oh, yes.' I try to leave it on that positive note. They'll usually say that in spite of the negatives, it has made their life better. I also want to know for my own sake that they would have chosen the same procedure." The unhappy patient is the one whose calls you should be returning right away, Dr. Faktor- ovich said. After listening to them, she says, "I can totally understand what you're saying" and "I am committed to helping you." Once you've identified what's causing their discontent, spend time explaining what's going on so they understand. Dr. Faktorovich said she doesn't dumb down her explanations; she finds patients understand and appreciate when she takes the time to explain what's going on in technical terms. If a patient's vision is blurry, do a refraction and demo even the smallest prescription in a trial frame. Dr. Faktorovich said this will reassure the patient, even if they don't decide to do a touch-up procedure. Dr. Faktorovich advised involving a signifi- cant other in conversations with the patient, if the patient agrees, and she gives her cell phone number to all patients. Ensuring happy patients Dr. Nikpoor said her practice has a lot of capital equipment for preop testing that she finds helpful in assessing and optimizing the ocular surface. Her practice doesn't require a contact lens holiday before screening, but if at screen- ing there are signs of an abnormality, scans are repeated at their preop appointment. Dr. Nikpoor said they put patients on loteprednol 3 days before their preop appointment because it cleans up the ocular surface for good refractions and topography. If there is any question about epithelial conditions, she'll get an epithelial map. If the topography is suspicious for subclin- ical keratoconus, she'll do PRK. Dr. Nikpoor advised ICLs for patients who are higher myopes, in cases where the stromal bed would be pushed to less than 300 microns, and where there would be more than 40% tis- sue altered with a cornea-based procedure. Preoperatively, Dr. Faktorovich looks for things like slight inferior steepening on the topography that could be a sign of either forme fruste keratoconus or epithelial basement mem- brane dystrophy (EMBD). She performs epithe- lial thickness mapping with widefield OCT to help differentiate between the two conditions. She steers patients with forme fruste keratoco- nus toward a lens-based procedure and patients with EBMD toward PRK. Dr. Faktorovich said she's not afraid of steering patients away from surgery altogeth- er. These patients often have good vision with contact lenses or glasses, and they expect great vision without these aids after. She tells these patients preoperatively about the healing pro- cess and what that could entail as well as the rare complications that could happen. Dr. Faktorovich said to not rush the preop process, tailor it to the patient's specific pre- scriptions and ocular findings, and consider having them come in for several visits. Dr. Nikpoor performs a LASIK procedure. Source: Neda Nikpoor, MD

• Blank Page
• Blank Page (1)