Eyeworld

66 | EYEWORLD | APRIL 2022 ATARACT C The Raviv "Getting to Happy" Post-IOL Algorithm Source: Tal Raviv, MD by Liz Hillman Editorial Co-Director About the physicians Douglas Koch, MD Department of Ophthalmology Cullen Eye Institute Baylor College of Medicine Houston, Texas Tal Raviv, MD Eye Center of New York New York, New York Blake Williamson, MD Williamson Eye Baton Rouge, Louisiana Dr. Raviv said. He added that he tells presby- opia-correcting IOL patients that about 3–4% will need an enhancement. "I see a number of unhappy post-refractive patients who are com- ing 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-correct- ing IOLs preop that "even with the most exact- ing surgery and latest generation of customized IOLs, there is a small likelihood of needing an enhancement procedure." "There are some patients who tell us pre- operatively that they don't ever want a second surgery, and in those we rule out a multifocal IOL," Dr. Raviv continued. "Our profession still can't get to 100% within ±0.25 D with any presbyopic IOL solution, so enhancements are critical." A patient comes in for a postop visit un- happy 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 "Getting to Happy" Post-IOL Algorithm—to help guide physicians through the process of manag- ing a patient who is unhappy with their presby- opia-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 enhance- ment, such as PRK/LASIK or IOL exchange," An algorithm for 'Getting to Happy' after cataract surgery

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