JUL 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/146899

Contents of this Issue


Page 47 of 66

February 2011 July 2013 Cataract challenges The post-cataract refraction Slit lamp view of post-RK eye plain monofocal aspheric lens. I've been surprised with the results obtained and with the range of vision possible due to the spherical equivalent." Dr. Masket avoids toric lenses in some post-RK patients "for fear they may someday need a corneal transplant" and because it's rare to have regular astigmatism in these eyes. In general, he advises adding "about a half diopter" of measured Source (all): Uday Devgan, MD IOL power for a patient with four incisions, between 1-1.5 D for those with eight incisions, and 2 D for those with 12 or more incisions. While intraoperative aberrometry may be very useful in eyes having prior laser vision correction, it is less accurate in the post-RK eye, as corneal curvature changes during cataract surgery in these eyes, he added. The key to judging the postop refraction in a post-cataract, post-RK eye "is to follow the keratometry values," said Uday Devgan, MD, in private practice, Los Angeles, and chief of ophthalmology, Olive View – UCLA Medical Center. "The RK incisions tend to swell even during the gentlest of phaco surgeries and this causes transient central flattening of the cornea." He advises measuring the preop Ks using an auto-keratometer and waiting until the eye returns to those K values before determining what the final refractive outcome of the cataract surgery is. No one can predict how long it will take the post-RK patient to return to pre-surgical curvature, Dr. Masket said, and the number of incisions, incision depth, central corneal zone size, and surgical details all factor into that timing. "They're going to have an induced transient hyperopic error, and patients need to be very tolerant of this," he said. Dr. Bowers tells patients it takes about two months for the refraction to stabilize, but "most patients will stabilize sooner than this." Patients with four incisions tend to stabilize closer to four weeks, while those with eight or more take a full 2-3 months, she said. EW FEATURE 45 "If they experienced visual fluctuations preop, they'll still experience them postop," she said. If after three months there's still a significant refractive surprise, options include PRK, LASIK, piggyback IOLs, or IOL exchange. EW Editors' note: Dr. Bowers has no financial interests related to this article. Dr. Devgan has financial interests with Aaren Scientific (Ontario, Calif.), Alcon (Fort Worth, Texas), Bausch + Lomb (Rochester, N.Y.), Gerson Lehrman Group (New York), Accutome (Malvern, Pa.), and LensGen (Irvine, Calif.). Dr. Masket has financial interests with Alcon, Bausch + Lomb (Rochester, N.Y.), Haag-Streit (Koniz, Switzerland), Ocular Therapeutics (Bedford, Mass.), PowerVision (Belmont, Calif.), and Carl Zeiss Meditec (Jena, Germany). Dr. Schechter has financial interests with Bausch + Lomb and Omeros (Seattle). Contact information Bowers: 270-415-0245, barbbowersmd@comcast.net Devgan: 800-337-1969, devgan@gmail.com Masket: 310-229-1220, sammasket@aol.com Schechter: 561-737-5500, bdsch77@aol.com Poll size: 335 EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send a 4-6 question online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the current 1,000+ physicians who take a minute a month to share their views, please send us an email and we will add your name. Email daniela@eyeworld.org and put EW Pulse in the subject line—that's all it takes. Copyright EyeWorld 2013

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - JUL 2013