Eyeworld

52 | EYEWORLD | SEPTEMBER 2022 Contact Hatch: Kathryn_Hatch@ meei.harvard.edu Parkhurst: gparkhurst@ parkhurstnuvision.com R EFRACTIVE "We're so knowledgeable about residual stromal bed and respecting the amount of tissue we're removing, obtaining genetic testing when available, as well as discussing habits such as eye rubbing," she said. She also said that she incorporates epitheli- al thickness mapping into her preop evaluation, helping her recognize early signs of abnormal- ities or pre-keratoconic eyes. Genetic testing can be helpful in ruling out patients who might otherwise be at risk for ectasia. Dr. Hatch said that educating patients about the detriment of eye rubbing is generally under emphasized. "When I see patients who have ectasia, the vast majority of them are eye rubbers or they're sleeping with their face in the pillow. It's one of the first questions I ask people with ectasia. It's a surprisingly common link," she said. Dr. Parkhurst also said that long-term com- plications from corneal laser vision correction done in good candidates are rare. The benefit of doing an annual exam in these patients is not so much to monitor for post-refractive ectasia but to ensure the long-term satisfaction with their procedure. He said most patients get corneal refractive surgery before becoming presbyopic. After the onset of presbyopia a decade or so later, they sometimes think the LASIK has "worn off." "Part of the utility of the annual exam is to reeducate the patient about the difference between myopia and presbyopia and offer solu- tions to that when it presents instead of trying to reeducate the patient that it's not their LASIK wearing off," Dr. Parkhurst said. Phakic IOLs and RLE For intraocular procedures like refractive lens exchange (RLE) and ICL surgery, Dr. Parkhurst and Dr. Hatch said that the postop period is similar to that of cataract surgery, with some differences. Dr. Parkhurst said the surgeon is looking at centration of the ICLs and making sure ev- erything is healing as expected. Visual acuity, IOP, the incision, and anterior chamber are all assessed. Within the first week, the surgeon is on the lookout for infection and aggressive inflammation as well. For phakic IOLs, the vault (space between the ICL and the crystalline lens) is assessed. "The vault that you observe postoperatively is dependent on the size of the phakic IOL cho- sen. We pick ICLs relative to the power the pa- tient needs to correct their vision; … the thing that is a little more nuanced is picking the size of the ICL that's needed to fit in the space in the front part of the eye. The ICL comes in four different sizes, and the vault will be dependent continued from page 51 The first arrow shows the vault of the EVO Visian ICL over the crystalline lens. The second arrow shows the central port of the EVO Visian ICL. EVO Visian ICL vault of approximately 100% of central corneal thickness Source (all): Roberto Saenz, OD

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