Eyeworld

54 | EYEWORLD | APRIL 2023 ATARACT C by Ellen Stodola Editorial Co-Director About the physicians Kevin M. Miller, MD Kolokotrones Chair in Ophthalmology David Geffen School of Medicine at UCLA Los Angeles, California Richard Tipperman, MD Attending Surgeon Wills Eye Hospital Philadelphia, Pennsylvania E ven with a successful cataract surgery, there are a variety of issues that can pop up postoperatively that can be prob- lematic for patients, warranting further follow-up from the physician. Kevin M. Miller, MD, and Richard Tipperman, MD, discussed some of the most common issues that they see following cataract surgery and how to address them. "While we may consider them minor nui- sances, the patient's perception is 'What went wrong with my surgery?'" Dr. Tipperman said. "Surgeons should realize that the first thing they need to do is reassure and explain to the patient what's going on and what we'll do or not do about it." On a busy day, when you're seeing a lot of patients and one of them tells you that their eye feels scratchy or they're only 20/25 instead of 20/20, surgeons might discount everything as fine, while from the patient's perspective, some- thing went wrong with the surgery. Of the issues that can come up postop, Dr. Tipperman said one of the most common he sees is corneal neuralgia and general complaints that "the eye doesn't feel normal." That could mean it feels big, small, uncomfortable, etc. After cataract surgery, the eye is irritated, and patients worry that there's something wrong, even though for other surgeries, it's normal to have swelling and postop effects. Dr. Tipperman said that cataract surgeons recognize dry eye and the difference it can make. "I think 100% of patients get surface irritation that's related to the betadine prep on the eye before surgery," he said. "I tell them that this helps reduce risk of infection, but it also irritates goblet cells and the surface of the eye." This short discussion helps calm the patient's worries, he said. Dr. Miller said another common source of dissatisfaction is small refractive errors. It's not possible for surgeons to guarantee 20/20, but it's important to tell patients you'll do every- thing in your power to get the best result. "We can't control where a lens will sit inside the eye; we can't determine exactly how incisions will heal. But patients will wonder what went 'wrong' if their vision doesn't turn out perfectly," he said. If there's a small refractive error, the op- tions for fixing it include glasses, contact lenses, and additional surgery. The additional surgery in Dr. Miller's practice, in the cataract age range, is usually PRK, although sometimes he performs LASIK. "Less commonly, but for larger refractive errors, one might consider a lens exchange or a piggyback lens," he said. When addressing small refractive errors, timing is also a big factor. For example, he said that you don't want to do PRK too soon because you want there to be refractive stability. He sug- gested waiting 3–6 months after surgery. But by that time, another problem is often kicking in, which is that the capsule starts wrinkling. Now you have a dilemma, Dr. Miller said, of how much of the problem is refractive error and how much is the capsule. He will often wait to do a refractive touch- up until he's opened the capsule. There are different challenges and expectations depend- ing on which lens the patient had implanted. "When you implant a multifocal lens, you can be pretty sure the patient does not want to wear glasses," he said. "Their expectations and the bar you have to exceed are higher." Monofo- cal patients have often resigned themselves to wearing reading or computer glasses. "With a multifocal, it's a little harder sell to put them Potential issues after cataract surgery Subtle, prolonged corneal edema after cataract surgery can be a source of patient dissatisfaction. Source: Kevin M. Miller, MD

• Blank Page
• Blank Page (1)