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APRIL 2023 | EYEWORLD | 57
the original incision, and it's like magic." Dr.
Miller called this issue a "diagnosis of exclu-
sion," adding that "you have to make sure noth-
ing else is going on."
When dealing with irregular astigmatism,
Dr. Miller said it's possible that there may be
more irregularity to the cornea than previous-
ly known. You hope you pick this up ahead of
time, he said, but it's hard to predict the effect
corneal irregularity will have on someone's
vision. "The 800-pound gorilla in the room is
the cataract," he said, adding that when you
take the cataract out this could also impact the
astigmatism, regular and irregular.
In terms of when he addresses some of
these issues after cataract surgery, Dr. Tipper-
man said for refractive errors, he tells patients
to wait for the prescription to be stable (around
12 weeks). If the patient is complaining that
their eye is uncomfortable, irritated, or doesn't
feel right, Dr. Tipperman will do a normal stair-
case approach to dry eye.
People don't realize that cataract surgery
is surgery, he said, adding that it's important to
stress to patients that they're still going through
a healing phase following the procedure. "I
think the most important thing is to maintain a
good therapeutic relationship with the patient
so that they know that you think their prob-
lems are important," he said. "If they know that
you're going to stick with them and do every-
thing you can to make them comfortable, it
gives you a lot of mileage and time for most of
this to get better."
In terms of new technologies to help with
some of these issues, Dr. Tipperman said the
biggest improvement has been to IOL power
formulas. It's impressive how much better the
newer formulas are than some of the older
ones, he said, adding that this is an important
message because some physicians are still using
the older formulas in their practices.
