AUG 2013

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

Issue link: https://digital.eyeworld.org/i/153099

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Page 35 of 66

August 2013 Diagnostic technologies for February 2011 cataract surgery enhancement rate. This paradox also explains why cataract surgeons are so concerned by a relatively small enhancement rate with toric IOLs. They are used to an almost zero enhancement rate with routine monofocal IOLs," he said. Investing in more sophisticated technology will decrease the enhancement rates after toric IOL placement and result in a net decrease in costs and an improvement in surgeon and patient satisfaction, he said. Post-refractive surgery patients Everyone agreed that getting a true refraction in a post-refractive surgery patient is a bit trickier than in a virgin eye, but the amount of preop tests doesn't differ. "The biggest challenge in these eyes is getting the correct IOL power," Dr. Yoo said. Dr. Trattler opts to use the Haigis-L formula, calling it "very effective" in these eyes to the point that "I don't worry about the preop data. I just use the Haigis-L and have found it consistent in post-RK and post-LASIK eyes." However, he will pay more attention to the optical zone and the centration of the optical zone depending on how far back the patient underwent refractive surgery. Because these are patients who previously paid out of pocket to reduce, if not eliminate, their need for glasses, "expectations are going to be higher when it comes to their cataract removal," Dr. Wallace said. As Dr. Waltz noted, it's not the quality of the preop testing that changes in post-refractive patients, "it's the discussion. We need to prepare this patient group and educate them about the difficulty in choosing an IOL and the potential for enhancement surgery." Dr. Wallace does not treat 0.75 D or less of against-the-rule corneal astigmatism "because the incision is going to have some effect. We'll talk to the patient about it, but counsel against addressing it. If the astigmatism is oblique or with the rule, we are going to be a little more aggressive in treatment." Dr. Horn added posterior corneal astigmatism may play a role in some cases, too, noting cases where removing the cataract alone addressed the astigmatism because it was all in the lens. EW FEATURE Toric lenses add about $400-500 to the cost of the overall package, and the patient has to purchase the lens. "If it's just the astigmatism that needs to be corrected, I prefer toric Dr. Wallace presents both options to patients, noting the LRIs are a less expensive option than a toric lens. lenses to limbal relaxing incisions," Dr. Horn said. "LRIs are subject to healing responses and may interfere with tear film and ocular surface disease issues." 33 continued on page 34 We're Changing The Game with our new Model M4 valve. Model M4 Porous Plate www.ahmedvalve.com 800.832.5327

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