EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1540963
WINTER 2025 | EYEWORLD | 51 R is leftover correction, we do a fine tune at 3 months postop. If there is dry eye blur, we need to treat that, or if there is capsule haze causing blur, we need to do a YAG laser capsulotomy. If vitreous floaters are scattering light and degrad- ing image quality, we need to take care of that," he said. Dr. Donnenfeld also brings the patient back through some of the drawbacks of the presby- opia-correcting IOLs that were discussed pre- operatively, reminding them that what "they're going to gain in quantity of vision is going to offset the loss of quality." Dr. Thompson reminds his patients that the process of neuroadaptation (the brain's role) in the postop period can take 4–6 months. "I remind them we are embarking on a 1-year journey together, and at the end of that journey, they will have some of the world's most sophis- ticated optics in their eyes. The patient joy can be so wonderful with these proper expecta- tions," he said. Step 2: Treat, if needed If the cause of dissatisfaction was identified in the clinic, it's time to address it when possible. But first, Dr. Berdahl reiterated, these patients aren't just frustrated—they're often scared. "Acknowledging that fear and giving them a roadmap forward can be just as important as any therapy," he said. Dr. Thompson said if a quality manifest refraction is crisp, there is not much that can be done to improve the patient's experience other than wait for healing, stability, and do an enhancement if there is residual refractive error. If the manifest refraction is not crisp, "we need to bring our A-game," Dr. Thompson said. "Tear film testing and treating dry eye helps image quality so much. I explain the air/tear interface and its power to focus light 2–4 times stronger than the actual implant we are putting in and that happy vision requires a happy tear film and implant," he said. Dr. Berdahl said that if dry eye is the issue, he emphasizes that this is chronic and fluctu- ating. He begins with punctal plugs, pharma- cologic therapies, and often an eyelid thermal continued on page 52 A decentered multifocal IOL due to angle kappa The same IOL as above following an argon laser pupilloplasty Source (all): Eric Donnenfeld, MD