Eyeworld

T he most frequent cause of patient dissatisfaction following any refractive IOL procedure is residual refractive error. This is especially true with diffractive multifocal IOLs, which are much less forgiving than monofocal IOLs of residual refractive error. However, many cataract surgeons are unable to perform keratorefractive enhancement on their own premium IOL patients and thus may not have a viable strategy for addressing residual refractive error. Frequent enough failure to attain emmetropia undermines the surgeon's confidence and ability to recommend presbyopia-correcting IOLs for certain patients (e.g., astigmatism, atypical axial length). Several factors potentially inhibit cataract surgeons from referring their patients to colleagues for keratorefractive laser enhancement. One is the inability to control or specify cost. Another is the potential perception by patients that something went wrong if they must be transferred to the care of another surgeon. However, imagine keratorefractive surgeons trying to perform LASIK without the option or ability to enhance the initial result. For all of the aforementioned considerations, is it worthwhile for cataract surgeons to learn to perform keratorefractive laser enhancement for their pseudophakic patients? This month's cover focus explores this question. Scott M. MacRae, MD, Steven C. Schallhorn, MD, and John Berdahl, MD, discuss how much residual refractive error is acceptable for premium refractive IOL patients. Richard L. Lindstrom, MD, Sonia H. Yoo, MD, John A. Vukich, MD, and Joel Gaslin discuss ways that cataract surgeons might access an excimer laser for occasional refractive enhancement procedures. Uday Devgan, MD, Richard S. Hoffman, MD, and Karl G. Stonecipher, MD, explore whether it is realistic for cataract surgeons to learn a keratorefractive procedure, such as PRK. Richard Tipperman, MD, William Trattler, MD, and Kevin Waltz, MD, offer their pearls for counseling premium IOL patients about the potential need for a refractive enhancement. The growth of presbyopia-correcting IOL use with cataract surgery is stagnant, remaining at approximately 7% to 8% for the past 5 years in the U.S. Pseudophakic monovision remains popular. In either case, hitting the refractive target is the key to patient satisfaction, and that should mean employing enhancement procedures when needed. If you or someone in your practice does not perform keratorefractive surgery, then contemplate adding PRK to your armamentarium or establish a relationship with someone in your community who does. We hope this issue inspires you to consider these options. David F. Chang, MD, chief medical editor World view Enhancing your refractive cataract practice David F. Chang, MD, chief medical editor Publisher Donald R. Long don@eyeworld.org Editorial Editor Erin L. Boyle erin@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Staff Writer Lauren Lipuma lauren@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury Susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Enette Ngoei Dublin Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. 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The ideas and opinions expressed in EYEWORLDdo not necessarily reflect those of the editors, publisher, or its advertisers. P U B L I S H I N G   S T A F F July 2014 Volume 19 • No. 7 A S C R S The official publication of the American Society of Cataract & Refractive Surgery Keep up on the latest in ophthalmology! Follow EyeWorld on Twitter at twitter.com/EWNews EyeWorld @EWNews 2-11 O&C_EW July 2014-DL_Layout 1 6/30/14 8:33 AM Page 8

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