49
EW FEATURE
December 2015 • Patient satisfaction
Contact information
Berdahl:
john.berdahl@vancethompsonvision.com
Macsai: MMacsai@northshore.org
Masket: avcmasket@aol.com
However, before removing the
IOL at that point, Dr. Macsai still
recommends using trial frames so
patients can see what their vision
would be. "Frequently, patients are
not aware of how much near and
intermediate vision they may lose if
the multifocal lens is removed," she
said.
In some cases, training can
help improve neuroadaptation,
Dr. Macsai said. This can include
reading larger prints and working
to smaller prints, increasing illumi-
nation, and having patients focus
less on adaptation and more on how
their eyes are functioning.
Dr. Berdahl will instruct patients
to try and pay less attention to their
eyes. He uses the analogy of wearing
a watch. "You know it and you can
feel it, but if you don't pay atten-
tion to it, it becomes part of your
routine," he said.
He also will use the analogy
of getting used to wearing glasses,
although he points out to patients
that experience is multiplied by 10
because the patient has an entirely
new optical system.
Residual astigmatism
and toric IOLs
Generally speaking, toric IOL pa-
tients will have fewer issues than
multifocal IOL patients. "If you mea-
sure them correctly and place the
lens on the correct axis, it's a win-
ner," Dr. Masket said. "The problem
comes when you have incorrectly
measured or incorrectly placed."
If a patient with a toric IOL
has residual astigmatism, an IOL
rotation might be necessary. Dr.
Berdahl and David Hardten, MD,
Minneapolis, developed the web-
site Toric Results Analyzer (www.
astigmatismfix.com) for surgeons to
assess if an IOL is properly aligned.
If it is not, the calculator on the site
can help determine proper place-
ment.
Dr. Macsai uses the website
ASSORT (Alpins Statistical System
for Ophthalmic Refractive Surgery
Techniques; www.assort.com) to
help with IOL repositioning. "In
many instances, the outcome is due
to the surgeon's failure to incorpo-
rate or be aware of the refractive
effect of the backside of the cornea,"
she said.
LASIK or PRK enhancement
is another option for this patient
group, as are limbal relaxing inci-
sions, Dr. Macsai said.
The ideal time to address resid-
ual astigmatism is at 1 month to 6
weeks, Dr. Berdahl said. EW
Editors' note: The physicians have no
financial interests related to this article.
