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Presbyopia correction:
Exploring surgical options, expectations, and postoperative error
by Rosa Braga-Mele, MD, MEd, FRCSC
After the fact:
Mitigating and managing postoperative error
Time invested in
preop assessment
reduces risk of postop
surprises
S
urgeons need to
take a two-pronged
approach to address
refractive surprises
after presbyopia-cor-
recting procedures—perform-
ing meticulous preoperative
assessments and developing
strategies to manage postoper-
ative errors.
Preoperative protocols
Careful patient selection is
key when implanting toric or
presbyopia-correcting IOLs.
1,2
The first step is to per-
form corneal topography to
assess corneal health (Fig-
ure 1). I prefer Placido disc
topography to help assess the
corneal surface and look for
ocular surface disease. Any
dry eye should be treated
before other preoperative
measurements are performed.
Epitropoulos et al. reported
hyperosmolarity increased
variability in preoperative
measurements and affected
IOL calculations.
3
Epithelial
basement membrane disease
should be treated or presby-
opia-correcting IOLs should
be avoided in these patients.
Furthermore, macular op-
tical coherence tomography is
recommended if there is any
question of macular health
and to rule out macular
disease, such as an epiretinal
membrane or macular edema.
Figure 1. Surgeons should look for dry eye and multiple variable K readings. Dry eye or epithelial basement membrane
disease should be treated before proceeding, and measurements should be repeated to assess corneal astigmatism.
