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EW NEWS & OPINION February 2017 23 to the other. In the above case, if the –1.50 target resulted in –0.50 this eye could be dubbed as the emmetropic eye and the second vision, right eye emmetropia, left eye –2.00. Do you do the emmetropic eye or the myopic eye first?" The tradeoffs as I see them are as follows. Doing the emmetropic eye first has the following advantages: • Emmetropia is a state that is easiest to acclimatize to; simply go without glasses and use the ap- propriate near correction, usually OTC readers. • There likely will be no need for a temporizing spectacle lens to correct the first eye so that the patient can function with driving while in the postop period for the second eye. • If uncorrected visual acuity is unsatisfactory due to unantici- pated residual distance refractive error, this can be addressed before operating on the second eye. • If uncorrected visual acuity is unsatisfactory due to residual refractive error, and the patient is not inclined to pursue an enhancement procedure such as IOL exchange, piggyback IOL, or laser correction such as LASIK, this may affect the decision to target myopia on the second eye since monovision may no longer be practical. Doing the myopic eye first has the following advantages: • It allows the use of an adjustment factor for the second emmetropic eye based upon the actual result of the first myopic eye. • A deviation from the myopic target may be less clinically im- portant than with the emmetropic eye. For example, a target of –1.50, which actually results in –0.50 or –2.50, may still be an acceptable result for the patient and gives you the opportunity to regroup and strive for greater precision for the second emmetropic eye with- out needing to fix the refractive miss for the myopic eye. • In an extreme situation, a substan- tial refractive miss for the myopic eye could prompt the surgeon to switch the myopia from one eye That's all you need! One-size-fits-all punctum plug eliminates sizing and simplifies stocking Pre-stretched shape (on inserter) avoids dilation and facilitates insertion Expanded shape (once inserted) assures snug fit and virtually eliminates pop-out Soft collar prevents migration and provides patient comfort FCI-Ophthalmics.com 800.932.4202 Plug into FCI for Dry Eye Treatment and watch the SnugPlug insertion video. Visit PlugintoFCI.com for promotional pricing ™ eye instead as the myopic eye for monovision, probably employing an adjustment to attempt to hit Emmetropic eye first 46% Myopic eye first 54% Figure 3. Refractive vergence formula Source: Warren Hill, MD continued on page 24

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