Eyeworld

EW REFRACTIVE 42 May 2017 by Rich Daly EyeWorld Contributing Writer Surgeons discuss the questions they ask and the tests they perform when presbyopic patients are exploring their optical and surgical options A sking the right questions in combination with the right diagnostics can help ophthalmologists' dis- cussions with presbyopic patients. This patient population is more complex, but surgeons have found the right approach to illuminating their optical situation and options can be rewarding for both physi- cians and patients. When presbyopic patients with correctable 20/20 vision arrive for a surgical consult. Bryan Lee, MD, JD, Altos Eye Physicians, Los Altos, California, is fairly conservative. "It's important to keep in mind that the technologies to help this patient are all imperfect and involve tradeoffs, so my job is to provide the best options for this individual but also clearly explain their down- sides," Dr. Lee said. For Kevin L. Waltz, OD, MD, president, Ophthalmic Research Consultants, Indianapolis, such dis- cussions are viewed as a trade. "I have to offer them something in trade that is better than what they have," Dr. Waltz said. For instance, 50-year-old pa- tients who are +6 with poor near vision have options. "I can make their lives a lot bet- ter," Dr. Waltz said. "The 20/20 cor- rectable part does not inhibit me. It is one of the factors that I take into account in their situation compared to what their complaints are." Patient understanding For Francis Price, Jr., MD, founder, Price Vision Group, Indianapolis, and chairman of the board and founder, Cornea Research Founda- tion of America, an explanation of dysfunctional lens syndrome has helped patients understand the changes they notice as they move from a perfect lens toward cataracts. "In between, the lens becomes dysfunctional to varying degrees, first with presbyopia and then deg- radation of the optical qualities of focusing light," Dr. Price said. Dr. Waltz explains early lens changes affecting patients' image quality by describing the realization of sailors long ago that they needed to use teenage crewmembers as look- outs instead of middle-age sailors be- cause the teens had the best vision. "Most people who are observant have noticed that even though their vision is 20/20 it's not the 20/20 they're used to," Dr. Waltz said. "It's like their hips are no longer 20/20. And most people understand that explanation very well." Understanding challenges To help understand the issues that frustrate presbyopic patients, the patient history taken by Dr. Price asks about the routine and non-rou- tine activities that are problematic for them. Lens, laser, or nothing? W hen a presbyope is exploring re- fractive surgery, asking the right questions in combination with the right diagnostics can supplement our exam immensely for the ultimate discussion about options available to them. Whether it is a 42-year-old new onset presbyope with early near frustrations, a 55-year-old plano presbyope wearing readers only who is experiencing some nighttime image quality issues, or a 68-year-old who needs both distance and near correction but isn't the greatest historian, if they are still correct- able to 20/20 on your Snellen chart it is important to peel back the onion and figure out all their frustrations. In addition to best-corrected visual acuity (BCVA), I like to think about best-corrected image quality (BCIQ). Thus, an important question is, "Is there anything going on in their optical system in addition to refractive error affecting their overall im- age quality?" I thank Bryan Lee, MD, Kevin Waltz, OD, MD, and Frank Price, MD, for sharing with us their pearls on working with presbyopic patients who might be correct- able to what's considered good Snellen vision to us, but who may not experience this as good quality, based on how they use their vision. Being a good listener in the ex- amining lane, using modern-day diagnostics to decide if a patient has a quality optical system that is simply presbyopic or has real optically degrading pathology, and having the all-important discussion can lead to recommendations and the ultimate answer to the question "Lens, laser, or nothing?" Vance Thompson, MD, Refractive editor These two panels are from the same scan of an eye with prior myopic lassie with a small optical zone. The patient complained of poor quality of vision. In the second panel, Dr. Waltz electronically limited the pupil to 3 mm from the original 6 mm. It significantly improved the conformed images in the upper right of the panel and the MTF and decreased the HOA in the bottom right. Source (all): Kevin L. Waltz, OD, MD Refractive editor's corner of the world

• Blank Page
• Blank Page (1)
• Blank Page (2)