Eyeworld

117 EW MEETING REPORTER ancies, you may need to remeasure or defer. Dr. Koch said to critically eval- uate the raw data. He also suggested factoring in posterior corneal astig- matism, which may be done using a regression formula. The problem with regression approaches, he noted, is they are based on averag- es, and there is clearly individual variation even with normal corneas. In complex eyes the relationship between the front and back is lost. Finally, he said to meticulously mark the eye to align the IOL. Jonathan Solomon, MD, Bow- ie, Maryland, shared pearls for man- agement of the unhappy patient. First, he said it's important to listen with understanding and sympathy. This typically will help diffuse anger and demonstrates your concern, he said, adding that he finds this can help alleviate 90% of all prob- lematic patients. With regard to a multifocal or toric IOL that's rotated out of position, Dr. Solomon said a patient's confidence often starts to drop in this situation. It's helpful if you let patients know that you're just as unhappy and want to fix the situation. Dr. Solomon stressed the impor- tance of not making excuses. Take full responsibility, and take the ini- tiative to do what you can to solve the problem in a timely fashion. Paraphrasing the patient's concerns can also be important. When appro- priate, he said to consider repeating back to patients an important point and letting them know that you want to understand their concerns. Find out what is desired, Dr. Solomon said. The patient may want a refund, a credit, or something else, but typically, the desire is to be heard and understood. He discussed the importance of proposing a solution. Be the patient's advocate, and regain the had some with-the-rule astigmatism. Some of the etiologies of residual astigmatism, Dr. Weikert said, are errors in biometry, poor choice of IOL, and misalignment of the IOL. To address this patient, the measure- ments were repeated and still proved to be accurate, with axial lengths in agreement, the same average K and astigmatism levels. The IOL choice was again evalu- ated. The Barrett calculator was used in this case. Dr. Weikert noted, how- ever, that the optimized axial length is not accounted for in this formula, making the eye seem shorter than it is because the formula doesn't do optimized axial length. The IOL was also slightly misaligned, Dr. Weikert said. Possible management options include glasses/contact lenses, refrac- tive surgery, IOL rotation, and ex- changing the lens, Dr. Weikert said, noting that patients likely would not want glasses/contact lenses as an option since they initially chose a toric lens. The surgeon in this case exchanged the lens. Editors' note: Dr. Donaldson has finan- cial interests with a number of ophthal- mic companies, including Alcon (Fort Worth, Texas) and Johnson & Johnson Vision (Santa Ana, California). Dr. Fram has no financial interests related to her presentation. Dr. Weikert has financial interests with Ziemer (Port, Switzerland). Premium cataract surgery: Setting and meeting expectations Douglas Koch, MD, Houston, high- lighted pearls in planning astigma- tism correction. First, he said to pick your threshold for recommending correction. Next, manage your surgically induced astigmatism (SIA). Take into account at least three data points, he said. If there are discrep- (COS) continued on page 118 September 2017

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