57
EW REFRACTIVE
February 2018
and if you're going to deliver what
they want, you have to be sure of
the numbers. If you cannot, you
need to manage their expectations."
He finds that with such a pop-
ulation, an approach that can often
work is to put a spherical lens in and
assure the patient that you can go
back later and correct the rest of the
refractive error using a PRK on top
of the LASIK flap. He added that in
most cases, since there is not much
residual refractive error, it's possible
to fine tune it later.
In a poster presented at the
2017 American Academy of Oph-
thalmology meting, Dr. Terry and
fellow investigators considered how
the topographic astigmatism in this
cohort that had previously under-
gone refractive surgery compared to
a group that had not had such prior
surgery. "We looked at the change in
astigmatism without prior refractive
surgery, and there was a correlation
between pre- and postoperative
astigmatism in the eyes that did
not have previous LASIK," he said,
adding that if you looked at the
eyes that had undergone previous
refractive surgery, there was no
correlation.
Overall, in Dr. Terry's view, a
toric lens in an eye that has not
had previous refractive surgery is
a reasonable thing to do. "But the
data shows that it's unreasonable to
do it in an eye that has had previous
LASIK unless you want to go back
and rotate that lens later; you have
a 50% chance you will have to do
something," he concluded. EW
Reference
1. Zeidenweber DA, et al. Descemet mem-
brane endothelial keratoplasty in eyes with
previous laser refractive surgery: outcomes
and complications. Cornea. 2017;36:1302–
1307.
Editors' note: Dr. Terry has no financial
interests related to his comments.
Contact information
Terry: mterry@deverseye.org
"
You are dealing with a population
of people that is tuned in to what
they want, and if you're going to
deliver what they want, you have
to be sure of the numbers. If you
cannot, you need to manage their
expectations.
"
—Mark A. Terry, MD
