39
EW REFRACTIVE
May 2018
Contact information
Chang: dchang@empireeyeandlaser.com
Koch: dkoch@bcm.edu
Schallhorn: steve.schallhorn@zeiss.com
for enhancement. I typically wait at
least 3 months to make sure I have a
stable refraction before considering
an enhancement," he said.
Dr. Koch said it is important to
explain to patients when they ini-
tially present for cataract evaluation
that they may need an enhance-
ment postoperatively. "However, we
also need to explain that there are
some small adjustments that could
make things worse. If a patient is
off by 0.5 D or more, you may or
may not want to do something,
particularly if it's on the hyperopic
side, because the predictability of
the procedure might not be as good
as you want, and you could make
the patient's vision worse. You need
to set expectations for the original
outcome and for the indications for
doing additional steps," he said.
Enhancement strategies
Dr. Schallhorn's enhancement
strategy depends on the patient's
refractive error. "If the patient has
a significant deviation in his or
her refractive error, some type of
intraocular procedure might be the
best option. For example, if the pa-
tient has a toric IOL that is not well
aligned and there is visually disturb-
ing astigmatism, rotating the toric
lens might be the most appropriate
procedure. Or if there is a consider-
able deviation in the sphere (postop
surprise), either exchanging that
IOL or a piggyback IOL may be the
best option. The best enhancement
procedure depends on the residual
refractive error," he said.
Dr. Koch will use relaxing inci-
sions in patients with astigmatism
and spherical equivalent within 0.25
D of plano. "Otherwise, I do PRK.
LASIK is also great, and patients love
the fact that they get their vision
back early, but you have be wary of
inducing a dry eye," he said.
Another option is IOL ex-
change. "In my premium patients,
I have always been able to address
problematic residual refractive errors
with corneal procedures, but an IOL
exchange may be the best option
for anything outside the range of
+1 on the hyperopic side and –2 on
the myopic side. I will also consider
a lens exchange if the patient feels
like the wrong lens is in his or her
eye. Sometimes it's a psychological
issue," Dr. Koch said. EW
Editors' note: Dr. Koch has financial in-
terests with Alcon (Fort Worth, Texas),
Carl Zeiss Meditec (Jena, Germany),
Johnson & Johnson Vision (Santa Ana,
California), and Perfect Lens (Irvine,
California). Dr. Schallhorn and Dr.
Chang have financial interests with
Carl Zeiss Meditec.
