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Unhappy patients after cataract surgery need complete evaluation
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NEW YORK — If a patient is unhappy after cataract surgery, a comprehensive workup of the patient and all preoperative testing, such as topography, evaluation of the ocular surface and OCT of the macula, needs to be completed again to determine the cause of the dissatisfaction, according to a speaker here.
According to a study by Gibbons and colleagues, the most common complaint for a patient after presbyopia-correcting IOL implantation is blurred vision due to refractive error and dry eye, Jennifer M. Loh, MD, said at OSN New York 2018.
“Repeat all of your tests, including refractions, and maximize ocular surface health. Look behind the lens to decide if there’s any posterior capsular opacification, and then if there’s a refractive error, you need to speak with your patient to eliminate that, and we have several options in which to do that with,” Loh said.
A physician should first determine the refractive endpoint for the unhappy patient. Multifocals and extended depth of focus lenses can achieve a refractive goal of plano, and accommodating IOLs can achieve a refractive goal of slight myopia, she said.
“We have lots of treatment options. Glasses, contact lenses, PRK, LASIK, SMILE, piggyback IOLs, IOL exchanges or even femto AKs. Remember, the treatment technique can vary by the postoperative refraction, the length of time after surgery and whether there were complications during the primary surgery,” she said. – by Robert Linnehan
References:
Gibbons A, et al. Clin Ophthalmol. 2016;doi:10.2147/OPTH.S114890.
Loh JM. Enhancement of presbyopic IOLs with refractive surgery. Presented at: OSN New York 2018; Sept. 28-30, 2018; New York.
Disclosure: Loh reports she is a consultant for Allergan, Johnson & Johnson, Shire and Sun and is on the speakers bureau for NovaBay, Shire and Sun.