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Good refraction, quality eye wear sometimes the best therapy
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Let me share with you one of our most enjoyable, yet challenging, patients. This individual had the misfortune of developing an ocular tumor approximately 3 years ago. Fortunately, she was the beneficiary of prompt diagnosis, excellent consultative care and successful irradiation. Unfortunately, shortly there after, she developed a retinal detachment.
Again, fortunately, she was successfully treated with a scleral buckle procedure. In the months to follow our patient developed a visually significant cataract, and an uncomplicated cataract extraction with posterior chamber implantation was performed. Unfortunately, due to the rather complex nature of her case the postoperative refraction revealed approximately 5 D of myopia, resulting in 6 D of anisometropia. Given an intolerance (and aversion) to contact lenses and the significant risks associated with IOL exchange, she elected to undergo refractive surgery in an effort to lessen the myopia and anisometropia. How ever, in light of a rather enophthalmic posture, scleral buckle and IOL, laser in situ keratomileusis was considered a relative contraindication. As a result, she underwent a myopic surface photorefractive keratectomy (PRK).
Vision correction still necessary
Despite a rather uneventful postoperative course – very little discomfort, rapid re-epithelialization, no haze – her refractive outcome was approximately 3.5 D of hyperopia and 2.5 D of anisometropia. To further complicate matters, her postoperative course has also been marked by a decompensating hyperphoria with attending diplopia.
Granted, our patient is very grateful. Considering the rather ominous initial diagnosis, it is feasible she could have lost her eye or a whole lot more. And I, too, am appreciative for the marvels of modern ophthalmic surgery. Considered individually, she’s been the beneficiary of exceptional retinal, cataract and corneal care. Unfortunately, scleral buckles often induce myopia, IOL calculations are difficult in scleral buckle patients and we’re often at the mercy of post-PRK wound healing. So, after a long an arduous journey, ametropia and anisometropia prevail. And after enduring this journey our patient has one lingering question: “Can you make me see better?” Having exhausted every surgical option, we turn to one of our most fundamental tools. The refraction.
Stay informed, but don’t forget basics
At Primary Care Optometry News we make every effort to keep our readers apprised of the latest developments in instrumentation, contact lenses and pharmaceuticals, as well as diagnostic and therapeutic strategies. And for good reason. It’s consistent with our goal of assisting optometrists in their quest to provide the most comprehensive and competent patient care possible. However, amidst integrating these rapidly developing advances, we must never diminish the significance – and relevance - of a skilled refraction and well-crafted eye wear. For in an era in which cataract surgery is as much a refractive endeavor as a therapeutic procedure, and in which refractive surgery is equated with life long emmetropia, a good refraction and eye wear are often precisely what many of our patients need. Indeed, refractions are powerful tools and, often, the outcome by which our patients judge us.
So, what about our patient? Well, I’m not naive enough to think a good refraction and quality eye wear is all that is necessary in a case as complicated as this one. However, I am confident it will afford her improved comfort and vision as well as a sense of hope and progress. And, sometimes, that can be the most powerful therapy of all.