Think REFRACTIVE when suggesting surgery

PHILADELPHIA – Lecturers here at the PCON Symposium challenged participants to become experts at matching their patients with the correct refractive procedure.

“We’re trying to help you talk to your patients a little bit better and trying to help you determine who is a good candidate and for what procedure they’re a good candidate,” said Sondra R. Black, OD, clinical director at TLC Laser Eye Center of Toronto. Dr. Black lectured with Richard L. Lindstrom, MD, of Minnesota Eye Consultants in Minneapolis and a PCON Editorial Board member.

Dr. Black suggested doctors use the initials REFRACTIVE to remember what to examine on a potential surgery candidate:

R – Refractive error. Think of using an ICL when you have a patient who is above -10 D or +4 D.

E – Existing health. It is critical to manage blepharitis and meibomianitis before surgery. Amblyopic patients should demonstrate the ability to function with the amblyopic eye alone. Practitioners also should make themselves aware of medications and absolute and relative contraindications.

F – Flat/steep keratometry. Do not go beyond 36 D after myopic or 49 D after hyperopic treatment.

R – Reading glasses (presbyopia).

A – Age and stability. If age or maturity of the patient is in question, consider suggesting PRK with the option of future treatments.

C – Corneal topography. Watch for any indication of keratoconus, pellucid marginal degeneration and irregular cylinder.

T – Thickness of cornea (pachymetry). If the preoperative pachymetry is less than 460 micrometers, surgery is not an option. Also be sure to check for guttata and incipient Fuchs’ corneal dystrophy.

I – Iris (pupil diameter). Custom technology has helped reduce the risk of night glare on patients.

V – Vision (UCVA/BCVA). Always consider the patient’s motivations. Would he or she be happy having to eventually wear reading glasses?

E – Extraocular muscles (best corrected visual acuity and binocularity).