Cataract patients who wear contact lenses or who’ve had refractive surgery present special challenges in achieving targeted outcomes. Knowing what these are and how to deal with them can avoid refractive surprises, says ophthalmologist Allen Roth, MD.
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The first thing ophthalmologists need to do in preparing for cataract surgery is to find a way to accurately measure corneas that have been altered by previous refractive surgery or lens wear. It’s necessary to then use additional calculations or formulations to make sure that they’ve accounted for subtle differences, Dr. Roth says.
“You have to know that an individual wears hard lenses,” says Dr. Roth, “then the solution is somewhat simple.” He says that patients need to be measured three times: on their first visit; three to four weeks after they stop wearing lenses; then again two to three weeks later to make sure that the shape of the cornea has stabilized. If the last two numbers are equal, the preoperative calculations will be accurate regardless of what kind of lens is implanted.
Soft contacts also alter the cornea, but to a much smaller extent. Cataract patients need to keep them out of their eyes for at least three to seven days prior to their appointment versus three to four weeks for hard lens wearers.
Knowing that a patient has had previous refractive surgery is of critical importance. Identifying those who’ve had RK is obvious, but those who’ve had PRK often show no signs of it and in those who’ve had LASIK the scar can be small and very faint.
“Some of these procedures were performed so long ago, patients don’t think there’s a need to mention them, or they forget to do so. It’s up to the surgeon to perform due diligence,” Dr. Roth says.
The corneas of refractive surgery patients aren’t changing, but they’re frequently irregular and somewhat difficult to measure. Moreover, patients have many choices of how they want and expect to see.
For example, a person might want great distance vision, but be willing to use reading glasses. Or someone who’s been wearing soft contacts for years with monovision would be an excellent candidate for one distance implant and one near vision implant. “It’s a matter of doing your research, of running a few more calculations, of finding out how a patient is used to seeing and what compromises he or she is willing to make,” Dr. Roth says.
Attention to detail is the key ingredient for bringing about an excellent outcome in cataract surgery, not just the surgical procedure itself. “It’s always a good idea to ask more questions, see if there’s any historic information on the patient’s original curvature, go the extra mile” says Dr. Roth. “Diligence in preparing the patient for surgery is the best way to factor in changes from refractive surgery or lens wear; the best way to come up with a good lens implant calculation.”
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