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2019 ASCRS•ASOA San Diego Daily Saturday

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ASCRS NEWS ASCRS ASOA ANNUAL MEETING 6 | EYEWORLD DAILY NEWS | MAY 4, 2019 by Ellen Stodola EyeWorld Senior Staff Writer/Meetings Editor the current status of the posterior capsule, rhexis size, and zonular stability. Complications may occur even in seemingly routine ex- changes, he said. Editors' note: Dr. Berdahl has financial interests with a number of ophthalmic companies. Dr. Ouano has no financial interests related to his comments. focal IOL exchange include glare, halos, and dysphotopsias, as well as reduced contrast sensitivity. Dr. Ouano said you should carefully deliberate when making a decision on whether or not to explant or exchange a multifocal IOL. Considerations include what the residual refractive error is, if the patient can be happy with glasses or contacts, if there is coexisting ocular surface disease or irregular astigmatism, if there is concurrent macular disease, and IOL in the U.S. that gives good distance, intermediate, and near vision, he said. Dr. Berdahl moved on to discuss the "real question" of LASIK vs. PRK for enhance- ments. LASIK pros include rapid recovery, minimal epithelial re- modeling, and more predictability. Cons of LASIK include a need for a flap-maker, the irregular ep- ithelium is still there, you need to watch out for AKs and incisions (especially intrastromal AKs), and patients may have dryness. Pros of PRK are you don't need a flap-maker, you can clean up irregular epithelium, and it's easier on the surgeon. Cons in- clude that there's less predictabili- ty, slower wound healing, pain, and potential dryness. Also during the session, Dean Ouano, MD, New Bern, North Carolina, discussed when to per- form an IOL exchange. He noted that the four IOL maladies that require an IOL exchange are malposition, mal- adaption, malrefraction, and malfunction. IOL decentration and dislo- cation is by far the most common reason for IOL exchange, regard- less of the IOL type, he said. There have been shifting indica- tions for IOL exchange, including the recognition of gradual aging out of obsolete ACIOL designs. Dr. Ouano said that uve- itis-glaucoma-hyphema (UGH) syndrome caused by a sulcus-fix- ated single-piece acrylic PCIOL is a relatively new indication for IOL exchange. Manifestations of clas- sic UGH syndrome can include elevated IOP, blood in the anterior chamber, chronic cell and flare in the anterior chamber, a grossly malpositioned IOL, and obvious iris or pupillary abnormalities. Dr. Ouano moved on to discuss maladaption, noting that up to 7% of patients dissatisfied with a multifocal IOL require IOL exchange. Indications for multi- D uring an afternoon session at the 2019 ASCRS Refractive Day, presentations focused on "Tips, Pearls, and Take-home Messages." John Berdahl, MD, Sioux Falls, South Dakota, discussed refractive enhancements following cataract surgery. He not- ed that his practice's enhancement rate is pretty high, and he sees this as a good thing. Of course, we want to nail it the first time, he said, but we want to have a plan to finish. The biggest source of unhappiness for patients comes when the surgeon is not taking them to the end. Dr. Berdahl stressed the im- portance of describing the entire journey to the patient first. He dis- cussed his three-step process of: surgery, YAG, and enhancement. It's also important to include ev- erything you can in the bundle. Refractive error, Dr. Berdahl said, is the most common problem in these unhappy patients, but he said this is not the first thing you should treat. Formulas and aber- rometry help, he said, adding that multifocality may compound the issue. Excimer enhancements are still needed, and most people end up very happy. The second most common problem he sees is dryness, and this is the issue Dr. Berdahl said should be treated first. You can use lubrications, medications, thermal pulsation, and other treat- ments. Finally, he noted problematic near point as another source of unhappiness. We don't have an Refractive tips and take-home messages Dr. Berdahl presents on refractive enhancement following cataract surgery during an ASCRS Refractive Day session.

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