Eyeworld Daily News

16 | EYEWORLD DAILY NEWS | MAY 6, 2023 ASCRS ANNUAL MEETING DAILY NEWS D uring the final session of ASCRS Refractive Day, Blake Williamson, MD, shared a case of what he called "the second eye debacle." A 47-year-old patient came in for a custom lens replacement evaluation. The patient had reading glasses on top of his contacts and didn't want to wear either. He has a normal healthy eye and doesn't drive much at night. The patient had an uneventful surgery on the left eye with Synergy IOL (John- son & Johnson Vision), and the right eye was scheduled for a Symfony OptiBlue (Johnson & Johnson Vision) the following week. Dr. Williamson did a virtual postop day 1 exam. The patient had sunglasses on with a bucket hat and was complaining that he couldn't see anything, could barely drive, couldn't see the computer screen, reiterated multiple times that he was a CEO of a large company, and wanted to cancel his second eye surgery. The patient was 20/25 J2. Dr. Williamson questioned pan- elists what they would do. Cathleen McCabe, MD, said vision is subjec- tive, and there's usually a lot going on at postop day 1. She recommend- ed telling the patient to just "give it some time." Eric Donnenfeld, MD, said this is a patient who absolutely needs to come into the office, be seen right away, and have tests done. When testing is done, Dr. Donnen- feld said, "I come in knowing what's wrong before I see the patient." You should always make sure the patient knows that you're on their side and are there to solve problems with them, he said. Sometimes, this happens for a good reason (like K abrasions, refrac- tive target miss, etc.), sometimes for another reason (like a high myope is unhappy with an EDOF near), and sometimes for no reason, Dr. Wil- liamson said. So how do you prevent problems like this? Dr. Williamson said it's important to overeducate and overcommunicate, letting that patient know not to expect to be hap- py until both IOLs are in place. "it's not what you tell them, it's what they remember," he said. Dr. Williamson said he likes to tell the patient, "Let me tell you how you used to see," and he will put their old prescription in the phoropter. It's important that you say something to these people to let them know that this is normal, he said. Dr. Williamson noted the po- tential link between mental health and cataract surgery time intervals between eyes. The effect on time interval between cataract surgeries and utilization of healthcare services for anxiety and depression has rarely been studied, he said. There was a study, he said, that looked at half a million patients over a 10-year period undergoing cataract surgery who also sought mental health services for anxiety, depression, and sleep deprivation. The study found the closer the time interval between eyes coincided with a lower need for mental health services. To follow up with this case, Dr. Williamson ended up having the patient physically come into the clinic, making sure the patient picked a time that was best for him. He also recommended the patient bring his wife. He put into perspective the ob- jectively solid 20/25 J2 outcome and showed him his initial prescription by putting it in the phoropter. He then rediscussed all the informed consent that had been detailed preoperative- ly. Dr. Williamson said it's important to inspire confidence and educate about the mix and match approach. He then scheduled his patient for one more visit before the second eye surgery to ensure improvement but noted that he stuck with his original lens plan. Zaina Al-Mohtaseb, MD, shared a case of a 76-year-old female patient who presented with decreased vision in the right eye. She had CE/IOL in the left eye (Eyhance, Johnson & Johnson Vision) but was unhappy with the visual outcome. The patient came to see Dr. Al- Mohtaseb for a second opinion on the left eye and wanted to proceed with cataract surgery in the right eye. OCT of the macula showed that there was something wrong in the left eye, with an epiretinal mem- brane. So, how do you tell the patient and explain it without throwing the other surgeon under the bus? Dr. Williamson said he'd like to look at the preoperative image to see if it was there preoperatively, and he said he would start with the good and tell the patient that there's a reason for what's happening, and it can be addressed. Dr. Al-Mohtaseb sent this patient to retina, letting her retina colleague know that she planned to proceed with cataract surgery. When some- thing like this happens, it can help to get retina on your side. It's also important to have support because it's often about how the patient perceives it and not what you do, she said. Editors' note: Dr. Williamson has financial interests with Johnson & Johnson Vision. Dr. Al-Mohtaseb has financial interest with a variety of ophthalmic companies. Postoperative considerations in refractive surgery

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