EW San Francisco
than positive reinforcement for re-
fractive IOL use by the surgeon, and
similarly turns patient word-of-
mouth from positive to neutral or
negative.
Many cataract surgeons do not
have a viable strategy for addressing
residual spherical error and astigma-
tism in their refractive cataract
patients. Several factors might
potentially inhibit cataract surgeons
from referring their patients to
colleagues for keratorefractive laser
enhancement. One might be the
inability to control or specify cost.
Another is a concern that patients
will perceive that "something went
wrong" if they are transferred to an-
other surgeon's care. However, imag-
ine keratorefractive surgeons trying
to perform LASIK without the op-
tion or ability to enhance the initial
result. In my opinion, this is the
missing part of many refractive
cataract surgeons' armamentarium.
If you or someone in your practice
doesn't perform PRK or LASIK, then
I recommend establishing a relation-
ship with someone in your commu-
nity who does. Patients must then
be prepared up front for the possibil-
ity of being referred to that surgeon
for an enhancement (along with the
estimated cost).
References
1. Woodward MA, Randleman JB, Stulting RD.
Dissatisfaction after multifocal intraocular lens
implantation. J Cataract Refract Surg. 2009;
35:992-997.
2. de Vries NE, Webers CA, Touwslager WR, et
al. Dissatisfaction after implantation of multi-
focal intraocular lenses. J Cataract Refract
Surg. 2011; 37:859-865.
3. Zheleznyak L, Kim MJ, MacRae S, Yoon G.
Impact of corneal aberrations on through-
focus image quality of presbyopia-correcting
intraocular lenses using an adaptive optics
bench system. J Cataract Refract Surg. 2012;
38:1724-1733.
Dr. Chang is clinical professor of ophthalmol-
ogy, University of California, San Francisco,
and in private practice, Los Altos, Calif. He can
be contacted at 650-948-9123. His consulting
fees from Abbott Medical Optics are donated
to Project Vision and the Himalayan Cataract
Project through the ASCRS Foundation.
13
Managing residual refractive errors following refractive IOL implantation
"
If your
practice doesn't
perform PRK or
LASIK, establish
a relationship
with someone in
your community
who does.
"
Update on the latest in refractive cataract techniques and technologies
Data on the impact of residual error on patient satisfaction rates from 4,970 eyes implanted with multifocal IOLs
Source: Steve Schallhorn, MD
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