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More and more patients are considering the option of using advanced implants to correct their vision after cataract surgery. We educate all patients on monofocal IOL technology, wavefront adjusted aspheric monofocal technology to maximize night-time vision, toric implants for astigmatism correction and presbyopia correcting implants that address distance, intermediate, and near vision. We find that when a patient chooses a traditional monofocal implant and bifocals postoperatively, they are at peace, because they were educated on all the options and feel that they made an informed decision.
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The cataract evaluation is a comprehensive ocular evaluation in addition to the determination of the cataract’s effect on vision. Pre-operative evaluations include an anterior and posterior segment slit lamp examination, dry eye testing, corneal topography (corneal higher order aberrations), measurements to determine IOL power, posterior segment photography/OCT, an extensive discussion on cataract surgery and IOL options, a discussion of risks/benefits with informed consent, patient education and counseling on costs and instructions. It is our job as doctors to identify which patients are good candidates for refractive cataract surgery and which patients will perform better with a monofocal IOL. For patients who desire a specific refractive outcome through our Refractive Cataract Surgery program there are additional diagnostic and educational components of the refractive surgery evaluation included in this evaluation. As you can see in Table 1, there are many similarities between the refractive cataract and refractive corneal evaluations.
Expectations of cataract patients have grown due to advances in vision-correcting technology. We find that after a thorough discussion of implant options, many implant patients choose the monofocal or wavefront designed implants. This allows them to achieve great distance vision and compensate for near with either bifocals or reading glasses. When they choose these monofocal implants they are appreciative that they had an honest discussion about the advanced implants that could have provided them with distance and near vision.
The patients that choose the advanced implants for distance and near are the ones that have expectations like younger, LASIK patients. They want to be able to experience life without glasses or contacts. They are fine having a pair of glasses for certain activities, but they have a great desire to function throughout the day without optical devices.
The reason we offer the full array of advanced implants is that just like in the corneal refractive surgery arena, we want to maximize the chance of delivering the very best outcome for any particular patient’s needs and expectations. Again, even the ones who do not choose the advanced technology tend to appreciate the discussion and options.
Educating the patient on the risks of cataract surgery through an adequate informed consent procedure is paramount. Informed consent can be accomplished through written documents or video tapes and can include written tests on the material. An informed consent document contains descriptions of the procedure, alternative treatments and options, and a thorough list of potential risks.
Risks that should be included in a cataract informed consent document should include blindness, infection, cystoid macular edema, retinal detachment or hemorrhage, overcorrection, under correction, corneal scarring, irregular astigmatism, anisometropia, reduced BCVA, difficulty wearing contact lenses postoperatively, the potential need for permanent glasses correction, and that it is impossible to list every complication that may occur as a result of surgery.
Patients are seen at 1 day, 1 week, 1 month, 3 month and 6 mos after surgery
Patients who elect the Light Adjustable Lens will follow the post op schedule detailed in the post op schedule featured above.
At the one week post-op exam, especially between the first and second eye surgery, we like to see uncorrected and best corrected vision with a MRx , slit lamp exam and IOP, as well as a statement of how the patient is doing with their first eye. This information becomes critical when performing their second eye to know we are on the right path and it is medically the right thing to do proceeding with the second eye.
All refractive cataract surgery patients are educated that it is a process to correct their vision. It may be a 2 to 3 step process including YLC and laser corneal enhancement to get patients to see as best as possible.
Patients now have a choice with pre and post-operative medications. An antibiotic, a steroid and a non-steroidal anti-inflammatory will always be used following cataract surgery. The choice patients now have is how those medications are administered. Traditional drops can be taken, or the patient may elect Drop A Day Cataract surgery, with intra-operative injectable antibiotic and steroid medication. With traditional drop cataract surgery patients will take drops 9 times per day the first week and 3 times per day for the next 3 weeks. With Drop A Day cataract surgery the patient, obviously as the name implies, uses one drop per day for 4 weeks. We now offer a combination drop which contains all three medications - antibiotic, steroid and non-steroidal anti-inflammatory, in one bottle and which patients can pick up at Vance Thompson Vision prior to surgery. Below is an explanation of the various pre and post-op protocols patients may follow prior to and after surgery, as prescribed by their surgeon based upon individual need. Each is supplemented with a printable drop schedule as a visual and for daily tracking.
Drop A Day Cataract Surgery: These patients will be administered an injection of Dex-mox-ketor (Dexamethazone - Moxifloxacin - Ketoralac) at the time of surgery.
Combination drop of Prednisolone-Moxifloxican-Bromfenac QD x 4 weeks post operatively