Treat refractive error, dryness before labeling patients as “visually demanding”

05 October 2021

2 minutes to read


Berdahl J. Management of a dissatisfied multifocal patient. Presented at: Real World Ophthalmology; Sep 18, 2021 (virtual meeting).

Disclosures: Berdahl declares to have been a consultant for Alcon, Allergan, AMO, Avedro, Aurea Medical, Bausch + Lomb, ClarVista, Dakota Lions Eye Bank, DigiSight, Envisia, Equinox, Glaukos, Imprimis, Iantech, New World Medical, Ocular Therapeutix, Omega Ophthalmic, Ocular Surgical Data, RxSight, SightLife Surgical and Vittamed.

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According to one speaker, when working with patients who are dissatisfied with their multifocal IOLs after cataract surgery, there are several factors to consider before assuming the patient is visually demanding.

John P. Berdahl

“If I had had cataract surgery with a multifocal IOL and spent a lot of money on it, I would have high expectations too. ” John P. Berdahl, MD, said at the virtual real-world ophthalmology meeting. “And our job is to meet those expectations. “

The first problem Berdahl tackles is drought.

“This is the second most common problem – it’s the problem you deal with first,” Berdahl said. Lubrication, medications, thermal pulses, modifications, tear plugs, and omega-3 supplements can help, but dryness is a challenge for many patients.

“Refractive error is the most common problem,” Berdahl said. “By treating refractive error, most patients will be genuinely happy.”

To make sure that a refractive error is the real culprit, Berdahl said he will prescribe an inexpensive pair of glasses.

“If a patient puts on these glasses, does he like it? If so, then we know it is a refractive error, and we will eventually move on to excimer enhancement. Otherwise, something else happens. We are not going to YAG this patient. We’re not going to do LASIK on them until we find out what else it might be, ”he said.

“It’s also important to know if the positive dysphotopsia was the problem with the lens itself, not the BCP, before doing the capsulotomy,” Berdahl said. “Patients with multifocal IOLs will have rings, highlights, and halos, but the vast majority of patients don’t mind. ”

If posterior capsule clouding (PCO) is the problem, it’s easily treatable with the YAG laser, Berdahl said. “But you only want to do it if you know that’s the problem.”

Finally, a near problematic point could cause misfortune, Berdahl said. The problem became less of a problem with the use of trifocal IOLs.

“If you are using bifocal multifocals that have far vision and a near to intermediate or distant point, there is usually a no man’s land, depending on where that near point is,” he said. .

Before deciding that a patient is “visually demanding,” Berdahl suggested addressing all other possibilities first.

“Show them a pair of -3 glasses and put a pair of loose -3 lenses in front of them and show them what their near vision would look like if they didn’t have this lens.” It’s really helpful for them to see what they’re actually getting, ”Berdahl said.

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