The conclusions from this presentation suggested that patients with an angle kappa (as measured with a Marco OPD-Scan III or Hoya iTrace device) greater than 0.40 mm would be happier with an appropriate aspheric monofocal or accommodating IOL, and multifocal IOLs would be equally successful in patients with an angle kappa of less than 0.40 mm. With regard to LASIK patients, data was presented by me at the joint meeting of OSN, the Italian Society of Ophthalmology and the Italian Association of Cataract and Refractive Surgery in Milan, Italy, in May, looking at angle kappa as the determining factor for which post-LASIK patients should receive a multifocal IOL. RK patients normally are loaded with wavefront aberrations from the outset, and avoiding multifocal IOLs in this subset of post-refractive surgery patients is probably the safest route. Even if the target is achieved, these patients typically have the “trampoline” effect of vision fluctuation and the “starburst” effect from the RK scars.
Hitting the postoperative refractive target is usually most difficult in RK patients. Most of these patients expect the best and will most likely choose a premium IOL at the time of cataract surgery. Typically, the post-refractive surgery patient will have the highest expectations after cataract surgery, whether receiving a monofocal or premium IOL. In my experience, there are three types of dissatisfied patient when it comes to premium IOL technology: the post-refractive surgery idealist, the surprised multi-pathology patient and the timid-by-proxy patient. The old adage still holds true: A happy patient will refer one or fewer patients, but an unhappy patient will tell 10 or more to avoid you.Īs I have revealed in the first seven parts of this series, patient satisfaction will require due diligence on the part of the surgeon in terms of setting realistic expectations, performing the proper preoperative evaluation, managing the ocular surface, managing astigmatism, preventing cystoid macular edema, managing posterior capsular opacification, and selecting the correct IOL and IOL power for your patient.
Various studies show that up to 25% of patients will be unhappy in some way, indicating so by either complaining outright or just leaving the practice and seeking a second opinion. If you continue to have this issue please contact to Healio