Hello fellow eye nerds,
Whilst working in the eye clinic, Iāve found most patients are unaware of the various refractive targets that they can choose from which makes it difficult in a public clinic to pick the right IOL in 5 minutes (even though itās just single focal IOLs +/- torics) for them.!
I tend to go for emmetropia OU as itās the most safe but whatās everyoneās thoughts on this?
Thereās also monovision, mini monovision, myopic aim. If itās monovision/mini - my advice is to get a contact lens trial with their Optom to ensure theyāre not anisometrooic and they actually like it - which is not doable if they have a dense cataract (as is the case in the public system).
Some ophthalmologists Iāve talked to state that monovision essentially takes away your stereopsis? But some ophthalmologists (that have had R emme and L -0.75 post phaco/IOL) simply adjust their microscope power for each eye and operate completely fine - is that because they āregainā their stereopsis by doing so?
Is the new thought to make previous myopes emmetropic? So that they are more glasses independent and less likely to fall over as they age?
And what about torics? Usually I try to pick a toric if the IOL master + Pentacam + Glasses matches up nicely. But some consultants wonāt put a toric in for <1.5D of cyl especially if it is ATR astigmatism as they believe that the main wound incision will flatten out that meridian and reduce their toricity.
How do you best optimise a pre-op patient for cataract surgery? I find sometimes they will have a bit of dry eye or blepharitis/MGD and so their pentacam is irregular appearing but still kinda matches with their IOL master and glasses. But because itās irregular, a lot of my seniors will opt for a spherical lens and then they come back with an unaided VA of 6/12-6/9. Idk - that would piss me off as a patient so I wonder how do you guys optimise the cornea before hand? And is there anything else to optimise?
Iāve seen some consultants do warm compress + low dose topical steroids (FML BD) + lubes + gel/ointment for a month then bring back the patient. What about oral azithromycin for 3 days or novatears with omega3 or oral omega 3 supps?
Just a junior doctor wanting to get better and do better for my patients š