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    My refractive surgery journey as surgeon and patient

    Spanning 40 years from early research to my own procedures, including cataract surgery

     

    Moving on to cataract surgery

    Now that I had a near spherical cornea with topography that looked like hyperopic PRK,  the next challenge was to remove my cataract because my vision had decreased to 20/40-.

    Dr. Seibel had removed my right cataract seven years earlier, and it was time to plan the surgery on my left eye. I decided I wanted a monofocal lens targeted for monovision of between -1.00 D and -1.50 D. I had corneal measurements which showed four different amounts of astigmatism (Table 1), and the Pentacam showed over 1.00 D of posterior astigmatism.

    I consulted with my friends Dr. Jack Holladay and Dr. Dough Koch. Because of the uncertainty of the keratometer readings, we used the ASCRS post hyperopic PRK or LASIK formula, and we had both a toric lens and a monofocal lens available. The plan was to use a toric if ORA readings revealed consistent astigmatism and a monofocal if the readings were variable. We could not obtain consistent readings, so we chose a monofocal implant, targeted for monovision of about -1.50 D.

    Dr. Seibel also used the Catalys Femtosecond laser system to create a 5.3 mm rhexis and pre-divide the nucleus into sextants (Figure 4).

    I am happy to report that six months postop, my UCCA is 20/100, near vision is J3, and my refraction is -1.25 D. Although I can function quite well without glasses, I still wear progressive lenses most of the time.

    So, when discussing LASIK and premium cataract surgery with patients, this question still comes up. “If this surgery is so great Dr. Salz, why are you wearing glasses?”

    References

    1. Salz JJ. Clinical results of radial keratotomy in human cadaver eyes. Radial Keratotomy. Los Angeles: Denison, 1980. 133-143.

    2. Salz JJ, Rowsey JJ, Caroline P, Azen SP, Suter M, Monlux R. A study of optical zone size and incision redeepening in experimental radial keratotomy. Arch Ophthalmol. 1985 Apr;103(4):590-4.

    3. Salz JJ, Lee T, Jester JV, Villaseñor RA, Steel D, Bernstein J, Smith RE. Analysis of incision depth following experimental radial keratotomy. Ophthalmology. 1983 Jun;90(6):655-9.

    4. Salz JJ. Pathophysiology of radial keratotomy incisions. Refractive Surgery: A Text of Radial Keratotomy. Ed. Sanders D, Hoffman R. Thorofare, NJ: Slack, Inc. 1984. 73-85.

    5. Salz JJ. Four-incision radial keratotomy for low to moderate myopia and eight-incision radial keratotomy for high myopia. Radial Keratotomy Surgical Techniques. Thorofare, NJ: Slack, Inc. 1986. 5-34.

    6. Salz JJ, Fasano A. Indications, techniques, and results of a conservative approach to radial keratotomy. Current Practice in Ophthalmology. Ed. Schachat A. St. Louis: Mosby. 1992.

    7. Waring GO 3rd, Arentsen JJ, Bourque LB, Gelender H, Lindstrom RL, Moffitt SD, Myers WD, Obstbaum SA, Rowsey JJ, Safir A, et al. Design features of the prospective evaluation of radial keratotomy (PERK) study. Int Ophthalmol Clin. 1983 Fall;23(3):145-65.

    8. Salz JJ. Radial keratotomy in fresh human cadaver eyes. Presentation at: American Academy of Ophthalmology annual meeting; 1980 November. Chicago.

    James J. Salz, MD
    Clinical professor of ophthalmology, University of Southern California, Los Angeles

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