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    Put patients first with refractive surgery

    We now live in the age of refractive cataract surgery. As optometrists, we think daily about refractive endpoints for glasses and contact lenses. But few think about it in terms of ocular surgery.

    I have been fortunate to work with surgeons whose goal was to give each patient the vision he wanted without this glasses with each surgery, even PTK and transplants. This was, at times, a lofty if not unreachable goal, but the fact that we discussed it reassured the patient that we had his best result in mind. I firmly believe this philosophy can help grow our practice and improve your referral surgeon’s impression of you as well. I try to maximize my patients’ vision at each encounter. Here’s how. 


    Before referral

    Prior to referral for surgery, I consider the endpoint. Many default to distance correction and target plano. But that may not be the best for every patient. Consider the -4.00 D myope who reads in bed every night, or builds model airplanes competitively. I admit I see more than my share of these rare hobbies in the engineering capital of Huntsville, AL. What is the best endpoint for these patients? Determine this prior to surgery to avoid an unhappy patient. Ask if they want to see the TV or read without glasses, or if they want to replicate the monovision that they have been successful with in contact lenses. 

    If a patient expresses interest a presbyopic correction, investigate monovision or a multifocal prior to referral to the MD. This may include a short monovision or multifocal contact lens trial in the office or overnight. Staff can apply lenses and remove them to avoid the dreaded I&R. If the trial fails, then a discussion of monofocal vs. accommodative lens is beneficial. The point is you are trying to determine what the patient will be happy with after surgery.

    Next: Assessing ocular health

    Tracy Schroeder Swartz, OD, MS, FAAO
    Tracy Schroeder Swartz currently practices at Madison Eye Care Center in Madison, Alabama. She serves as Education Chair for the ...


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