Issue: October 2021
Source:

Yeu E. Management of residual refractive error. Presented at: Real World Ophthalmology; Sept. 18, 2021 (virtual meeting).

Disclosures: Yeu reports having financial disclosures for Ace Vision Group, Alcon, Allergan, Avellino, Bausch + Lomb, Bio-Tissue, BVI, BlephEx, Bruder, CorneaGen, Dompé, Equinox, Expert Opinion, EyePoint Pharmaceuticals, Glaukos, Guidepoint, Johnson & Johnson Vision, Kala Pharmaceuticals, LayerBio, Lensar, Mati, Melt, Merck, Modernizing Medicine, Mynosys, Novartis, Ocular Science, Ocusoft, Omeros, Orasis, ScienceBased Health, Sight Sciences, STAAR, Sun, Surface, Tarsus, TearLab, Thea, Topcon and Zeiss.
October 05, 2021
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Use least invasive option possible when treating residual refractive error

Issue: October 2021
Source:

Yeu E. Management of residual refractive error. Presented at: Real World Ophthalmology; Sept. 18, 2021 (virtual meeting).

Disclosures: Yeu reports having financial disclosures for Ace Vision Group, Alcon, Allergan, Avellino, Bausch + Lomb, Bio-Tissue, BVI, BlephEx, Bruder, CorneaGen, Dompé, Equinox, Expert Opinion, EyePoint Pharmaceuticals, Glaukos, Guidepoint, Johnson & Johnson Vision, Kala Pharmaceuticals, LayerBio, Lensar, Mati, Melt, Merck, Modernizing Medicine, Mynosys, Novartis, Ocular Science, Ocusoft, Omeros, Orasis, ScienceBased Health, Sight Sciences, STAAR, Sun, Surface, Tarsus, TearLab, Thea, Topcon and Zeiss.
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When managing residual refractive error, physicians should treat the source of the problem and use the least invasive intervention possible, according to a speaker at the Real World Ophthalmology meeting.

“Find the cause and treat it if it is possible,” Elizabeth Yeu, MD, FACS, said. “If it’s an ocular surface issue or if it’s a toric IOL malrotation, those are easier ones to kind of get managed vs. having to do a refractive error correction, enhancement or exchange, and I always start with the least invasive intervention possible.”

“When we are looking at our patients with residual refractive errors, we have to kind of have a stepwise, methodical approach.”  Elizabeth Yeu, MD, FACS

When choosing a corrective option for refractive error, first determine whether the error is residual mixed astigmatism alone or if the spherical equivalent is off as well, and determine how large the error is, Yeu said. Then, evaluate if there are any comorbidities such as an irregular cornea, dry eye disease, or prior LASIK or radial keratotomy.

For residual mixed astigmatism of 1.25 D or less, Yeu said corneal relaxing incisions or IOL realignment may be warranted.

“If the mixed astigmatism is high, it might be a realignment, but this is where either laser vision correction or exchange is going to be more warranted,” she said.

If performing laser vision correction, it is important to wait at least 2 to 3 months after cataract surgery for wounds to settle.

“For myself, any time I am going to do any kind of excimer laser surgery, because the effective lens position can shift due to contraction fibrosis, I do perform a YAG capsulotomy before doing any kind of LASIK or PRK adjustment,” Yeu said.

An IOL exchange should be considered if the patient is experiencing a lens-related issue or poor quality of vision, specifically glare or dysphotopsias. Additionally, large refractive errors, a significant spherical equivalent error, cases in which a realignment will not help and cases in which laser vision correction is not an option are other instances in which an exchange should be considered, Yeu said.

“At the end of the day, when we are looking at our patients with residual refractive errors, we have to kind of have a stepwise, methodical approach, but the actual surgical correctional options are going to depend on the following: how much refractive error exists, if it is a toric IOL, where is the steep meridian, is it a mixed astigmatism or is the spherical equivalent off too, and are there any other concerns related to the IOL or corneal issues,” Yeu said.