EP: Post-laser Patients: Understanding Aberrations (Part 1)

Summary

Professor Graham Barrett is joined by Professor Dan Reinstein and Mr Darshak Patel to discuss the benefits of RayOne EMV for post corneal refractive surgery patients, focusing on the importance of tailored approaches through careful diagnostics and lens selection to reduce the risk of post-operative complications.

Bios:

Professor Graham Barrett, is a consultant ophthalmic surgeon at Sir Charles Gairdner Hospital and a Clinical Professor in the University of Western Australia’s Centre for Ophthalmology and Visual Science. Professor Barrett has a made an extensive and varied contribution to ophthalmology, both nationally and internationally. He is founder and immediate past President of the AUSCRS. He is the recipient of major international awards and he has developed innovative instruments aimed at improving outcomes for patients undergoing cataract surgery which are widely used by ophthalmic surgeons, including the Rayner RayOne EMV.

Professor Dan Z. Reinstein, Founder and Medical Director of the London Vision Clinic and part of the EuroEyes Group, is a board-certified ophthalmologist in the US and Canada, with professorships in the UK, New York, and Paris. Dedicated to Refractive Surgery since the 1990s, he has pioneered epithelium mapping and corneal 3D pachymetric imaging with VHF digital ultrasound and OCT. His extensive contributions include over 215 scientific papers, 1,000+ lectures globally, and significant roles in Therapeutic Refractive Surgery and as the Section Editor for the Journal of Refractive Surgery. Reinstein developed PRESBYOND Laser Blended Vision, now a part of the Carl Zeiss Meditec platform, and has been their Lead Refractive Surgery consultant since 2001. He authored a definitive textbook on SMILE, contributed to 44 book chapters, and holds patents for VHF digital ultrasound technology, commercialized as the Insight 100 by ArcScan Inc., which is pivotal for the most accurate ICL sizing. His achievements have earned him numerous awards, including the Waring Medal (2006), the Kritzinger Award (2013), the ISRS President’s and American Academy of Ophthalmology Senior Achievement Awards (2020), and a Lifetime Achievement Award from UKISCRS (2023). An accomplished saxophonist, he has maintained a monthly residency at the 606 Club in Chelsea for over 20 years.

Mr Darshak Patel is a highly accomplished ophthalmic surgeon graduating from University College London with a distinction in clinical science in addition to multiple medical school awards and a further distinction in his Masters. He completed his Ophthalmic residency in London followed by 2 years of corneal, cataract and refractive surgery subspecialisation at the Western Eye Hospital and Moorfields.

Key Takeaways:

  • Refractive Surgery and Lens Extraction: The discussion focuses on managing patients who have undergone refractive surgery (LASIK, PRK, SMILE) and now require lens extraction, either for cataracts or refractive purposes.
  • Spherical Aberration and Lens Selection: Traditionally, negative aspheric lenses were recommended for patients with myopic or hyperopic laser surgery. Today, however, this isn’t a strict rule. There’s an emphasis on customising the lens choice based on the patient’s spherical aberration profile.
  • Cataract Surgery after Refractive Surgery: When performing cataract surgery after a patient has had procedures such as Presbyond, the goal is to restore their previous range of vision by accounting for spherical aberration.
  • Lens Selection Considerations: The selection of intraocular lenses (IOLs) post-refractive surgery is influenced by factors such as the patient’s spherical aberration, pupil size, and coma. RayOne EMV is one of the few choices if you want to increase the patient’s spherical aberration.
  • Need for Comprehensive Measurements: The speakers agree that patients with a history of laser refractive surgery should undergo thorough corneal profile measurements (e.g., topography) before cataract surgery. This includes evaluating spherical aberration and coma, even if it may not always lead to major changes in lens choice.
  • Topography as a Standard: The panel stresses that topography is essential in modern cataract surgery, especially for those with prior laser treatment, to avoid complications. Even small levels of astigmatism should be checked through topography to ensure accuracy in biometry.
  • Lens Selection Based on Corneal Aberration: Lens selection should be tailored to the individual’s corneal aberrations, particularly spherical aberration. Rather than having a universal lens for post-refractive patients, choices should be made depending on whether there is excessive spherical aberration that needs correction.
  • Monovision and Anisometropia: For post-refractive patients, mini monovision or anisometropia is recommended to maximise near and distance vision without excessive reliance on reading glasses. The degree of anisometropia may depend on the individual’s corneal characteristics and depth of field.

Additional Resources:

Follow Prof Graham Barrett on Social:
Prof Graham Barrett | LinkedIn
Dr Ben LaHood| Twitter

Follow Prof Dan Reinstein on Social:
Prof Dan Reinstein | LinkedIn
Prof Dan Reinstein| Instagram

Follow Mr Darshak Patel on Social:
Mr Darshak Patel | LinkedIn