Joint Archive of Continuing Education

44583-PO-109481 – Outline

Refractive Error after Cataract Surgery – Outline

Amit Tandon, MD
Clinical Associate Professor of Ophthalmology

  1. Overview
    1. Cataract Surgery
    2. Rate
    3. Outcomes
    4. IOL measurements/selection
    5. Refractive Changes During Cataract Surgery
    6. What Causes Refractive Error after Surgery
    7. How to Correct Residual Refractive Error After Cataract Surgery
  2. How to Pick IOL Power
    1. Need to know: Axial length (L), K’s, A Constant of specific IOL, Equation to calculate lens power
    2. IOL master/LenStar
      1. Easy for techs
      2. Precise, reproducible data
      3. Measures Axial Length/K’s
      4. More reliable than prior instruments
    3. A scan
      1. Careful to center, Careful not to indent
      2. If indent 1/3 of a mm, off by 1 Diopter
    4. Immersion A scan
      1. Harder for patient, Harder to center
      2. No indentation error
    5. Keratometry
    6. Topography
    7. Manual K’s
    8. Topography
    9. Harder for technician, Not reimbursed by insurance for cataracts
  3. How to Pick IOL Power – A Constant and formula
    1. Definition of A constant
    2. Different for IOL master and A scan 
  4. Refractive Changes During Cataract Surgery
    1. Change in K’s
      1. Main incision
      2. LRI (limbal relaxing incisions)
    2. Change in effective lens position
    3. Capsullorhexis size?
    4. Optimize A constant
  5. What Causes Refractive Error after Surgery?
    1. Residual Astigmatism
      1. Planned, Unplanned, Unpredictable
    2. Residual Sphere
      1. Poor measurements, Lens position, Other
  6. How to Correct Residual Refractive Error
    1. Glasses/Contacts
    2. LASIK touchup
    3. Lens Based Surgery
      1. IOL exchange
      2. Piggyback IOL
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