REFERRING TO CLARITY VS SEEMA
Pro Tip:
It isn’t always that simple, is it? In general, Clarity Laser Vision is always private pay Refractive Surgery. For the ‘grey area” cases, send to Seema and we can triage accordingly.
It isn’t always that simple, is it? In general, Clarity Laser Vision is always private pay Refractive Surgery. For the ‘grey area” cases, send to Seema and we can triage accordingly.
When referring for enhancement, please either include last 3 refractions, or a comment on stability of refraction
Chamber should be well formed with no reaction. If any issues, likely unrelated to cataract surgery and should be investigated as appropriate.
Any uveitis at this stage of healing is likely unrelated to surgery. Need a second opinion, or just want someone else to manage a uveitis? Send to me and I’ll manage the acute condition, while you remain the primary eyecare provider!
If lens is too tight as evidenced by excessive conjunctival conjestion and excessive pain, consider removing and replacing the BCL
***Ideally done undilated. Patient may arrive still dilated in the first few days after surgery, which will affect your assessment
The fenestrated ports in the EVO ICL design have significantly lowered the risk of cataract formation. If vault is 0.5 or less, consider sending to the surgery centre for more exact measurement/monitoring. If vault is greater than 2, watch closely for pupil block.
You can also measure vault in microns on some OCTs and Pentacam
You may have noticed that the patient experience is quite different between the two clinics. Seema Eye Care is a very popular specialty clinic that sees a very high volume of patients, striving to help all those in need of our care. For this reason, it takes more time to process patients through the system. There is also an expected waiting time for surgery for AHS covered cataract surgeries, which is influenced by AHS policies and outside the control of Seema Eye Care centre. Clarity is designed to offer a higher touch, premium experience for our private pay Refractive clients. Clarity sees less volume, therefore can accommodate more timely referrals and appointments.
Patients with these conditions should absolutely not consider refractive surgery:
We evaluate each individual as a whole and carefully weigh the risks/benefits of surgery. If refractive surgery is not in their best interest, we won't do the surgery. If you are unsure, send them our way- be sure to include any questions/concerns you may have!
***looks like a rolled up carpet
- a small detachment can be observed
- a large detachment needs to be assessed by the surgeon
***both are required to notify the surgeon. It is imperative
to differentiate the two so you can implement timely
treatment correctly
Maassen JL, Folk JC: Endophthalmitis: 82-year-old male status post phacoemulsification in the left eye with acute decrease in vision. Eyerounds.org. December 5, 2005; Available from: http://www.EyeRounds.org/cases/45- Endophthalmitis-After-Cataract-Surgery.htm.
Both require urgent attention by the surgery centrenotify the surgeon immediately. If you suspect endophthalmitis this is an emergency and every hour counts!
It is recommended to wait a minimum of 3 months after surgery before performing a YAG capsulotomy to ensure a stable capsule/zonule system.
Some symptoms that would suggest considering a YAG are:
Send for YAG capsulotomy if patient is symptomatic and they present with one of the following in the posterior capsule:
Sometimes if a patient has an unwanted residual refractive error, we will perform a YAG capsulotomy prior to intervening with more invasive surgery to see if the IOL placement would be improved.
***looks like "lobes" of choroidal elevation in up to 4 quadrants
- differentiate from retinal detachment
- can have shallowing of the anterior chamber
- may have increased pain
- look for wound leak
- look for hypotony
- although some small choroidal effusions can be monitored for self resolution, it is best to notify the surgery centre, as this can potentially be a vision-threatening condition requiring surgical intervention
Contributor: Jesse Vislisel, MD
Photographer: Brice Critser, CRA
***injectable corticosteroid during cataract surgery - used in complex cataract cases to help reduce inflammation and visualize vitreous especially if there was trauma during surgery
Contributor: Eric Chin, MD
Photographer: Cindy Montague, CRA
Phimosis is a fibrotic metaplasia of the anterior capsule causing the anterior capsulotomy to "shrink" and create visual disturbances.
It is recommended to wait a minimum of 3 months after surgery before performing a YAG capsulotomy to ensure a stable capsule/zonule system. However if the phimosis is visually significant, can send sooner for surgeon to evaluate.
Contributor: Jesse Vislisel, MD
Photographer: Stefani Karakas, CRA
http://webeye.ophth.uiowa.edu/eyeforum/atlas/pages/capsular-phimosis/index.htm
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