Postoperative Intolerance of Monovision

Surgeons are asked to address a case in two parts.

Brandon D. Ayres, MD; Kara Jones, MD; Clara C. Chan, MD, FRCSC, FACS; Jennifer Loh, MD; and Gregory S.H. Ogawa, MD

Cataract and Refractive Surgery Today

KEY TAKEAWAYS Surgeons consider how to manage a patient’s intolerance of monovision 2 years after bilateral cataract surgery Interventions considered include a refractive enhancement and an IOL exchange The panelists weigh how to proceed when the patient’s visual acuity decreases to no light perception following an IOL exchange CASE PRESENTATION A 63-year-old woman is referred by her ophthalmologist for evaluation for an IOL exchange. Two years ago, the patient underwent bilateral cataract surgery with a Light Adjustable Lens (LAL; RxSight) and a monovision strategy; the right eye was targeted for distance vision and the left eye for near vision. She has been experiencing headache and nausea because her eyes are not working together properly. On examination, the patient’s UCVA is 20/20 OD and 20/20-1 OS. The manifest refraction is -0.50 +1.00 x 019º OD and -0.75 +0.25 x 008º OS. Pupillary motility is full, and no relative afferent pupillary defect (RAPD) is evident. A slit-lamp examination shows a well-positioned LAL and an open posterior capsule in each eye. A posterior examination of each eye is normal. How would you approach the patient’s intolerance of monovision? Biometry is provided in Figure 1 to assist with decision-making.

Conjunctivochalasis and Hyaluronic Acid in the Dry Eye Space

Eyetube

Co-hosts Jackie Garlich, OD, FAAO, and Jessilin Quint, OD, FAAO, sit down with Damon Dierker, OD, FAAO, on To the Point to talk about his approach to conjunctivochalasis. Dr. Dierker notes that he prefers to start the dry eye management process by addressing more common patient symptoms, such as inflammation. If symptoms persist, it’s time to introduce conjunctivochalasis as a diagnosis into the conversation. Dr. Dierker covers what to look for and different treatment options, including a more significant intervention that he has found success with: plasma-based conjunctivoplasty. Drs. Garlich and Quint then pick Dr. Dierker’s brain on hyaluronic acid, how he’s integrated it into his clinic, and patient candidacy.

Biomarkers, Imaging, and Early Treatment Decisions in Geographic Atrophy

Geeta Lalwani, MD; Murtaza Adam, MD; and Carl Danzig, MD

Eyetube

Which imaging biomarkers matter most at diagnosis of GA, and how should they shape the decision to treat? In episode 1 of the GA in Practice miniseries on New Retina Radio, moderator Geeta Lalwani, MD, and panelists Murtaza Adam, MD, and Carl Danzig, MD, review the practical role of fundus autofluorescence and OCT in identifying high-risk GA, discuss ellipsoid zone integrity as an emerging endpoint, and work through a hypothetical case of an active, motivated patient with bilateral extrafoveal GA and good vision to explore how lifestyle, lesion characteristics, and patient education factor into early treatment decisions.