Eyeworld Supplements

a lot of patients in a refractive practice, patients who are getting too old for LASIK or are outside the range of LASIK or have a bit of cataract. You can provide a solution that gives them a high level of spectacle independ- ence, particularly if there are patients who have the wrong personality type for multifocal IOLs—again, the perfec- tionist types don't do well with multifo- cals, they don't like their quality of vision. It has a place at any refractive surgical practice, in my opinion. That's different from the advice I would give a cataract surgeon. For a cataract surgeon, it's a different mind- set—Crystalens AO implantation is refractive surgery. They can still do it, as long as they have a plan for who's going to fix the refraction if it is wrong. Surgeons can't ask the patient to pay for that. They've got to include that in the original fee. There's nothing worse than having to say to a patient 6 months later, "Your distance vision is blurry and you're not happy, but it'll cost you to fix it." Then the patient says, "Doctor, this is your botch-up, you should fix it for free." Surgeons can't ask patients to pay for fixing their refractive error as they were trying to give them more distance vision. They've got to factor that into the original fee or the original surcharge. If you are a cataract surgeon, I think you to need to develop a rela- tionship with a refractive surgeon and come up with an agreed price for doing laser refractive surgery where the refractive surgeon does the proce- dure and you do the follow-up. As has been mentioned, you have to keep performing the surgery and implanting the lens to gain more confi- dence and make your patients hap- pier. Dr. Ang: I tell my colleagues that the Crystalens AO is a vital addition to their armamentarium of cataract and refractive products. They shouldn't let themselves get stuck in the multifocal age where, if someone asks, that's all they offer. There is a place for the Crystalens AO in practice; if they talk to their patients and ask them what they need, what they want, some of them will need a Cryst alens AO more than a multifocal. It's important to offer all the lenses to all your patients so you're not biased and stuck with just one kind of lens. Dr. Lindstrom: I couldn't agree more. One other thing that I do is treat my patients a little bit longer with anti- inflammatory drops. I'm wary of capsular fibrosis, and I'm also much more aggressive with the YAG laser with the Crystalens AO than I am with a monofocal lens. With the longer-term anti-inflammatory therapy, I'm hoping to retard capsular fibrosis, so I have my patients on a topical steroid twice a day for a full 2 months, which is more than many use on monofocals. So maybe a little more anti-inflammatory therapy may have value as well. Dr. Kent: My advice would depend on who the surgeon is. If he is a refractive surgeon, then I'd say yes, it's good for March 2012 11 " Over time, I've learned I need to ask the right questions and get a feel for the patient and then make a recommenda- tion, and that's pretty much what I think many people experience. As you say, in the end, we have to listen to our patients and then make a recommendation " Richard Lindstrom, M.D.

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