ESCRS - FPM07.08 - An Algorithmic Approach In Management Of Unhappy Patients Post-Refractive Surgery

An Algorithmic Approach In Management Of Unhappy Patients Post-Refractive Surgery

Published 2022 - 40th Congress of the ESCRS

Reference: FPM07.08 | Type: Free paper | DOI: 10.82333/j4t8-vj21

Authors: Soumya Ganesh Nanaiah* 1 , Rohit Shetty 2 , Pooja Khamar 3 , Sumitha Muthu 3 , Puja Sarbajna 4

1Cataract & Refractive,Lopamudra Drishti Eye Hospital,Kodagu,India;Cataract & Refractive,Narayana Nethralaya Superspecialty Eye Hospital,Bangalore,India, 2Cornea & Refractive Surgery ,Narayana Nethralaya Superspecialty Eye Hospital ,Bangalore ,India, 3Cornea & Refractive,Narayana Nethralaya Superspecialty Eye Hospital,Bangalore,India, 4Narayana Nethralaya Superspecialty Eye Hospital,Bangalore,India

Purpose

To report a step-wise evaluation of post-refractive surgery patients presenting with myopic, hyperopic shift or glare and delineate the role played by Non Strabismic Binocular Single Vision Anomalies (NSBVA) in the causation of the same. We further evaluated whether altered lifestyle in COVID-9 era impacted the incidence of NSBVA.

Setting

Super specialty Eye hospital 

Methods

Out of 4000 patients who underwent refractive surgery during the year 2019, 65 were unhappy after surgery. Patients presenting with blurred vision, difficulty in night vision, glare & focusing issues underwent refraction, dry eye evaluation, topography, aberrometry, contact lens (CL) trial & orthoptic evaluation. Patients improving with CL trial were given glasses or subjected to laser treatment. Patients with dry eye were given targeted dry eye treatment. Patients with high dysfunctional lens index (DLI) underwent lens-based procedure.Vision therapy (VT) exercises were initiated in those diagnosed with Non Strabismic Binocular Single Vision Anomalies (NSBVA)

Results

22 patients had dry eye, 35 NSBVA, 5 early lens changes and 3 decentered ablations. Appropriate treatment was given to all. In patients with NSBVA, 35% eyes with post-operative myopic shift with a mean (SD) of -2.25D and 16.7% eyes with hyperopic shift with mean (SD) of 1.75D were associated with vergence/accommodation infacility (p<0.05). 67% eyes with glare were associated with vergence anomalies. Incidence of NSBVA increased by 26% in COVID lockdown. After VT, mean residual refraction reduced to 0.35D & 0.50 D in patients with myopic shift &patients with hyperopic shift respectively. Glare reduced significantly in 99% eyes (p<0.05)

Conclusions

Non Strabismic Binocular Single Vision Anomalies contribute to majority of patients presenting with post-refractive surgery patient dissatisfaction. Meticulous evaluation and VT exercises has thus gained importance. A systematic algorithmic approach helps identify the true cause leading to patient dissatisfaction & helps in appropriate management.