8/13/2019 Perfect Surgery, Unhappy Patient?

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A t St. Lukes Cataract & Laser Institute, the motto isExcellencewith Love. Physicians who performcataract and refractive surgeries, as well as theirmedical teams at St. Lukes seven ofces in Tampa

Bay and central Florida, fulll the promise of excellence usingthe latest surgical advances and technologies. Patients, in turn,expect the practices promise of excellence to translate intorst-rate visual outcomes. The love comes from caring staffmembers, who engage with patients and help educate them atevery opportunity.

We want happy patents, and patients are happy whentheyre completely satised with their vision after surgery, saysJeffrey A. Wipi, MD, who performs more than 200 cataractand refractive surgeries per month at St. Lukes. With all ofthe advanced IOLs available to cataract patients, Dr. Wipischallenge is to identify candidates who will be successful and,therefore, happy with the results. In order to accomplish that,

he has to know a patients personality, history and pathology.But those things arent enough.The vast majority of patients are happy with their vision

after they receive an advanced IOL such as a multifocal, heexplains. But sometimes even when surgery goes smoothly andthe refraction looks good, patients may experience glare or poorimage quality. Few things are more frustrating than performingall the appropriate preoperative work and screening, only tohave a patient be dissatised because of factors we couldntidentify before surgery.

Dr. Wipi points to two major factors that lead to thisproblem: high angle kappa and higher-order aberrations.

Weve always known that patients with high angle kappacould have problems with multifocal lenses because theymay not be looking through the center of the lens. If patientsarent looking through the middle of the concentric rings onthe lens, they may experience glare and poor image quality.Patients with irregular corneas or higher-order aberrationscan experience poor image quality as well, he says. But it hasbeen difcult to turn this knowledge into action, to rule outthese patients as multifocal candidates. We had no device toeasily and accurately measure angle kappa. I didnt put muchfaith in our previous wavefront device for mapping high-er-order aberrations, so we were stuck with the occasionalunhappy outcome.

Essential Data

Dr. Wipi and his colleagues needed a way to measure anglekappa and higher-order aberrations accurately within theefcient timeframe of a high-volume practice. Marcos EPICsystem had been automating the practices fast, accurate preop-erative workups and efcient patient ow for 5 years, and therewas no room to backtrack by adding time to the process.

The solution came from St. Lukes clinical director, MyraCherchio, COT, who suggested that surgeons try using MarcosOPD-Scan III with the EPIC workstation. The OPD -Scan III offersautorefraction/keratometry, corneal topography, wavefront

aberrometry, the ability to measure angle kappa and much more.These capabilities set it apart and made it a potential solution tothe problem of unhappy multifocal IOL recipients.

Though we knew little about the new OPD-Scan III, Imvery glad we were able to experience all of the advantages of thenew device, says Dr. Wipi. Ive been very happy with it for nu-merous reasons, the most important being that the informationit provides has helped dramatically in determining which IOLs

are best for our patients. We have a much better idea, for exam-ple, who will have satisfying outcomes with multifocal lenses.

The OPD-Scan IIIs added capabilities, such as retroillumi-nation to measure angle kappa and higher denition for viewingrings and dry spots, make a big difference in our work, explainsSarah Saile, a lead technician at St. Lukes. And it still happens allin one snap when we capture the corneal topography.

Happy PatientsWe havent had one unhappy multifocal patient since westarted using the OPD-Scan III, Dr. Wipi says. That doesntmean it wont happen, but the device has denitely helped. Nowwe can predict much more accurately which patients are goodcandidates for the lenses and which ones risk visual problems. Itmeasures angle kappa very accurately and clearly, so we can seeif the visual axes align.

I couldnt live without it. It gives us more informationand cuts the mystery factor when it comes to lens options sosurgeons can offer more educated suggestions, Ms. Saile says.When patients with high angle kappa come in askingspecically for multifocal lenses, we can show them clearly onthe OPD-Scan III if a multifocal isnt likely to work. Its not aboutselling lenses, its about making patients happy.

That teaching component helps OPD-Scan III users engagepatients in the discussion about IOLs and other aspects ofsurgery. There are more teaching screens for patients thanweve even learned to use yet! Dr. Wipi says. But were using

the OPD-Scan III to explain some things, such as astigmatismand its treatments. Because the analysis separates lenticular andcorneal astigmatism, we can show patients what the IOL willand will not correct.

Ms. Saile says the OPD-Scan III makes an excellent educa-tional tool for another type of unhappy patient: one whoexperiences dry eye. Patients who have dry eye after surgerytend to think that it was caused by the surgery, she says. NowI can show them that they had dry spots before surgery, and

explain that surgery doesnt cure that. Its both a visuavisual proof, so patients understand and accept it.

Bonus BenetsIn addition to removing the mystery from IOL selectiohelping St. Lukes have happy patients, the OPD-Scanseveral added benets, according to Ms. Saile.

Technicians are more condent that weve collecte

image for the doctor because of the advanced denitioaccuracy topography of the OPD-Scan III, she explaialso condent that measurements are correlated betwe

K-readings from the IOLMaster (Carl Zeiss Meditec) OPD-Scan III. We dont have to go back and forth, remand double checking to ensure that they match.

And remember the highly automated and efcientpreoperative workup that St. Lukes wanted to maintabecame a little more efcient.

The OPD-Scan III collects more data in less time OPD-Scan II, says Ms. Saile It shaves 20 to 30 secon

EPIC process, which adds up in a high-volume practicThe OPD-Scan III not only helps us clinically, but it althe process noticeably more efcient.l

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BY ERIN MURPHY, CONTRIBUTING EDITOR

Perfect Surgery,

Unhappy Patient?

THE ENGAGED PRACTICE

For multifocal IOL recipients, the secret to successis in the preoperative data. We havent had one unhappy

multifocal patient since westarted using the OPD-Scan III,

Dr. Wipi says. Now we canpredict much more accurately

which patients are goodcandidates for the lenses and

which ones risk visual problems.It measures angle kappa very

accurately and clearly, so we cansee if the visual axes align.