Premium Implants Preop
October 26, 2009DrHovanesian No Comments »Premium Implants – requires extensive preop workup.
Patients having cataract surgery with a premium lens implant expect surgeons to deliver spectacle independence for at least a majority of activities. There is little room for unwanted surprises. For this reason, many surgeons using these lenses perform an extensive preoperative workup, including testing that goes beyond the standard of care for cataract surgery. In our practice, Harvard Eye Associates in south Orange County, California (http:www.harvardeye.com), we find that patients may benefit from the following tests:
Corneal topography
Our Humphrey Atlas topographer provides useful information, including:
Axial maps of overall corneal shape. Central flattening might suggest previous corneal refractive surgery that might have been missed on history-taking.
Corneal astigmatism. Correcting corneal astigmatism is particularly important for patients with multifocal implants such as the ReSTOR (Alcon), ReZoom (Abbott Medical Optics) and Tecnis multifocal (AMO). We have found that keratometry underestimates the magnitude of cylinder; we therefore rely on the color map of corneal topography to plan astigmatism correction, which can usually be accomplished with a limbal relaxing incision. For the latter, we use a modification of the Nichamin nomogram.
 Cystoid macular edema. |
Numerical view. This topography view shows an array of diopter powers measured at the corresponding points on the cornea. Moreover, it gives an average diopter power of the cornea in the central 0 mm, 1 mm, 2 mm and 3 mm. These are extremely useful for eyes with prior refractive surgery and can be used with Warren Hill’s formula for lens power calculation.
OCT
Although not common, epiretinal membranes and other causes of maculopathy are occasionally uncovered when the presence of cataract precludes a clear view of the macula. Patients appreciate that we do this simple, noninvasive test to help confirm good macular anatomy.
Endothelial cell counts
Newer-generation, non-contact endothelial cell cameras such as our Tomey EM-3000 calculate endothelial cell density and provide a clear image of the corneal endothelium without touching the eye. Rarely, this instrument helps us uncover a case of non-guttate Fuchs’ endothelial dystrophy that would have otherwise gone unnoticed on exam.
Most insurance carriers will not accept billing for these procedures as a simple screening procedure. Per the advice of Corcoran Consulting, we accept reimbursement for these extra tests as part of the fees we charge for using a premium implant. Naturally, we also perform these and other tests for any cataract patient – regardless of lens implant — if there is reason to suspect an accompanying disease.
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