eye consultation test results

How a Consultation Determines if Vision Correction Surgery is Appropriate

GH consultation case study

The following is a case study on one of our patients GH to illustrate how a consultation determines if vision correction surgery is appropriate.

Consultations to decide if surgery is appropriate are much more comprehensive than an eye examination. This means we often find conditions that have gone unnoticed throughout a patient’s life even though they have been attending regular eye exams. Here is an interesting example and how the patient was treated.

Consultation Eye Test

One of our long term partners referred a 49 year old male who had been wearing RGP lenses for the last 32 years. He was finding his vision was not as good as it used to be and wanted to find a permanent solution. The partner optometrist had discussed clear lens exchange surgery briefly with him.

At the time of his consultation, we wanted to meticulously gather the most accurate test results, so our clear lens exchange surgeon can advise the patient of their surgical options and outcomes. For this we need a precise refraction. As the optometrist knew this, they kindly refitted the patient with soft contact lenses so the cornea could start to demould.

Consultation Eye Test Results

The patient was then seen by AVC 5 weeks after for a consultation. The following results were found:

Patients current single vision distance spectacles about 2-3 years old:

Sph

Cyl

Axis

VA

RE

-6.75

-1.00

106

6/20

LE

-5.50

-2.75

95

6/10+

Refraction:

Unaided

Sph

Cyl

Axis

VA

Add

VA

RE

6/120

-6.00

-1.75

107

6/10

+2.00

N4

LE

>6/120

-6.00

-2.75

90

6/10+

+2.00

N5

 

Ocular Examinations:

Right

               

Left

587

Corneal Pachymetry (µm)

594

5.0

Colvard Pupil Diameter (mm)

5.0

14

Goldmann Contact Tonometry (mmHg)

14

 42.7 @ 175, 38.9 @ 85

Orbscan keratometry (D)

43.5 @ 15, 36.1 @ 105

3.03

Anterior Chamber Depth (mm)

3.04

Ptosis

Anterior Segment Evaluation

Ptosis

Clear

Crystaline Lens

Clear

Unremarkable

Opthalmoscopy

Unremarkable

The corneal topography revealed the patient has bilateral pellucid marginal degeneration condition is more progressed in the left eye.

orbscan eye test resultspentacam eye exam results

Consultation Recommendations

The condition, along with his bilateral amblyopia, was discussed with the patient so he could better understand his complex case.

If a patient has any corneal conditions like Pellucid Marginal Degeneration or keratoconus, laser surgery is not advocated.

The Medical Director of Advanced Vision Care, Dr Pillai, personally sees our patients to formulate and discuss their treatment plans. Many surgeons in this case would choose not to treat because of their lack of expertise for irregular corneas. By contrast, Dr Pillai with over 25 years worth of experience has treated patients with these type of conditions with great success previously.

It was recommended the patient have bilateral clear lens exchange surgery with monofocal toric IOLs. He was counselled the measurement of the IOL is less accurate than with ‘normal’ corneas. This would mean he would require bilateral piggyback IOLs to correct any residual prescription. Laser top up was not an option. He was also advised he was not a suitable candidate for multifocal IOLs because of the irregular cornea and minor amblyopia.

The patient was happy with everything discussed and gave his consent to proceed. Due to the nature of his prescription, he did return for refraction checks to determine stability (cornea demoulded from the RGP contact lenses) and reliability. Once this was achieved, the IOLs could be calculated and ordered.

The patient underwent bilateral clear lens exchange surgery with monofocal toric IOL implants in August 2015. At the first day post-operative appointment, the right eye had a vision of 6/9 and the left 6/12.

As the eyes began to heal and the IOLs to settle, the right eye vision deteriorated to 6/20 and the left improved to 6/7.5, 2 months following surgery. The following refraction was found:

Sph

Cyl

Axis

VA

RE

+1.25

-0.75

85

6/7.5

LE

+0.00

-0.50

95

6/7.5

Surprisingly the left eye had performed remarkably and did not require a piggyback lens, even though this eye had the greater corneal irregularities.

The patient had surgery for a piggyback IOL to be inserted into the right eye in December 2015. We check the patient 10 days post-operation. His vision had improved to 6/7.5 in the right eye and the left eye was stable at 6/7.5. Binocularly he could achieve 6/6. This shows what remarkable vision can be achieved. The patient was delighted with his vision and very happy to wear spectacles for near. At this stage the patient was handed back to his optometrist to continue the post-operative check-ups. He continues to be delighted with his vision.
 

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