A patient´s ocular journey over a lifetime Martin Bechmann Smile Eyes München/Trier/Luxemburg
Financial disclosures • Zeiss • Staar
Dealing with patients and their needs over a life time and not just for one surgery
Only Myopia and Astigmatism
First contact: Patient age 20 - 39
Patient age 20 - 39 • Adventerous • Don’t think too much about the future • Limited budget
Patient age 20 - 39 • LVC // PRK / LASIK / SMILE • Phakic IOL
Patient age 20 – 39 / PRK • Safe • Cheap • Inconvenient • Touch up Overcorrection/Undercorretion
Patient age 20 – 39 / LASIK • Safe Ectasia • convenient • Touch up easy / 1 – 2 times possible
Patient age 20 – 39 / SMILE • Safe • convenient • Touch up PRK / CIRCLE
Accuracy • CIRCLE enhancement after myopic small incision lenticule extraction (SMILE) • Jakob Siedlecki 1,2 , Nikolaus Luft 1,2 , Wolfgang J. Mayer 1 , Martin Siedlecki 1 , Daniel Kook 3 , Bertram Meyer 4 , Martin Bechmann 3 , Rainer Wiltfang 3 , Siegfried G. Priglinger 1,2 , Martin Dirisamer 1,2
Safety • CIRCLE enhancement after myopic small incision lenticule extraction (SMILE) • Jakob Siedlecki 1,2 , Nikolaus Luft 1,2 , Wolfgang J. Mayer 1 , Martin Siedlecki 1 , Daniel Kook 3 , Bertram Meyer 4 , Martin Bechmann 3 , Rainer Wiltfang 3 , Siegfried G. Priglinger 1,2 , Martin Dirisamer 1,2
Efficacy • CIRCLE enhancement after myopic small incision lenticule extraction (SMILE) • Jakob Siedlecki 1,2 , Nikolaus Luft 1,2 , Wolfgang J. Mayer 1 , Martin Siedlecki 1 , Daniel Kook 3 , Bertram Meyer 4 , Martin Bechmann 3 , Rainer Wiltfang 3 , Siegfried G. Priglinger 1,2 , Martin Dirisamer 1,2
Touch up opportunities are the most important factor for the future
Second contact: Presbyopiacorrection?
Patient age 40 – 55 • Reasonable • Risk-averse
Patient age 40 – 55 / after LVC • Monovsion • Presbyond • EDOF phakic IOL • Multifocal RLE ?
Patient age 40 -55 / Retinal detachment Incidence, Risk Factors, and Impact of Age on Retinal Detachment after Cataract Surgery in France Daien, Vincent et al. Ophthalmology 2015 , Volume 122 , Issue 11 , 2179 - 2185
Patient age 40 – 55 / after LVC • Monovsion • Presbyond • EDOF phakic IOL • Multifocal RLE ?
Third contact: RLE / Cataractsurgery
Patient age > 55 • Reasonable • Think about health
Patient age > 55 • Refractive surgery is lens surgery • RLE monofocal / monovsion • RLE multifocal
Lens surgery after LVC • Predicatbility
Lens surgery after LVC • Predicatbility • Different formulas Haigis L and ASCRS online calculator
Lens surgery after LVC • Predicatbility • Different formulas Haigis L and ASCRS website • Touch up opportunities PRK / LASIK /SMILE
Touch up opportunities after PRK • Predictability comparably low in Hyperopiacorrection • Uncomfortable
Touch up opportunities after LASIK • Risk of EI increases over time
Touch up opportunities after LASIK Risk factors for epithelial ingrowth after LASIK Friehmann A, Mimouni M, Nemet AY, Sela T, Munzer G, Kaiserman I. J Refract Surg. 2018 Feb 1;34(2):100-105.
Touch up opportunities after SMILE • CIRCLE • No increased risk of EI • Best touch up options in LVC
Multifocal RLE?
Contraindications • Amblyopia
Contraindications • Amblyopia (Lang +) • Myopia ≧ 6 dpt
ö Contraindications ü OD, IR 30 ° ART + OCT 30 ° (8.5 mm) ART (100) Q: 36 [HS] • Amblyopia (Lang +) • Myopia ≧ 6 dpt 200 µ m 200 µ m 200 µ m 200 µ m • Macular Pathology OS, IR 30 ° ART + OCT 30 ° (8.4 mm) ART (92) Q: 32 [HS] 200 µ m 200 µ m 200 µ m 200 µ m Ü
Contraindications • Amblyopia (Lang +) • Myopia ≧ 6 dpt • Macular Pathology • Irregular cornea
Contraindications • Amblyopia (Lang +) • Myopia ≧ 6 dpt • Macular Pathology • Irregular cornea
Lens surgery after LVC • Very demanding patients!
“Aller guten Dinge sind drei ” “all good things come in three”
EVO+ Evolution in Visual Freedom
EVO+ Evolution in Visual Freedom
Stabilisation of myopia The COMET Group. Myopia Stabilization and Associated Factors Among Participants in the Correction of Myopia Evaluation Trial (COMET). Investigative Ophthalmology & Visual Science . 2013;54(13):7871-7884. doi:10.1167/iovs.13-12403.
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