A patients ocular journey over a lifetime Martin Bechmann Smile - - PowerPoint PPT Presentation

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A patients ocular journey over a lifetime Martin Bechmann Smile - - PowerPoint PPT Presentation

Apr 24, 2023 277 likes •708 views

A patients ocular journey over a lifetime Martin Bechmann Smile Eyes Mnchen/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

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A patient´s ocular journey over a lifetime

Martin Bechmann Smile Eyes München/Trier/Luxemburg

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Financial disclosures

  • Zeiss
  • Staar
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Dealing with patients and their needs

  • ver a life time and not just for one surgery
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Only Myopia and Astigmatism

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First contact:

Patient age 20 - 39

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Patient age 20 - 39

  • Adventerous
  • Don’t think too much about the future
  • Limited budget
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Patient age 20 - 39

  • LVC // PRK / LASIK / SMILE
  • Phakic IOL
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Patient age 20 – 39 / PRK

  • Safe
  • Cheap
  • Inconvenient
  • Touch up

Overcorrection/Undercorretion

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Patient age 20 – 39 / LASIK

  • Safe

Ectasia

  • convenient
  • Touch up

easy / 1 – 2 times possible

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Patient age 20 – 39 / SMILE

  • Safe
  • convenient
  • Touch up

PRK / CIRCLE

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  • CIRCLE enhancement after myopic small incision lenticule extraction (SMILE)
  • Jakob Siedlecki1,2, Nikolaus Luft1,2, Wolfgang J. Mayer1, Martin Siedlecki1, Daniel Kook3, Bertram Meyer4, Martin Bechmann3, Rainer

Wiltfang3, Siegfried G. Priglinger1,2, Martin Dirisamer1,2

Accuracy

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Safety

  • CIRCLE enhancement after myopic small incision lenticule extraction (SMILE)
  • Jakob Siedlecki1,2, Nikolaus Luft1,2, Wolfgang J. Mayer1, Martin Siedlecki1, Daniel Kook3, Bertram Meyer4, Martin Bechmann3, Rainer

Wiltfang3, Siegfried G. Priglinger1,2, Martin Dirisamer1,2

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Efficacy

  • CIRCLE enhancement after myopic small incision lenticule extraction (SMILE)
  • Jakob Siedlecki1,2, Nikolaus Luft1,2, Wolfgang J. Mayer1, Martin Siedlecki1, Daniel Kook3, Bertram Meyer4, Martin Bechmann3, Rainer

Wiltfang3, Siegfried G. Priglinger1,2, Martin Dirisamer1,2

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Touch up opportunities are the most important factor for the future

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Second contact:

Presbyopiacorrection?

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Patient age 40 – 55

  • Reasonable
  • Risk-averse
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Patient age 40 – 55 / after LVC

  • Monovsion
  • Presbyond
  • EDOF phakic IOL
  • Multifocal RLE ?
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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

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Patient age 40 – 55 / after LVC

  • Monovsion
  • Presbyond
  • EDOF phakic IOL
  • Multifocal RLE ?
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Third contact:

RLE / Cataractsurgery

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Patient age > 55

  • Reasonable
  • Think about health
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Patient age > 55

  • Refractive surgery is lens surgery
  • RLE monofocal / monovsion
  • RLE multifocal
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Lens surgery after LVC

  • Predicatbility
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Lens surgery after LVC

  • Predicatbility
  • Different formulas Haigis L and ASCRS
  • nline calculator
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Lens surgery after LVC

  • Predicatbility
  • Different formulas Haigis L and ASCRS

website

  • Touch up opportunities

PRK / LASIK /SMILE

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Touch up opportunities after PRK

  • Predictability comparably low in

Hyperopiacorrection

  • Uncomfortable
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Touch up opportunities after LASIK

  • Risk of EI increases over time
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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.

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Touch up opportunities after SMILE

  • CIRCLE
  • No increased risk of EI
  • Best touch up options in LVC
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Multifocal RLE?

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Contraindications

  • Amblyopia
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Contraindications

  • Amblyopia (Lang +)
  • Myopia ≧ 6 dpt
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Contraindications

  • Amblyopia (Lang +)
  • Myopia ≧ 6 dpt
  • Macular Pathology
ö ü Ü 200 µm 200 µm 200 µm 200 µm OD, IR 30° ART + OCT 30° (8.5 mm) ART (100) Q: 36 [HS] 200 µm 200 µm 200 µm 200 µm OS, IR 30° ART + OCT 30° (8.4 mm) ART (92) Q: 32 [HS]
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Contraindications

  • Amblyopia (Lang +)
  • Myopia ≧ 6 dpt
  • Macular Pathology
  • Irregular cornea
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Contraindications

  • Amblyopia (Lang +)
  • Myopia ≧ 6 dpt
  • Macular Pathology
  • Irregular cornea
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SLIDE 36
  • Very demanding patients!

Lens surgery after LVC

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“Aller guten Dinge sind drei”

“all good things come in three”

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EVO+ Evolution in Visual Freedom

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EVO+ Evolution in Visual Freedom

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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.