2011-2012 Basic and Clinical Science Course, Section 13: by Christopher J. Rapuano MD

By Christopher J. Rapuano MD

This up to date quantity covers a couple of themes, from the technological know-how of refractive surgical procedure to accommodative and nonaccommodative remedy of presbyopia, from sufferer evaluate to overseas views. It examines particular tactics in refractive surgical procedure, in addition to refractive surgical procedure in ocular and systemic ailment. significant revision 2011-2012.

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Additional resources for 2011-2012 Basic and Clinical Science Course, Section 13: Refractive Surgery (Basic & Clinical Science Course)

Example text

Patients and surgeons need to be awa re of this issue, espeCially if the patient has glaucoma or is a glaucoma suspect. Samuelson TW. Refractive surgery in glaucoma. Curr Opill Ophthalmol. 2004; 15(2):112-118. Slit-Lamp Examination A complete slit-lamp examination of the eyelids and anterior segment should be performed. The eyelids should be checked for significant blepharitiS and meibomitis, and the tear lake should be assessed for aqueous tear deficiency. The conjunctiva should be examined, speCifically for conjunctival scarring, which may cause problems with microkeratome suction.

If the patient has obviously unrealistic desires, such as a guarantee of 20/20 uncorrected visual acuity or perfect uncorrected read in g and distance vision, even though he or she is pres- byopic, the patient may need to be told that refractive surgery cannot currently fulfill his or her needs. The refractive surgeon should exclude patien ts with unrealistic expectations. Social History The social history and medical history can identify the visual requirements of the patient's profession. Certain jobs require that best vision be at a speCific distance.

Ocular Motility. Confrontation Fields. and Ocular Anatomy Ocular motility should also be evaluated. Patients with an asymptomatic tropia or phoria may develop symptoms after refractive surgery if the change in refraction causes the motility status to break down. If there is a history of strabismus (see Chapte r 10) or a concern regard ing ocular alignment postoperatively, a trial with contact lenses before surgery CHAPTER 2: Patient Evaluation. 35 should be considered. A sensory motor evaluation can be obtained preoperatively if strabismus is an issue.

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