Originally Posted by
AndyOptom
Solid advice already given on the lens correction options and how to go about that.
Having dealt with similar patients since these sorts of implants became popular (almost all of which eventually relented to get the other eye operated on), thought I'd share a tidbit regarding the observation you made with the OTC readers +2.50:
For monocular post-op IOL cases with resultant aniso plus, I have also observed them happily using OTC readers that somehow seemed to work despite being right in the middle of what should have been the proper distance and near Rx (in this case, OTC readers +2.50).
From the Rx you shared, it's about distance RE +1.00/-0.50, LE +1.75/-0.50, near RE ???, LE +4.25/-0.50.
So, +2.50 DS used for distance would be a fog RE +1.50, LE +0.75 (not too surprising, I've seen quite a few office lens wearers happily driving around with about +1.00 fog originally intended for their intermediate). And while too weak for the LE near, it's probably just tolerably over whatever residual add the IOL has on the RE.
After the first couple such cases, I eventually wound up doing a normal refraction to get the full distance and near Rx for my records, then using the SV power they had been wearing as a baseline. From that baseline, backing it off binocularly until the best tolerated distance clarity (adequate for standard road signage font) and easing it stronger for the best tolerated near clarity, yielded the improvised multifocal Rx (not perfectly clear at distance or near, but the best that could be done in light of the circumstances).
So for a case like this, maybe something like this could result after such binocular adjustments:
Patient's OTC Rx: +2.50 DS OU
Improvised multifocal RX: distance +1.75 DS, Add +1.50, OU (putting the +2.50 approximately in the middle)
As mentioned, almost all such cases eventually relented and opted to operate on the other eye. But for the rare few who didn't, the improvised Rx as described above worked out to their satisfaction. Not perfect and definitely wrong clinically, but an extension of 20/happy, I suppose.
Last thing of note, though: I'm in the relative wild West of Southeast Asia, where such matters rarely lead to litigation, enforcement is rare, many patients do take their respective healthcare practitioners' advice in good faith. So I do acknowledge that my general mindset towards experimentation in this regard may seem inappropriate in the eyes of a more regulated industry professional and established clinical guidelines.
Bookmarks