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    Aspiring for zero tolerance of residual astigmatism

    Case examples highlight tools, techniques toward quest for excellent visual endpoint


    Figure 10 shows the case of a patient with traumatic mydriasis and a subluxated cataract. Instead of focusing on the iris distortion, one can simulate vision preoperatively and aim for emmetropia by implanting a toric IOL and placing a capsular tension ring with a small capsulorhexis (so it opacifies, acting to make up for the compromised iris).

    Figure 11 shows a patient who underwent a series of RK procedures. This patient was an artist who required a high level of vision that exceeded her preoperative level of 20/40.

    The current confidence in the toric IOL implants and correction of astigmatism despite previous RK procedures allowed me to proceed to heed to her request and bring this patient to achieve 20/20 vision and improved quality of life. This is an example of cases surgeons shall see more and more of when what we perceive as “good enough” vision (20/40) is “debilitating” to certain patient’s work demands and we must commit to helping them.

    Arun C. Gulani, MD
    Dr. Gulani is director of refractive surgery and chief, cornea & external disease, as well as assistant professor, department of ...

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