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    RLE choice factors in benefits, risks, alternatives


    Case-by-case decision

    Dr. Wiley mentioned a refractive surgery grid developed by Kugler, Parkhurst, and Sandberg for providing guidance on choosing between different refractive procedures, taking into account patient age and refractive error. According to this grid, refractive lens exchange can be considered for people with a wide range of refractive errors and across a broad age range, from young presbyopes (i.e., patients in their late 30s) to much older individuals who have not yet developed a cataract.

    A recently published study by Schallhorn et al. [Clin Ophthalmol. 2017;11:1569-1581] compared outcomes of RLE in younger and older presbyopes. It included nearly 1,300 patients categorized into four age groups (45-49, 50-54, 55-59, and 60-65 years) and found no significant differences between the groups in clinical or patient-reported outcomes, including for postoperative satisfaction, visual phenomena, dry eye symptoms, and distance or near vision activities.

    One of the main reasons for not performing RLE in even younger adults is that younger age is a risk factor for retinal detachment after lens removal.

    Having no posterior vitreous detachment is another risk factor, and patients should be screened for this feature using OCT, Dr. Wiley said.

    There is also evidence that YAG laser capsulotomy increases the risk of retinal detachment, especially in high myopes.

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