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Painless Cataract Surgery
Surgical Efficacy Index SEI = (VFI postop) - (VFI preop) The surgical efficacy index considers postoperative result and preoperative function, thereby allowing for documentation of surgical efficacy. SEI 100 major improvement 50 significant improvement 20 minimal improvement o no improvement <0 worsening Examples: 1. 30 y.o. RK
-1.00 20/40 po stop VFI = - 3.00 20/200 preop VFI = SEI = 40 - ( - 20) = 60
- 20
40
2.70 y.o. IOL
+ .50 20/30 postop VFI = - 4.00 20/200 preop VFI = SEI = 62 - ( - 30) = 92
- 30
62
Percentage of correction is not a valid concept in our opinion, since we are fighting toward a fixed goal of 20/20. A -15.00 D myope who has 80% correction is still -3.00 D and 20/200 while a -3.00 who has 80% correction is - 0.6 D and 20/20. The preoperative refraction is not really significant in judging refractive surgery; what counts is how close the patient ends up relative to the desired goal. We believe that widespread use of the VFI and SEI concepts would allow comparison of surgical results in a meaningful, objective way and would document the change in patient satisfaction with age even though refraction may stay constant.
Howard L. Friedberg, M.D. Oram R. Kline, Jr., M.D. Barry D. CaIman, M.D.
Woodbury, New Jersey
IN DEFENSE OF THE OMNIFIT LENS
Lee T. Nordan, M.D. Leo Bores, M.D. Stephen Brint, M.D. David Dulaney, M.D. Daniel Durrie, M.D. Wesley Herman, M. D. Melvyn Koby, M.D. Fredrick Kremer, M.D. W. Andrew Lyle, M.D. Robert Maddox, M.D. W. Andrew Maxwell, M.D. Francis Price, M.D. Robert Rubman, M. D. Harold Sawelson, M. D. PAINLESS CATARACT SURGERY To the Editor: "You won't feel anything" is the reply we often give our patients when we are asked about their upcoming cataract surgery. With proper preoperative sedation, our patients rarely complain and seldom remember the lid or peribulbar block we use and the subsequent 100
surgery most times turns out to be painless. We are often informed that nothing was felt duriIlg the operation and we can smile and say, "We told you so." More often than we would like, we have had the patient who seemed to have absolutely no discomfort during the surgery itself, but at the conclusion of the case when the subconjunctival injections of antibiotic and steroid were administered, his or her entire body seemed to rise off the table and we had visions of the recently implanted IOL squirting out of the eye and ending up in our laps. In this instance, we often hear, "Doc, those last two needles were murder." The past few months we have been giving the subconjunctival injections at the beginning of the case, immediately after placement of the rectus bridle sutures and we seem to have eliminated this uncomfortable situation. We initially had concerns that giving the injections prior to entering the eye might produce its own set of problems, but none have occurred. Exposure has not been a problem as we give the injections inferiorly and we have not seen any apparent toxic reaction of the solutions leaking out and entering the eye during the cataract surgery. We routinely now give our injections in this manner and find ourselves doing more postoperative smiling and less explaining.
J CATARACT REFRACT
To the Editor: I am writing regarding Dr. Kenneth J. Hoffer's letter (Anterior chamber lens terminology. ] Cataract Refract Surg 13:460, 1987). While I do agree with my distinguished colleague that all Kelman lenses are not equal, I am firmly convinced that the main difference lies between the semi-flexible lenses (the pregnant 7) and the flexible lenses including the Omnifit from AMO and Precision Cosmet and the Multiflex from Cilco. I am firmly convinced that the Omnifit style, contrary to what Dr. Hoffer feels, is every bit as tolerant to improper sizing as is the Multiflex. Dr. Hoffer's statement that "... many (Omnifits) are being explanted" is in my opinion unsubstantiated. I, in fact, have never had to explant an Omnifit and the Food and Drug Administration has recently qualified one of the Omnifit styles as the first "safe and effective" anterior chamber intraocular lens. This letter is written expressly for those who are using Omnifit lenses and who wish to have my opinion on the subject: The Omnifit three-point fixation lens manufactured by Allergan Medical Optics, as well as
SURG-VOL 14. JANUARY 1988
-1.00 20/40 po stop VFI = - 3.00 20/200 preop VFI = SEI = 40 - ( - 20) = 60
- 20
40
2.70 y.o. IOL
+ .50 20/30 postop VFI = - 4.00 20/200 preop VFI = SEI = 62 - ( - 30) = 92
- 30
62
Percentage of correction is not a valid concept in our opinion, since we are fighting toward a fixed goal of 20/20. A -15.00 D myope who has 80% correction is still -3.00 D and 20/200 while a -3.00 who has 80% correction is - 0.6 D and 20/20. The preoperative refraction is not really significant in judging refractive surgery; what counts is how close the patient ends up relative to the desired goal. We believe that widespread use of the VFI and SEI concepts would allow comparison of surgical results in a meaningful, objective way and would document the change in patient satisfaction with age even though refraction may stay constant.
Howard L. Friedberg, M.D. Oram R. Kline, Jr., M.D. Barry D. CaIman, M.D.
Woodbury, New Jersey
IN DEFENSE OF THE OMNIFIT LENS
Lee T. Nordan, M.D. Leo Bores, M.D. Stephen Brint, M.D. David Dulaney, M.D. Daniel Durrie, M.D. Wesley Herman, M. D. Melvyn Koby, M.D. Fredrick Kremer, M.D. W. Andrew Lyle, M.D. Robert Maddox, M.D. W. Andrew Maxwell, M.D. Francis Price, M.D. Robert Rubman, M. D. Harold Sawelson, M. D. PAINLESS CATARACT SURGERY To the Editor: "You won't feel anything" is the reply we often give our patients when we are asked about their upcoming cataract surgery. With proper preoperative sedation, our patients rarely complain and seldom remember the lid or peribulbar block we use and the subsequent 100
surgery most times turns out to be painless. We are often informed that nothing was felt duriIlg the operation and we can smile and say, "We told you so." More often than we would like, we have had the patient who seemed to have absolutely no discomfort during the surgery itself, but at the conclusion of the case when the subconjunctival injections of antibiotic and steroid were administered, his or her entire body seemed to rise off the table and we had visions of the recently implanted IOL squirting out of the eye and ending up in our laps. In this instance, we often hear, "Doc, those last two needles were murder." The past few months we have been giving the subconjunctival injections at the beginning of the case, immediately after placement of the rectus bridle sutures and we seem to have eliminated this uncomfortable situation. We initially had concerns that giving the injections prior to entering the eye might produce its own set of problems, but none have occurred. Exposure has not been a problem as we give the injections inferiorly and we have not seen any apparent toxic reaction of the solutions leaking out and entering the eye during the cataract surgery. We routinely now give our injections in this manner and find ourselves doing more postoperative smiling and less explaining.
J CATARACT REFRACT
To the Editor: I am writing regarding Dr. Kenneth J. Hoffer's letter (Anterior chamber lens terminology. ] Cataract Refract Surg 13:460, 1987). While I do agree with my distinguished colleague that all Kelman lenses are not equal, I am firmly convinced that the main difference lies between the semi-flexible lenses (the pregnant 7) and the flexible lenses including the Omnifit from AMO and Precision Cosmet and the Multiflex from Cilco. I am firmly convinced that the Omnifit style, contrary to what Dr. Hoffer feels, is every bit as tolerant to improper sizing as is the Multiflex. Dr. Hoffer's statement that "... many (Omnifits) are being explanted" is in my opinion unsubstantiated. I, in fact, have never had to explant an Omnifit and the Food and Drug Administration has recently qualified one of the Omnifit styles as the first "safe and effective" anterior chamber intraocular lens. This letter is written expressly for those who are using Omnifit lenses and who wish to have my opinion on the subject: The Omnifit three-point fixation lens manufactured by Allergan Medical Optics, as well as
SURG-VOL 14. JANUARY 1988