After cataract surgery, a healthy eye can regain the best corrected visual acuity of 1.0 to 1.2 or 20/20 to 25/20 if the following conditions exist:
- Inconspicuous structure of the retina in OCT
- Healthy optic nerves with intact RNFL
- Clear optical media (vitreous body, lens, IOL and cornea)
- No higher order aberrations (Coma, Trefoil, etc.)
5-15% of cataract surgeries still have a visual defect of +/-0.5-1.5 diptoria (low-order aberration) after surgery; this cannot be avoided even with the best lens formula. These residual defects can be corrected using glasses, contact lenses or even with another procedure, known as a touch-up.
ONO packages with touch-up option
Patients who wish to be able to see sharply at one or more distances without glasses after cataract surgery have the option to select one of the following self-paying packages. If there is still a residual error after the procedure, we will correct this using touch-up at no additional charge.
- Vision package
- Binocular vision in the distance
- Close or medium range binocular vision
- Monovision
- Prime package (Vision femtose-customer laser-assisted package)
- Binocular vision in the distance
- Close or medium range binocular vision
- Monovision
- Deluxe package
Option without ONO package
Patient underwent external surgery without ONO package
- Self-payer share 1500 CHF
- Preliminary examination and follow-up checks are billed by health insurance
Indication for a touch-up
- Patient is not satisfied with the refractive outcome of cataract surgery
- The patient is willing to have a second eye procedure
Proceed
Patient guidance and education
- Touch-up option -> helps patients calm down and gives them hope for sharper vision in the future
- Visual defects must be stable for several weeks before a correction can be carried out
- Visual defects must be identified using extended subjective refraction and briefly simulated to the patient using glasses.
- Show how the view changes in the distance as well as in the vicinity after correction (excerpt in 40 and 80 centimeters, respectively)
- smaller ametropies in the minus range or astigmatisms enable mid-range or depth-of-focus vision
- A YAG capsulotomy is always necessary once before a touch-up (cave: After a YAG capsulotomy, the position of the IOL and thus the refraction can still change)
- Use the waiting time until the touch-up to:
- If necessary, to treat meibomian stasis, meibomian dysfunction and sicca
- If necessary, carry out a contact lens test for simulation
Special for patients with monovision
Monovision is simulated before cataract surgery using eyeglasses or contact lenses. However, patients may not feel well after surgery.
Possible symptoms caused by monovision: dizziness, discomfort, covering one of the two eyes with the hand
Possible reasons:
- Too high anisometropy
- 1 to 1.5 diopters are generally well tolerated)
- > 1.5 Diopters are usually only tolerated if there was a larger anisometropia, possibly with consecutive amblyopia, before the operation
Procedure: Waiting allows the patient to get used to the situation, if necessary, correct the anisometroipia with contact lenses or glasses until the touch-up
Multifocal IOLs or hybrid monofocal Edof-IOL (e.g. Lucidis)
Typically, patients are very satisfied shortly after implanting multifocal IOLs as they can now see far and close. This so-called initial euphoria usually disappears after a few weeks and patients complain of reduced visual acuity at a distance and reduced contrast vision nearby.
In this situation, patients must be informed about “neuronal processing.” Multifocal optics always create multiple images on the retina simultaneously. An object or text that is viewed is therefore displayed several times and the effect of “ghosting” is created. The brain must therefore read out the correct or sharp image, process it further and suppress the blurred ghost images so that the overall impression of a sharp image can be created. This process of neuroadaptation can take several months. The brain also suppresses “halos” or the vision of light circles around light sources, especially at night, and “starbursts” or the star-shaped distortion of light sources.
Tips to improve neuronal adoption
- Do not use reading glasses or only use them in an emergency (cave: The reading glasses do not teach patients to use the different images or only use images from the remote part of the IOL, which prevents neuroadaptation)
- Instead, use more light to read (cave: with most multifocal implants, the weighting for the close range is more in the center of the implant and for the distance rather in the middle periphery of the implant
- In good weather and lots of sunlight, sunglasses help to improve visual acuity at a distance (cave: pupil widens and the peripheral parts of the implant gain more weight)
With multifocal IOLs, minor visual defects (0.25 to 0.5 diopters) and surface or tear film problems lead to massively reduced visual acuity -> even smaller ametropies must be corrected using a touch-up
If, after intensive moisturizing therapy and even with the best corrected visual acuity (correction on a phoropter or with glasses), the quality of vision is not satisfactory for several weeks (2x3 weeks) should be avoided for the time being before the YAG capsulotomy. Even with good visual acuity, patients may not be able to cope with the new multifocal optics and a change of lens is inevitable. In this case, it is an advantage if the rear capsule is still intact.
Requirements for a touch-up
- Intact tear film (no blepharitis or meibomian stasis)
- Clear optical media
- YAG capsulotomy performed
- Stable subjective refraction and topography over 2 x 3 weeks (+/- 0.25 diopters)
- Refractive surgery (VR) preliminary examination including information on the various refractive options with advantages and disadvantages (e.g. post-operative Sicca symptoms)
Types of touch-up
- Implantation of an add-on IOL
- Advantages: no iatrogenic Sicca symptoms
- Disadvantages: relatively inaccurate, especially when correcting astigmatism, risk profile of intraocular surgery
- FemtoLasik Touch Up
- Indication: Schirmer test > 3-10 mm, cornea without pretreatment
- Advantages: high accuracy
- Disadvantages: post-operatively aggravated Sicca symptoms
- TransPRK Touch Up
- Indication: Schirmer test < 3-10 mm, cornea with condition after refractive laser eye surgery
- Advantages: high accuracy, less post-operative Sicca symptoms
- Disadvantages: pain and prolonged rehabilitation period
Register a touch-up for a preliminary examination
VR (preliminary examination of refractive surgery) at VW (surgeon) in Wallisellen with 1st shrinkage measurements 2nd Schirmer test 3rd VW 4. mydriasis
preparation
- Moisturize the surface with Optava or Lacrycon eye drops for 2 weeks
- Contact lens abstinence for 1 week
- Patients should not come to the examination by car (cave: mydriasis)
- Patient should be informed > link
