IOL Insertion/Toric IOLs

The Unhappy Premium IOL Patient: Don’t Become Defensive or Dismissive

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No matter what, some patients in whom you have inserted premium IOLs will be unhappy, acknowledged Asim Piracha, MD, associate professor of ophthalmology at the University of Louisville and the University of Kentucky. When this happens, don’t become defensive or be dismissive. And consider these options to improve patient satisfaction: 

  • Ocular surface disease. Treat aggressively, fully rehabilitating the surface to prepare the eye for an enhancement, if necessary. 
  • Residual refractive error.  If there’s a high spherical refractive error, consider an IOL exchange or secondary piggyback IOL. Dr. Piracha prefers the former if the capsule or zonules are intact. 
  • Posterior capsular opacification. Consider a YAG capsulotomy as soon as 6 weeks after surgery. Ideally, Dr. Piracha prefers to wait longer to allow the IOL becomes more stable and to avoid causing cystoid macular edema (CME). 
  • CME. Treat until fully resolved. If epiretinal membrane is present, consider referring to a retinal specialist.
  • Neural adaptation. Some patients are never able to adapt to their new vision. In these cases, consider exchanging a multifocal or extended depth of focus lens for a monofocal IOL.

You can read more here.

Piracha A. Handling the unhappy premium IOL patient.  [Published online May 10, 2018]. Review of Ophthalmology.


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