We are often told there’s no “i” in team and this applies to the delicate inter-professional relationship that is refractive surgery and cataract (which is just about the most common form of refractive surgery). In the olden days of generalist ophthalmologists who did OMP “green form” work many ophthalmologists had a good understanding of refraction and, more importantly the fine art of prescribing. Qualifying as an ophthalmologist still requires refraction training but its hardly top priority.
Where does that leave us ? In many cases a team effort is involved where the optometrist suggests an ideal end refraction, sadly not always. Not really applicable to those undergoing multifocal implants but in any single vision IOL it’s critical. How many times do we see a low myope end up as plano just because the surgeon “can”. Great for maximising unaided vision but it does nothing to decrease spectacle dependence as this person, who has spent a lifetime reading without specs now has to take a pair or wear near-plano varifocals to use a phone, read or pay by PIN ! I’ve lost count of the times I’ve suggested leaving a patient in low myopia only to find the patient miraculously changes their mind at the doors of the theatre !
What’s worse is the refractive surprise patient who goes from sphere to low oblique cyl, only to be told post-op that 6/9 is “a result and they no longer need to bother with distance Rx because they have eyes like a fighter pilot and enough enhanced depth of focus to be OK at near”. Doesn’t last long before they’re back at their optometrist. Its fine, we can sort it, nice dispensing too, but it isn’t a great reputational advance for either party.
Advancements in CL design and repeatability mean that the old wives tales of “thick lenses masking astigmatism” have been confined to the bin and our threshold for toric fitting is the lowest ever. Something similar has happened in the multifocal world where most au fait fitters bypass monovision and jump straight to multifocal lenses often ending up not far away from that magical term “blended vision” which the cynic might say is a euphemism for compromise. My advice is stick to your guns, you may have known the patient for years. Only refer privately to those surgeons with the necessary empathy to not play omnipotent and certainly never for money !
