Ophthalmology Update - Cleveland Clinic

however, a few months later she returned, complaining
that she was still having difficulty with vision
at night in her left eye. dr. Krueger dissuaded
the patient from having a custom upgrade in that
eye with 20/15 Ucva, but she returned 2 months
later determined to have surgery. still reluctant, dr.
Krueger proceeded to do a preoperative work-up
that revealed abnormally high levels of coma and
spherical aberration. a carefully planned ablation
was performed with a good result. at 1 week and 6
weeks, aberrometry showed a refraction of –0.25 d
with the level of coma reduced by about one-third
and spherical aberration reduced by about 50%.
complaints of starburst and glare at night were
markedly improved, and the patient was very happy
with her vision in both eyes.
WR: +0.38–0.57x09
– Coma=0.76 µm
– Sph Ab=0.78 µm
– Other=0.26 µm
FIGURE 1a
Note of caution
although the outcome in this case and others has
been favorable, dr. Krueger warns that in eyes in
which there is minimal refractive error, the custom
re-treatment needs to be carefully planned to avoid a
spherical overcorrection that can leave the patient
even more unhappy.
“When correcting higher amounts of higher-order
aberrations, it is important to incorporate an offset
into the ablation that will compensate for the
relatively large amount of treatment that is delivered.
Unfortunately, we have seen several patients
treated elsewhere with a custom enhancement
whose vision has been massively overcorrected,”
dr. Krueger says.
FIGURE 1b
i n v e s t i g a t i O n s
c O l e e y e i n s t i t U t e c l e v e l a n d c l i n i c . O r g / e y e //