Contact Lens Practice Pearls

Co-Managing Post-Cataract Patients with Contact Lenses

BY JESSICA H. MATHEW, OD, PHD, FAAO

After patients undergo cataract surgery and intraocular lens (IOL) implantation in one eye, they are often left in a short holding period while waiting to have the second eye completed. While it is easy enough to pop the lens out of their current glasses, this is not necessarily the best option for most patients because of induced anisometropia. This could be tolerated for a very short period of time, but most patients would be better served by wearing a contact lens on the non-operated eye.

Benefits for Experienced or Inexperienced Lens Wearers

For current contact lens wearers, continuation of their habitual lens and wear schedule will work fine in the non-operated eye. However, many of our older patients are not current or experienced contact lens wearers. If there is only a short wait until the next surgery, then it might make the most sense to fit these patients in an extended wear option, if you are comfortable with that. Although this isn’t ideal, it is the smoothest transition with the least hassle for both practitioner and patient.

Fitting a contact lens in the non-operated eye helps patients feel reassured that the surgery was successful, and they can rest easy knowing that vision will be even better once both eyes are completed. Patients also really love the fact that one day post-op, they no longer need their glasses and can get by with only over-the-counter readers.

Monovision Test Drive

Fitting a contact lens post-cataract surgery also allows for a demonstration of monovision, especially if the dominant eye received the IOL first. For single-vision IOLs and for patients who have not yet tried monovision, practitioners can get a better feel for how to adjust the power of the second IOL to maximize the range of vision.

With baby boomers often having higher expectations and wanting more freedom from glasses, surgeons are leaning more toward multifocal and accommodating IOLs. During this interoperative period between eyes, it gives you an opportunity to better judge a patient’s residual needs and determine what power IOL they will benefit from more (i.e., low versus mid versus high add). For accommodating IOLs, this is a good time to test out whether a “mini” monovision will be enough.

Help Patients Maintain Their Independence from Eyeglasses

Although we hope to hit the mark with optimized vision once both IOLs are in place, often some small tweaking may be needed. Typically, after 90 days or so, once things have stabilized, some patients may opt to undergo laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) to correct these residual refractive errors.

Whether or not this route is taken, contact lenses can still benefit your patients during that 90-day period, or more long-term, to maintain their independence from glasses. CLS

Dr. Mathew is a research assistant professor at the University of Houston College of Optometry. She manages patients who have severe corneal distortions and require specialty contact lenses, and she is also involved in basic science and clinical trial research with The Ocular Surface Institute. She has received research funding from Allergan, CooperVision, Clearlab, Essilor, Shire, TearLab, Menicon, and Vistakon. You can reach her at jmathew@central.uh.edu.