1. Clear Lens Exchange
Case Studies
Dr. John Cheung

2. #1 - CD
 60 y/o ♂ government worker; pilot, sailor,
outdoor enthusiast
 Full time RGP wearer x 40+years
 Cyclo refraction: -6.00 +1.00 x180 OU
 BCVA: 20/25 OU
 Keratometry: 38.00/39.00 @180 OU
 SLE: gr ½+ N/S OU, Corneas clear OU

3. CD – Plan / Results
 CLE recommended re: flat Ks OU
 Monovision offered; pt opted for DV OU
 IOLS implanted:
 OD Alcon SA60AT 13.5D
 OS Alcon SA60AT 12.5D
6 mth post: 20/25- OD, 20/20 (!) OS
 Refraction: plano OU
 Lifestyle ∆s:
 Drivers license restriction revised
 Using OTC readers only (happy)

4. #2 - CD
 60yo ♂ semi-retired IT manager
 CC: ↓NV
 Cyclo refraction:
OD: +0.75+0.25x160
OS: +0.50+0.25x005
 Kreadings:
OD: 41.37/42.25@109
OS: 41.25/41.62@092
 OD dominant
 SLE: gr ½+ N/S OU, Corneas clear OU

5. GB – Plan / Results
 WGA SBK or CLE recommended; OS only with
monovision
 Pt opted for CLE with Toric IOL
 SN6AT2 23.0D, 1.00cyl
 NV goal: -2.25D
 Pt advised OD may need tx in future for ↑DV
3mth post:
 OU 20/25+2 @distance, OU 20/20- @near
 Pt states ↑MV adjustment, happy so far

6. AcrySof
Toric
Calculator

7. #3 - MC
 64yo ♀ registered nurse from Sault-Ste-Marie
 Cyclo refraction:
OD: +1.00+1.25x001
OS: +1.00+1.25x168
 Kreadings:
OD: 43.60/40.00@041
OS: 43.32/43.60@172
 OS dominant
 SLE: trace N/S OU + trace PSCC
http://www.ec.gc.ca/cas-aqhi/default.asp?lang=En&n=55517B0A-0

8. MC – Plan / Results
 CLE recommended OU with monovision (OD near)
 Spherical IOLs implanted OU
 Alcon SA60AT 24.0D
 Alcon SA60AT 21.5D
3mth post:
 UCVA 20/60 OD, 20/15-1 OS
 Refraction: -1.50DS OD, +0.25DS OS
 Patient/Co-managing OD feedback:
 “No discomfort, vision sharp and driving good”
 “Very pleased w results, adapting well to monovision”

9. #4 - LH
 39yo ♀ teacher
 Cyclo refraction:
OD -18.00+0.25x151
OS -18.25+1.50x057
 Kreadings:
OD 44.87/46.25@093
OS 45.00/46.50@089
 RGP wearer x28yrs
 + h/o corneal infections, DES, allergy to some polymers
 SLE: Gr ½ SPK OU

10. LH – Plan / Results
 Pre-toric IOLs (2008) = spherical IOLs OU
 Alcon MA60MA 2.0D
 Alcon MA60MA 3.0D
 Monovision
 LVC retx for cyl
OD plano+1.60x106
OS +0.50+1.90x084
 LEE - Oct 2011(OD annual notes):
 pt doing well
 20/20 @ distance & near

11. #5 - KHC
 52yo ♀ high school teacher
 ↑ near visual demands
 PALs - constant wear
 Cyclo: OD +1.75+0.25x006
OS +1.25+0.25x174
 Ks: OD 43.75/44.75@124
OS 43.25/44.25@037

12. KHC – Plan / Results
 2 options:
 1- SBK OU – partial MV only
 2- Bioptic procedure for full MV – pt’s choice
 OD – CLE @ near
 Alcon SN6AT3 25.0D, 1.50cyl
 OS – SBK @ distance
1mth post:
 20/200 OD, 20/20 OS @ distance
 20/25+ OU @ near

13. #6 - SA
 38 yo ♂ public servant
 Cyclo refraction O.D.: -17.25+4.25x105
 Referred for retinal consult prior to Sx
 Uneventful CLE w toric PC IOL

14. #6- SA – 24hrs Post-Op
 ↑ cells/flare/pigment in AC
 No discomfort/FBS
 Normal IOPs
 UCVA?

15. #6- SA – IOL Repositioning
 Done same day
 Eye dilated
 Oral sedation; topical/local anesthesia
 IOL reinserted in intact bag, toric IOL axis
realigned
 UCVA @ 24hrs & 1wk: 20/15
 Patient ecstatic!

16. Everest SurgiCenter
Focus Eye Centre
Thank you!