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Issue link: http://cmesupplements.eyeworld.org/i/743748
71 continued from page 70 outcomes exceeding 20/20 because they are younger, have a clearer lens, and have a better quality tear layer. During surgery, we focus on meticulous techniques, creating and customizing the flap size and thick- ness, performing customized laser ablation, and making sure that the ablation is centered within the bed on the visual axis. After surgery, we need to manage healing when possible. For example, if the tear layer changes, surgeons should manage it with tear supplements, punctal occlusion, or other treatments such as topical anti-inflammatories when needed. Checking for signs of blepharitis and treatment of any meibomian gland abnormalities is important. If patients are dissatisfied with visual outcomes, surgeons need to be prepared to perform enhancements. Improving satisfaction The better a patient's uncorrected visual acuity after surgery, the higher his or her satisfaction will be. In a retrospective case series of 2,530 patients, Schallhorn at al. reported that 91% of patients were satisfied with their results 5 years after LASIK. 5 Postoperative uncorrected distance visual acuity was most strongly associated with patient satisfaction. Patients with 20/20 uncorrected distance visual acuity were more likely to be satis- fied compared with those with 20/25 or worse vision. This has been a consistent trend in the Optical Express clinical data I have reviewed, regardless of the laser platform. If we can achieve 20/16 or better uncorrected vision post- operatively, we will have a higher percentage of happy patients (per- sonal communication with Steven Schallhorn, MD). Excellent visual results can be quantitated and associated with patient satisfaction. This is especial- ly relevant in an age where patients can access data instantly and com- ment on their results and experienc- es on social media. Conclusion A multifactorial approach is indis- pensable to achieving excellent clin- ical outcomes and patient satisfac- tion. In addition to ensuring a good clinical outcome, surgeons also need to provide a good experience for the patient on a personal level. References 1. Lazon de la Jara P, et al. Visual and non- visual factors associated with patient satisfaction and quality of life in LASIK. Eye (Lond). 2011;25:1194–1201. 2. Bamashmus MA, et al. Functional outcome and patient satisfaction after laser in situ keratomileusis for correction of myopia and myopic astigmatism. Middle East Afr J Oph- thalmol. 2015;22:108–114. 3. Shtein RM. Post-LASIK dry eye. Expert Rev Ophthalmol. 2011;6:575–582. 4. Sullivan BD. An objective approach to dry eye disease severity. Invest Ophthalmol Vis Sci. 2010;51:6125–6130. 5. Schallhorn SC, et al. Patient-reported outcomes 5 years after laser in situ keratomil- eusis. J Cataract Refract Surg. 2016;42:879– 889. Dr. Kraff is director of refractive surgery at Kraff Eye Institute, Chicago. He can be contacted at firstname.lastname@example.org CME questions (circle the correct answer) To take this test online and claim credit, go to bit.ly/2e4sDHP or complete the test below and fax, mail, or email it in. 1. A 32-year-old woman with a refractive error of –6.75 +4.75 x 090 in her right eye and –7.00 + 4.75 x 090 in her left eye with normal bow-tie astigmatism and cen- tral pachymetry of 570 µm in each eye is interested in laser vision correction. She has normal Pentacam indices and normal anterior and posterior elevation. The patient is not interested in PRK surgery. What would be your preferred surgical treatment? a. Toric ICL b. High resolution wavefront-guided LASIK c. Conventional LASIK d. Topography-guided LASIK 2. A 25-year-old patient has a refraction of –4.00 + 2.50 x 95 OU and moderate corneal coma. Topography images are good quality. What would be your preferred surgical treatment? a. Topography-guided ablation b. Wavefront-optimized ablation c. Wavefront-guided ablation d. Any of the above 3. Millennial patients appear disinterested in laser vision correction at your practice. What strategy would help bring patients into your office for a consult? a. Increasing television advertising b. Sending e-newsletters to millennials c. Targeting parents and grandparents, advertising LASIK as a gift d. Increasing billboard advertising 4. Which of the following preoperative clinical variables are key to achieving the best possible visual outcome in a patient in his/her mid-20s? a. Low refractive error b. Aiming for a slight overcorrection c. Optimizing the tear layer d. Normal cornea e. All of the above 5. In perimenopausal or postmenopausal women, what should be discussed to set postoperative expectations a. Tear film abnormalities are no different than in a younger population b. They may experience tear abnormalities in the postoperative period even if they have none preoperatively c. They should expect a result better than 20/20 because their refractive error is more stable at their age d. All the above Copyright 2016 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or the publisher, and in no way imply endorsement by EyeWorld or ASCRS. To claim credit, please fax the test and fully completed form by April 30, 2017 to 703-547-8842, email to GPearson@ascrs.org, or mail to: EyeWorld, 4000 Legato Road, Suite 700, Fairfax, VA 22033, Attn: November 2016 CME Supplement ASCRS Member ID (optional): First/Last Name/Degree: Practice: Address: City, State, Zip, Country: Phone: Email: Please print email address legibly, as CME certificate will be emailed to the address provided. Supported by Abbott Medical Optics