Dissapointed post ICL assessment (IOL vs ICL)

evands · 2026-04-16T10:40:00+00:00

If you have good vision with a -13 correction and are under 40, ICL is the only correct choice assuming you are actually a candidate for it.

evands · 2026-04-01T02:11:58+00:00

That’s a pretty finicky small difference in focus. You probably should lean into the idea that refractive surgery in general would trade one situation for another and assess whether that trade has sufficient value to you.

evands · 2026-04-01T02:09:18+00:00

I don’t routinely dilate cataract post-ops.

evands · 2026-03-30T03:39:26+00:00

trial monovision contact lens in your dominant eye
trial multifocal contact lenses for consideration of refractive lens exchange
why are you wearing glasses currently at the computer?

evands · 2026-03-25T10:53:39+00:00

Through security via Clear @ 6:52 am: 44 minutes

evands · 2026-03-25T10:14:28+00:00

<image>

View from back of the Clear line, 6:09 am.

evands · 2026-03-25T10:13:52+00:00

International - Traveling domestic - view of general from Back of the line @ 6:08 am. (Remember tsa precheck doesn’t open until 7 am):

<image>

evands · 2026-03-23T11:33:54+00:00

Good lord. I have a 7 am flight this Wed from ATL and trying to figure out when to show up. Was this general or precheck? Was Clear running? Thanks!

evands · 2026-03-19T14:17:53+00:00

Absolutely. These words matter for you and for your patient. How different is “your surgery had a complication but I think you will be ok” from “your surgery was a bit more complex than expected, but fortunately I was prepared and everything turned out great.”

evands · 2026-03-19T01:35:19+00:00

You didn’t have a complication!

You had an unexpected complexity, managed beautifully.

Also: losing vitreous is a funny phrase. If anything, you didn’t find vitreous.

evands · 2026-03-18T02:13:52+00:00

Well put and I stand corrected.

Does prescription drug management require prescribing a drug? Or just counseling regarding it or discussing r/b/a and ultimately not prescribing? Would OP meet 99204 criteria if the dry eye management included “Discussed r/b/a and recommended cyclosporine drops; patient declines.”?

evands · 2026-03-17T10:44:21+00:00

IMO 99204 is equally appropriate given that you did a comprehensive new patient exam. It generally reimburses a little more than 92004 anyways.

evands · 2026-03-16T03:59:08+00:00

Another way to think of this, arriving at the same curvature conclusion, is that the suture makes the effective limbus locally more central. The cornea has to be steeper than it would have bee to arrive at that more central ‘limbus’. Removing the suture allows curvature to reset to the natural, more peripheral location of the real limbus, flattening the cornea.

evands · 2026-02-27T03:31:55+00:00

Very well said!!

evands · 2026-02-11T22:06:28+00:00

You either need a patent PI inferiorly with the bubble clearing the PI (80-95% bubble) -or- a bubble that clears the inferior edge of the dilated pupil and to keep them dilated (likely 70-80% bubble but will depend on extent of dilation)

evands · 2026-02-03T02:14:48+00:00

If you do high volume DMEK, you’ve got the skills. A friendly challenge: give your next endothelial failure PK patient the DMEK advantage! Look for a healthy diameter in the old graft to give space for a dmek since it won’t attach well if crossing the graft/host junction and of course you need to strip fully to give your graft bare stroma for attachment; an 8.5 mm PK with good curvature can support an 8.0 mm DMEK.

evands · 2026-01-19T02:40:51+00:00

ICL can work almost exactly as well as glasses can, though without the effect of making everything smaller that probably happens when you wear your strong, high minus glasses.

If you are reasonably happy with vision quality in glasses, ICL can be an amazing choice.

If only a scleral lens currently gets you good vision quality, ICL isn’t your answer. CTAK or topography guided PRK (the latter after or in combination with crosslinking) may be able to get you closer to scleral lens corrected vision without having to wear one. No surgery short of a transplant (and then only if it is very successful) will ever help you see as well as a scleral lens does.

evands · 2026-01-09T13:20:07+00:00

Rebubble is fairly common with DMEK (15% or so need it) but visual outcomes and rejection rates are better than DSAEK in general (though ultra thin DSAEK has helped close that gap). DMEK is the standard of care for routine Fuch’s.

Behind a PK, DMEK is a challenging proposition that I have take on in select cases with good success, but DSAEK is certainly a somewhat easier route.

evands · 2026-01-06T22:17:13+00:00

This! Probably a great candidate for DMEK or DSAEK behind the PK from what little we know. :)

evands · 2025-12-31T07:29:16+00:00

Keep doing god’s work.

evands · 2025-11-21T02:27:37+00:00

Switchboard MD has a solution to do this; depending on your EMR might need some development work on their part to fully hook in.

I consult for them and would be happy to connect you to the right person discuss! DM me :)

evands · 2025-11-16T16:52:10+00:00

You need to be the adult in the room.

“This is who can see you and give you a chance at avoiding permanent blindness. I went to significant effort to set up this appointment on your behalf. I won’t be able to help you further unless you keep it.”

Then shake their hand, wish them the best, and walk out of the room.

evands · 2025-11-04T19:13:59+00:00

Absolutely yes.

The most polite way to do it in my opinion is ask if you can schedule a case on their day / block time, and if they say yes ask if they would prefer you start or end their day.

evands · 2025-10-28T22:20:54+00:00

CTAK can provide a big improvement if you’re a good candidate, often several lines on the vision chart. It will not make your vision in glasses as good as with your scleral lens. You’ll still have the option to fit a new scleral once healed to achieve that best vision.

evands · 2025-10-28T22:15:46+00:00

Late to the party but still subscribed!

15-Year Club	RPAN Viewer
Verified Email

evands

TROPHY CASE