You bet, it is epsilon special order E1-206, or when backordered Ambler: amblersurgical.com/7976e-kershner-reversible-lid-speculum-2-7-8-adult-size-thin-14-0mm-solid-blades-nasal-or-temporal-approach-adjustable-thumb-screw-tension

@@JJChopsticks thanks!

Yes, you can see the radial scars on the cornea. The refractive targeting suggested by biometry is hard to rely on, so I personally would only suggest LAL for these patients.

@@JJChopsticks thank you also for the perfect site of corneal incisions I.e. between radial scars

Great question :) I mostly do RLE on the West Coast of USA which means my patients are predominantly 50-65 years old and have "soft cataract" or as we call it, "clear lens". I have never seen a black cataract, unfortunately, I don't believe there are many currently in the USA.

Hi, I use the Alcon Luxor Revalia microscope which has a built in panasonic video camera. I bring a USB drive which connects to the microscope and I record the videos with the microscope foot pedal controls.

The pupil is darker in this patient, during nucleus disassembly, the cataract becomes opaque and the red reflex is dulled. The video camera then adjusts the white balance and further makes it harder to distinguish the pupil/iris from the cataract.

I completely agree with your ophthalmologist. When you have two highly myopic eyes and you only correct one with surgery, then you will end up with anisometropia (difference in prescription between the eyes) and aniseikonia (difference in size of images between the eyes). This is hard to adjust to beyond 2 diopters of difference. I would trust your ophthalmologist's recommendations.

@@JJChopsticks Thank you so much Dr Tian

Hi Dr Tian, after cataract surgery on one eye would I be able to return to work while I wait for surgery on the other eye? Or should I wait until both eyes are done before going back to work?

Welcome to my KZbin channel :)

Great question, yes, it is usually due to maladaptation with the technology (particularly Ringed lenses). Such patients may complain of rings around headlights while driving, which may cause anxiety and difficulty judging distance of nearby cars with nighttime driving. It is still a small percentage of patients who have this issue, most patients absolutely love this technology. You will see more IOL exchanges on my channel because I do them for other surgeons.

I would say less than that, I do IOL exchanges for other surgeons so you see them more on this channel. If the reason for lens exchange is due to dysphotopsias/maladaptations due to multifocal lenses, then I would say 2-5% (estimation) result in an IOL exchange to a non-ringed lens and improves patient satisfaction.

Yes, the J&J Symfony Optiblue has been out for 2 years now. Good lens!

They are used differently. One has rings and the other doesn't. The rings boost range but can be associated with negative side effects; the rings also limit the patient selection to very healthy eyes. The Vivity is shorter on range so a small offset can be introduced to boost the near potential. I would say patients favor and request the panoptix more often than the Vivity from my own experience, perhaps due to it being widely used in the USA. Both great lenses!