front office
Appointment for preliminary cataract surgery examination
- If possible, appointment with a planned surgeon
- Appointment with slot with optician
- Give consent (EV cataract surgery)
- Send the family doctor form and accompanying letter for the family doctor to the family doctor
- Should be completed by us 1 week before the planned operation
- directions
- Contact lens abstinence (1 week soft KL, 2 weeks hard KL)
- Moisturize the eye intensively 2 weeks before the examination with Lacrinorm Fluid/Optava/Lacrycon AT 4x/day
- May not drive after the preliminary examination (due to mydriasis)
optician/optometrist
Biometric measurements, general clarification and information regarding self-payment benefits
- Biometry (Pentacam ALX and IOL Master), possibly ultrasound biometry
- autorefraction (AR), air tonometry
- Blendvisus in patients < 50 years
- Refraction < 2 months
- OCT macular disc and photos
- endothelial cell measurement
- If < 2000 Zellen/mm2 > femtosecond laser recommends assisted cataract surgery, use HPMC 2% (note below cave in procedure)
- Guiding eye (motor, sensory and anamnestic)
- Monovision testing with test glasses (+1.5 addition for non-leading eye and then also for leading eye testing for far and near)
- Explain surgery and potential risks and complications
- Explain self-paying packages and make a recommendation
- Slit lamp photo if it cannot be ruled out that a toric IOL is being used
- Arrange surgery appointments
- 1. Non-guide eye (eye with poor visual acuity if explicitly requested by the patient)
- 2nd guide eye
- Priority for choosing the OP slot depends on the package: Diamond > Gold > Silver > Bronce > no self-payment services
- Slit lamp photo with toric IOLs
- The patient's head should be vertical, the entire limbus should be sharply imaged
- Integrate 365° degree grid (software)
- IOL determination in accordance with ONO Guideline
- Without package/bronze package -> by optician (approved by chief physician: JH, FH) or senior physician in continuing education ophthalmic surgery (as soon as approved by chief physician: JB, Cossa, ES, EL, GA, RG)
- silver/gold/diamond package -> by surgeon
- Enter IOL strength in cataract statistics and order
- If possible, schedule follow-up checks with the referrer or at branch offices
- Submit an invoice and ask that we receive the payment before the operation
- Print out an appointment confirmation and drop it off with medication
ophthalmologist
Analyzing measurements, planning the operation and answering questions regarding surgery and anesthesia
- Anamnesis (usually prepared by an optician, only completed)
- Subjective complaints
- systemic anamnesis (medical history sheet)
- Ophthalmic examination
- Slit lamp, fundus copy including peripheral retina
- Topography (cave: irregular astigmatism -> contraindication for multifocal/toric IOL)
- OCT (cave: macular edema, retinal gliosis, RnFL defects -> further clarification or treatment before cataract surgery)
- endothelial cells (cave: Fuchs endothelial dystrophy -> precautionary measures during cataract surgery)
- Biometry (cave: unequal axis lengths usually only with amblyopia otherwise measurement errors are possible)
- Check the indication
- increase in intraocular pressure due to cataract (phacomorphic glaucoma)
- Visual acuity reduction due to catarket < 0.8, or subjectively disruptive
- Blinding caused by cataract (cortical turbidity)
- Progressive myopization
- Wish for freedom from glasses
- Increased risk of amotio p.o. (usually with axle length > 26 mm)
- Document other eye diseases (e.g. retinal foramen, macular edema), complete the diagnosis list
- Briefly explain to the patient individually about the type of anesthesia, operation (including type of operation, target refraction) and prognosis and document them using keywords
- Edit the consent form visibly (paint or add notes) and sign
- If necessary, answer questions from the patient
- Determine IOL and complete entry in medical records
- Text module “vc”
- S: Anamnesis (medications and allergies)
- B: findings (cave: cataract grading)
- D/B: Update the daily list
- P: Procedural
- Defining the package
- Determine IOL
- Family doctor form not required if < 70J or < ASA II
- General practitioner form required if > 70 J or > ASA II
- Can't lie flat
- shortness of breath (COPD, asthma)
- Demez
- angina pectoris, heart disease
- hemiplegia < 1 year, neurodegenerative disease (Parkinson, Alzheimer's)
- multiple drugs
- Current tumours
