Post-OP Data and PLC

I am entering pre and post-op data and I am at the next to the last option which is SIRC calc. Do I enter any info on this screen? Or on the next screen which will be Back calc?

You only enter data on the PreOp, Toric PreOp Planner, Surgery Data and Post Op Exam TABS. All the other tabs are derived from the input on these screens.

Should I be entering more than 1 post-op refraction. We do a 1 week refraction, but we only give the final Rx at last pov

The 1 week post op is of no value, since the Refraction is not stable. It will only use the post op value to determine the Personalized Lens Constant (PLC) if it is over 14 days. If you enter more visits after this, the PROGRAM uses the most recent entry (the longest time since surgery).

I've entered many post-op measurements and I still don't have a PLC. Why?

Possible causes of the PLC not being calculated are

    1. PLC calculation is only done when the program starts. So if you leave the program running continuously that could cause it not to calculate PLC.
    2. Data is entered in Optical boxes instead of U/S or vice-versa relative to which one it should be entered in.
    3. You aren't looking at active IOLs
    4. Cases are being excluded and those causes aren't being dealt with. In the SOAP section you can click on the EXCLUDED CASES button to see which cases are excluded.

We have not put any post op data in our HicSoap program for three weeks, and our Holladay II program is varying from patient to patient. For example patient A has a constant of 5.33, patient B has a constant of 5.31 and patient C has a constant of 5.36. All of these measurements were taken within days of one another and on our IOL calculations report they are varying from one another. Is this normal? Will the A constant change from entering pre-op data only? We know that our lenstar does not update automatically when we enter post of data in the HicSoap program once it is optimized, so we manually enter the new constants in our lenstar, is it normal for the SRK-T, Holladay I programs to change as well without any new post op data entry? Our last manual entry of data into the lenstar matched our optimized data in the HicSoap program, now the Hic Soap calculations have changed.

This is wonderful … you have entered enough postoperative data for the PROGRAM to begin using the PLC+ (plus). All this means is that the Program has enough cases to determine the Personalized Lens Constant (PLC) for smaller sub-groups such as long and short axial length and steep or flat Ks. The difference in 5.33 and 5.36 for the SN60WF is 0.06 D, so it is 4 times less than the accuracy of refraction (0.25 D), but there are cases where it may be greater.

Regarding the Personalized Lens Constant (PLC).... Is there there somewhere I can read about this?

The are several articles on my website (www.docholladay.com) under physician resources and publications, but #26 is the original. Holladay JT, Prager TC, Chandler TY, Musgrove KH, Lewis JW, Ruiz RS. A three-part system for refining intraocular lens power calculations. J Cataract Refract Surg. 1988; 14:17-24.

Is it possible to have more than one post-op astigmatism group? e.g. LensX laser, LRI and without astigmatism correction?

Yes ... this is the purpose of the Procedure Code. When adding the IOL name the Procedure Phac w LRI, etc.

Are LRI's excluded from outcomes?

No ... if you want them separated you must use a separate

PROCEDURE CODE for the IOL when you add the IOL to your ACTIVE LENS LIST. Using something like "Phaco LRI" and then they will be separate.

If target post op manifest is -1.70, -1.00, etc will it throw off PLC calcs if dist manifest is used in po visit?

The TARGET HAS NO EFFECT. The PROGRAM CALCULATES the EXPECTED REFRACTION from the IOL IMPLANTED AT SURGERY and then takes the difference in the ACTUAL REFRACTION.

Do you suggest not entering po data for the two weeks Crystalens patients are on Atropine?

No … wait until their pupil is back to normal.

How do I delete post op info that was mistakenly entered on the wrong eye?

It must be the last one and it is done on the Patient Locator Screen.

How important is it to enter K’s for post op exams?

It is only used to determine you Surgically Induced Astigmatism primarily for TORIC IOLS. On the SIRC SCREEN below in the UPPER LEFT HAND CORNER the MEAN DEVIATION = 0.72 D. If you enter the POST OP Ks, this value is displayed and is what you would use for your SIA