How do you go about assessing a patient that has had refractive surprise following cataract surgery when determining the cause for surprise and in preparation for the other eye?

Pretty simple, if at the visit at 1 week BEFORE the second eye is done, if the vision is NOT good and they are refracted and there is a surprise, then look again. If necessary, DON'T do the 2nd eye until you know what is going on with the first surgery!

Repeat measurement, do corneal topography, consider anterior segment scan for lens location and anterior chamber depth, dilate and check zonular support.

We typically perform cataract surgery 1 week apart, so there is often not enough time to truly assess the refractive outcome unless it's a big surprise. Certainly, if you have a big surprise, you want to A.) make sure the correct lens was implanted by checking the sticker and B.) repeat biometry to ...