⚠ Prior RK: keratometry and IOL power prediction are unreliable — expect diurnal refractive drift; diffractive multifocal not advised; consider intraoperative aberrometry, multiple formula averaging, and light adjustable lens.
⚠ Prior RK: keratometry and IOL power prediction are unreliable — expect diurnal refractive drift; diffractive multifocal not advised; consider intraoperative aberrometry, multiple formula averaging, and light adjustable lens.
NoneAmblyopia — refractiveAmblyopia — strabismicGlaucomaPseudoexfoliation / zonular weaknessCorneal dystrophy / irregular astigmatismKeratoconus — fullKeratoconus — forme frustePrior corneal transplant (PK/DMEK/DSEK/DALK)Chronic severe dry eyeUveitis history
IOL Platform Candidacy — OS
Flags — OS
Clarification Needed — Package Structure
running log of cases that don't cleanly fit the current A/B/C/LAL/Traditional taxonomy
Toric-EDOF combination ("Package C — monofocal or toric Vivity") — a working note for a low-myope case (astigmatic left eye) described addressing astigmatism with "Package C (monofocal or toric Vivity)." Per the brochure, Package C is specifically a monofocal implant with astigmatism corrected via LRI/AK — it never involves a toric lens, and "toric Vivity" (a toric EDOF) doesn't map cleanly to Package A, B, or C as currently defined. Partially resolved: a later case explicitly paired "Vivity IOL (EDOF) + LRIs for astigmatism correction" — Package A/EDOF now carries an LRI cross-reference note for exactly this scenario, which likely covers what the original note meant. Still worth confirming whether a genuine toric-EDOF (not EDOF+LRI) pathway is ever separately offered.
Fixed while reviewing, not yet discussed: the "Uveitis history" chip existed on both eyes but wasn't wired into any logic at all — selecting it had zero effect on any card. Now wired the same way dry eye/PXF already were (diffractive-optics caution, with its own specific flag citing synechiae/PCO/CME risk). Flagging this because it was found by audit, not by a case example — worth double-checking the reasoning text matches how the practice actually thinks about uveitis history (e.g., does remote/quiescent history really warrant the same caution as recent/active disease? Currently treated as one flat flag either way.).
Combined surgery, non-glaucoma cases — cataract + trabeculectomy is now handled explicitly (bleb-induced irregular astigmatism → toric caution). Cataract combined with other procedures same session (vitrectomy, corneal transplant, etc.) still has no general flag — worth a future round if these come up.
Severe-glaucoma EDOF reversal, flagged for visibility: an earlier case (severe bilateral glaucoma) had EDOF explicitly recommended over multifocal. A later formal policy document states "severe glaucoma: no multifocal or EDOF." Built to the newer document as authoritative — EDOF now hard-blocks at severe glaucoma, astigmatism correction (Package B/C) unaffected. Noting this here in case that reversal wasn't intended, since it's a real behavior change from what shipped earlier, not just a refinement.