This figure shows various presentations of patients who have keratoconus and have undergone incisional surgeries to treat the keratoconus and also might have associated cataracts.
All of these cases scenarios, which are an everyday occurrence in my practice, demonstrate my desire to take every patient to emmetropia despite the “so-called” complexity of the cases.
This desire leads us to neutralize our mindset like that of a mathematician to solve the problem beyond the published formulas that are taught for addressing these scenarios in most cases, of course, with patient safety and their vision goals being the backbone of these concepts. This allows us to develop unique vision recipes for each patient and bring them to uncorrected emmetropia.
I encourage you to understand each equation to help you create a unique formula for each case. May I encourage you to “think outside the cone.”