EyeWorld Asia-Pacific September 2012 Issue

September 2012 61 EWAP MEEting REPoRt Measurements today go far beyond axial length, according to Wolfgang Haigis, PhD , Wuerzburg, Germany, who later gave a talk on IOL power calculations after refractive surgery. “We will need ultrasound biometry in the future,” Prof Haigis said. IOL calculators, too, are more involved, agreed Jaime Aramberri, MD , San Sebastian, Spain. “Toric IOL calculations are something more than using a web calculator with our brain set in pause mode,” he joked. IOL power calculations after refractive surgery “Corneal power after refractive surgery is a problem for IOL calculations,” Prof. Haigis said. If the measured corneal radii (K readings) are wrong, then there will be a radius problem. If the wrong radius is entered into an invalid corneal power, it will produce incorrect corneal powers, which will result in a keratometer index problem. There is an IOL formula problem when incorrect corneal powers are incorrectly processed in most IOL power formulas, Prof. Haigis explained. “The cornea power is responsible for all our problems,” he said. Radius measurement errors are not a big issue with today’s large optical zones, and keratometer index errors can be resolved using correction for effective corneal power (e.g., refractive history method, correction functions, etc.). Double-K corrections and use of a formula that doesn’t have error can help resolve issues with the IOL formula error, Prof. Haigis said. He suggested using the Haigis-L formula, which he developed, after myopic or hyperopic refractive laser surgery. Editors’ note: Prof. Haigis has financial interests with Carl Zeiss Meditec (Jena, Germany). New tools in biometry Claudio Carbonara, MD , Rome, gave an overview of biometry measurement tools. The Nidek AL-Scan (Aichi, Japan) has a large measurement range, from 14 mm to 40 mm, and even measures eyes that have dense cataracts. “It takes 10 seconds for complete measurements of one eye,” he said. Dr. Carbonara studied scan results from 47 eyes of 25 patients and concluded that there isn’t a strong difference between the Nidek and the IOLMaster (Carl Zeiss Meditec). The TopCon Alladin (Oakland, NJ, USA) is the only topographer/ optical biometer and offers the fastest measurements at 7 seconds per eye. Measurement range is from 15 mm to 38 mm. The Nidek OPD Scan III takes all of its data with a single measurement, including kappa angle, spherical aberration, pupil size, pupil position, HOA topography with APP, SimK, and ECCP. If the kappa angle, which is the difference in millimeters between the visual axis and the pupillary axis, is more than 5 mm, the patient will experience halos, blur, double vision, defocus, astigmatism, and coma. The Holladay IOL Consultant is exciting new online software that will help give the best IOL calculations for patients, Dr. Carbonara said. “It’s the most important because it has a complete database of all the IOLs and has every type of calculation,” he said. Nidek also has online software, he added. Dr. Carbonara also mentioned EyeNet, which is an iPhone/iPad app IOL calculator as well as the “Bible of biometry” (www.doctor- hill.com). Editors’ note: Dr. Carbonara has no financial interests related to his talk. Innovators share how-tos An evening symposium led by the International Society of Refrac- tive Surgery (ISRS) gave attendees an overview of challenging cases, novel procedures, and emerging technologies. Francesco Carones, MD , Milan, presented a talk on behalf of Jack T. Holladay, MD , Houston, who prepared a presentation on experience with 15,000 implants of the KAMRA corneal inlay (AcuFocus, Irvine, Calif., USA). Dr. Carones pointed out that nine ophthalmologists have the KAMRA inlay implanted in their eyes. “They are embracing this not only as surgeons but as patients,” he said. The KAMRA inlay is currently commercially available in 44 countries in Europe, Asia-Pacific, the Middle East, and South America. More than 15,000 inlays, which treat a broad spectrum of patients, including emmetropes, ametropes, post-LASIK and monofocal pseudophakes, have been implanted worldwide, Dr. Carones said. According to the data from the international clinical trial, patients’ uncorrected near visual acuity in the inlay eye was 20/25 at 12-month follow-up, with an average gain of 2-4 lines. “Mean monocular uncorrected distance vision in the inlay eye is 20/20 across all procedures at 12 months,” Dr. Carones said, adding that binocular photopic and mesopic contrast sensitivity remained within normal limits at 12 months post-op. Good results have been maintained with the inlay for 4 years, Dr. Carones said, and the device does not affect ocular assessments or prevent patients from getting cataract surgery when the time comes. EWAP Editors’ note: Dr. Holladay has financial interests with AcuFocus. Dr. Carones has no financial interests related to the talk.