EyeWorld Asia-Pacific June 2014 Issue

3 EWAP June 2014 Letter from the Editor Dear Friends T he reader of any issue of EyeWorld Asia-Pacific readily comes to the conclusion that as professionals ophthalmic surgeons are focused on the pursuit of perfection. Our pages are filled with descriptions of new technology and techniques all aimed at providing better outcomes for our patients. At times, these efforts can be challenging and controversial as can be seen by the continuing debate about the risk/benefit ratio of femtosecond laser cataract surgery contained in this issue. One of the justifications for considering this new technology is the promise of more predictable refractive outcomes through a more consistent capsulorhexis. Although some publications suggest this is indeed the case, others have found no difference compared to manual phacoemulsification. Intraoperative aberrometry is also proposed as a solution for more predictable outcomes but once again well-conducted studies are required to confirm that the additional expense and effort is of benefit. In the interim, improved methods of determining the correct axis for toric implants and understanding the role of the posterior cornea are equally important strategies for all surgeons and I am sometimes surprised to find that enthusiastic users of femtosecond laser technology are not paying detailed attention to formulae and methods of prediction which are equally if not more important in improving the predictability of refractive outcomes. Our enthusiasm for new technology often ignores other problems that are commonly encountered in modern cataract surgery. Unwanted dysphotopsia is not an uncommon complaint and this is not only encountered in patients with multifocal implants. Halos and scatter are well known issues with diffractive multifocal implants, but I am sure all surgeons will be familiar with patients who have had an excellent result but are troubled by dysphotopsia even with monofocal implants. Positive dysphotopsia often described as flashes of light or reflections in the early postoperative period do not appear to be as troublesome as the temporal shadow characteristic of negative dysphotopsia. This complaint was almost unheard of in the days when we implanted a round-edged PMMA implant and was first encountered with oval lenses due to the truncated edge. The basic optics behind the phenomenon is probably due to internal reflection in the square-edged optic which is characteristic of the current generation of IOLs as the feature does delay posterior capsular opacification. The higher refractive index of modern implants also contributes to this phenomenon. Other factors may also be relevant including the role of the edge of the anterior capsule. This topic is covered comprehensively in this issue with some useful suggestions which are worth considering in a patient where these symptoms persist. New intraocular lens designs, which alter the relationship of the edge of the rhexis to the optic, are being considered and it would be a great advance if we could diminish the frequency of this complaint. There are many other articles in this issue but all share the common theme of searching for perfection. Our ability to share ideas which can then be examined critically and challenged is an essential element of the scientific method. EyeWorld Asia-Pacific is delighted to be an integral part of this process. Warmest regards Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific EYEWORLD ASIA-PACIFIC EDITORIAL BOARD C HIEF MEDICAL EDITOR Graham BARRETT, Australia MEMBERS Abhay VASAVADA, India ANG Chong Lye, Singapore CHAN Wing Kwong, Singapore CHEE Soon Phaik, Singapore Choun-Ki JOO, Korea Hiroko BISSEN-MIYAJIMA, Japan ASIA-PACIFIC CHINA EDITION Editors-in-Chief ZHAO Jialiang ZHAO Kan Xing Deputy Editor HE Shouzhi Assistant Editor ZHOU Qi ASIA-PACIFIC INDIA EDITION Regional Managing Editor S. NATARAJAN ASIA-PACIFIC KOREA EDITION Regional Editor-in-Chief Hungwon TCHAH Regional Managing Editor Chul Young CHOI Hungwon TCHAH, Korea John CHANG, Hong Kong Johan HUTAURUK, Indonesia Kimiya SHIMIZU, Japan Pannet PANGPUTHIPONG, Thailand Prin ROJANAPONGPUN, Thailand Ronald YEOH, Singapore S. NATARAJAN, India YAO Ke, China Y.C. LEE, Malaysia