EyeWorld Asia-Pacific March 2015 Issue

March 2015 IOL Calculations 31 EWAP SECONDARY FEATURE Ophthalmology and led by Dr. Ianchulev, there was more than a 50% increase in accuracy with use of the device in eyes with previous myopic LASIK or photorefractive keratectomy compared against the surgeon’s best preop choice, the Haigis L formula, and the Shammas IOL formula. 1 Pre- and intraoperative pearls To get the best outcome with intraoperative aberrometry, remember that these are not plug- and-play devices, Dr. Solomon said. “You have to understand its limitations to appreciate the value of the machine,” he said. “There is a little bit of a learning curve, and you have to fall back on some of your training.” Here are some clinical pearls to maximize your use of the technology. 1. Always have a backup plan going into surgery, Dr. Weinstock advised. “Don’t abandon traditional techniques,” he said. Bring your readings from topography and preop biometry into the OR so you can see what is similar or different and validate your aberrometry findings. 2. Keep the eye moist with balanced salt solution (BSS, Alcon), Dr. Weinstock advised. “If you have a dry eye or if a patient has an issue with the cornea, it would be difficult to get a good refraction. The same thing takes place in the OR,” Dr. Weinstock said. “The eye can’t get dried out, and the tear film has to be stable.” “The surface of the cornea has to be pristine,” Dr. Bafna said. On the other hand, if there are globs of viscosurgical material on the cornea, that can throw off the data as well, Dr. Weinstock said. 3. Bring a tonometer to the operating room to check for consistent IOP, Dr. Bafna said. This is especially important if you are new to intraoperative aberrometry. “In a normal physiologic state, the eye is under a certain pressure. You want to make sure the IOP at the time of measurement is similar to that,” Dr. Solomon said. Pearls after lens placement Once the lens is placed in the eye and is well centrated, inflating the eye with BSS can help provide a good pressure measurement, he added. 4. Make sure the patient is not overly sedated, which could make fixation more difficult, Dr. Solomon said. 5. When taking measurements, check that there is no pressure from the lid speculum that could induce astigmatism, Dr. Bafna advised. 6. Ensure that the patient’s head has no significant tilt and that the microscope head is perpendicular to the patient’s eye, with no cyclotorsion relative to the patient, Dr. Weinstock said. 7. For pseudophakic readings, remove all viscoelastic material, make sure the eye is well sealed and the pressure is firm and stable, and avoid excessive hydration of the wounds, Dr. Weinstock said. “Refractive cataract surgery is an evolving subspecialty, and more and more devices, implants, and diagnostics are under development to integrate and improve refractive outcomes,” Dr. Weinstock said. “This is one piece of the puzzle in the evolution of cataract surgery and of the modality of trying to provide precise refractive outcomes at the time of cataract surgery.” EWAP Editors’ note: Dr. Bafna has financial interests with Abbott Medical Optics (Abbott Park, Ill.). Dr. Ianchulev holds 4 patents for intraoperative aberrometry and is a consultant for other ophthalmic companies. Dr. Weinstock has financial interests with Alcon and Bausch + Lomb (Bridgewater, NJ). Dr. Solomon has financial interests with Bausch + Lomb. Reference 1. Ianchulev T, Hoffer KJ, Yoo SH, Chang DF, et al. Intraoperative refractive biometry for predicting intraocular lens power calculation after prior my- opic refractive surgery. Ophthalmology. 2014;121:56–60. Contact information Bafna: drbafna@clevelandeyeclinic.com Ianchulev: tianchul@privatemedicalequity.com Solomon: jdsolomon@hotmail.com Weinstock: rjweinstock@yahoo.com Index to Advertisers Haag-Streit Page: 15 www.haag-streit.com Moria Page: 27 www.moria-surgical.com OCULUS Optikgeräte Page: 38 www.oculus.de Rayner Page: 41 www.rayner.com Topcon Corporation Page: 20 www.topcon.co.jp Ziemer Page: 60 www.ziemergroup.com ASCRS Page : 7, 23 , 34 , 57 www.ascrs.org APACRS Page : 2, 5, 47 , 49 , 56 , 59 www.apacrs.org