EyeWorld Asia-Pacific December 2016 Issue

December 2016 64 EWAP NEWS & OPINION peripheral nerves but is unlikely to observe it if it is at central nerves. There are many different ways neuropathic pain can develop, Dr. Asbell explained. An easy test for a patient with possible neuropathic pain is using a topical anesthetic. Dr. Asbell said to ask patients how they feel prior to a drop of proparacaine and then following the drop. “If the pain is gone, the chance is this is ocular surface disease and something you need to address,” she said. If the patient is still experiencing pain, it could be a combination of ocular surface disease and neuropathic pain or just neuropathic pain. In addition to many of the previously discussed ocular surface and lid treatments for dry eye, Dr. Asbell said post-LASIK patients might be candidates for peripheral nerve regenerative therapies, therapeutic scleral lenses, or systemic pharmacotherapy. Effect of postop pupil diameter on quality of vision with multifocal IOLs Studies have shown that pupil diameter affects visual performance of asymmetric multifocal IOLs, and it’s well known that pupil diameter decreases with age. As such, Richard McNeely, a PhD student, Belfast, Northern Ireland, presented research during a session that sought to assess the relationship between postop pupil size and quality of vision up to a 3-year period, specifically following those with asymmetrical multifocal IOLs. The study included 150 patients with the LENTIS Mplus MF30 IOL (Oculentis, Berlin). Pupil diameters were measured preop and postop at 1, 2, and 3 years. A quality of vision questionnaire was taken postop each year during the study period and a 0 to 10 score (0 being the worst, 10 being the best in terms of patient satisfaction) was also reported. Overall, the mean pupil diameter decreased over time in patients with asymmetrical multifocal IOLs, and a correlation was observed between quality of vision and pupil diameter each year of the study period, showing that the photopic pupil diameter does in fact impact visual quality. Patient satisfaction was very good in those who had a pupil diameter of at least 3.2 mm, while those with a diameter less than that appeared to have significantly reduced quality of vision. “To be 95% confident of attaining a pupil size postoperatively of 3.2 mm or above at 1 year postop, the mean drop in pupil size after surgery at 1 year is 0.2 mm plus two [standard deviations of error] of 0.07 mm, equaling a required preop pupil size of 3.54 mm,” Mr. McNeely said. Mr. McNeely said that assessing pupil diameter preoperatively could help predict quality of vision in patients considering asymmetrical multifocal IOLs, but he said the methodology still has to be validated further to see if it could be used to improve screening strategies. International Society of Refractive Surgery (ISRS) symposium During the ISRS symposium, Ronald Krueger, MD , Cleveland, gave the keynote lecture on “Upcoming technological revolution in cataract and refractive surgery.” What is a revolution? Dr. Krueger said that its definition is a forcible overthrow of social order in favor of a new system, or in this case, new technology. Dr. Krueger highlighted predictability, imaging, lasers, and lenses as the aspects of the coming cataract and refractive revolution. In terms of predictability, he highlighted simulations, alignment, and customization. In imaging, intraoperative aberrometry and intraoperative image overlay are two aspects that could improve and help customize procedures. There is also a revolution with lasers, with minimally invasive elastomodulation, a new generation of femtolasers, and new femto procedures, Dr. Krueger said. Current femtosecond lasers give us nice separation with laser ablation and cleaving, he said. New generation lasers may go into the ultraviolet, which could create even more refined pulses, he added. In terms of new procedures, Dr. Krueger said that SMILE is taking off around the world. “I think in the future, we’ll see more SMILE-like procedures being done,” he said, suggesting that perhaps procedures could be done using the lenticules and possibly reinserting them in eyes. New femto procedures may allow us to treat the lens itself and perhaps alter biomechanics and the rigidity of the lens, Dr. Krueger added. New lens updates include the possibility for intraoperative IOL adjustment and next generation presbyopic lenses. “Technology has been increasing [at] an exponential rate,” Dr. Krueger said. The upcoming technological revolution has already had a profound effect on cataract and refractive surgery and will continue to do so in the future, he added. It’s important to be prepared, informed, and ready to adapt and integrate technology to your practice, Dr. Krueger said, adding it’s important to be a part of the revolution and not a casualty of it. EWAP Reporting - from page 63 Today’s - from page 60 irregularities to help clinicians determine the source of the optical pathology. A retroillumination image of cataracts captured during the OPD exam allows better understanding of pupillary effects on vision and in patient education. According to Nidek, the 9.5- mm diameter measurement area “ensures full coverage of almost any pupil and provides 2,520 data points for wavefront aberrometry.” Additionally, the device’s 33 blue Placido mires “provide a minimum of 11,880 data points,” and the company notes blue wavelength allows for greater precision in ring detection. Orbscan 3 The Orbscan 3 (Bausch + Lomb, Bridgewater, New Jersey) is being introduced this month and uses slit scan technology with “an advanced Placido disk system,” the company said. The resolution is significantly higher than with previous models, providing 23,000 points of recognition. Like other new topographers, the Orbscan 3 provides both anterior and posterior corneal elevation and curvature, full corneal pachymetry, white-to-white diameters, and pre- and postop difference maps. EWAP References 1. Klyce SD. Computer-assisted corneal topography. High-resolution graphic presentation and analysis of keratoscopy. Invest Ophthalmol Vis Sci . 1984;25:1426– 1435. 2. Shirayama M, et al. Comparison of accuracy of intraocular lens calculations using automated keratometry, a Placido-based corneal topographer, and a combined Placido-based and dual Scheimpflug corneal topographer. Cornea . 2010;29:1136–1138. 3. Ambrosio R, et al. Imaging of the cornea: topography vs. tomography. J Refract Surg . 2010;26:847–849. Editors’ note: All information in this article is from public sources and websites.