EyeWorld Asia-Pacific June 2016 Issue

37 EWAP CATARACT/IOL June 2016 Using aberrometry to improve outcomes The tool can be used intraoperatively, as well as postoperatively to help surgeons track outcomes T he ability to obtain accurate measurements preoperatively is key in a surgeon’s treatment plan for a patient. However, being able to measure and adapt intraoperatively, based on any changes the eye may undergo during different parts of the surgery, is also important. The ability to make these adjustments can lead to better postop results for the patient. Darcy Wolsey, MD , the Eye Institute of Utah, Salt Lake City, Robert Weinstock, MD , the Eye Institute of West Florida, Largo, Fla., and Susan MacDonald, MD , Lahey Clinic, Peabody, Mass., discussed the value of intraoperative aberrometry. There are a number of systems available that surgeons use to help during the case as well as to track and improve outcomes following surgery. Some of the surgeons noted that they use the ORA system (Alcon, Fort Worth, Texas). Use of intraoperative aberrom- etry to guide treatment “I think the challenge of astigmatism right now is that even though we have good ways of measuring it preoperatively, there are aspects of astigmatism that we still don’t fully understand,” Dr. Wolsey said. One of those aspects is the effect of posterior corneal astigmatism. Additionally, differences among devices pose a problem. Sometimes surgeons get overloaded with information, she said. The surgeon may end up with different values using readings from auto K, topographer K, IOLMaster K (Carl :eiss -editec *ena 'ermany custom refraction, or the LENSTAR (Haag-Streit, Koniz, Switzerland). “Sometimes you get lucky and they’re all the same,” Dr. Wolsey said, but sometimes there’s a distinct difference among values or enough of a difference that it would affect what power toric the surgeon will use. Dr. Wolsey thinks that ORA helps manage all of the information the surgeon has. “I think it can help guide the variables among those measurements we have preoperatively,” she added. When the ORA technology and the concept of measuring the eye intraoperatively was first developed, it was groundbreaking, Dr. Weinstock said, because no one had taken measurements during surgery to guide decision making. “The first thing surgeons have to understand is it’s a new paradigm—the concept of taking measurements while you operate,” he said. In the operating room, the surgeon does things to the eye that can change its shape, like making the wound, making the paracentesis, and taking out the cataract. By taking measurements after those, the concept of getting more accurate biometry makes a lot of sense, Dr. Weinstock said. “When we measure the eye after we’ve made the wound and taken out the cataract, we have a new state of the eye, which is different than it was during preoperative testing,” Dr. Weinstock said. Now it’s possible to make decisions for IOL power selection, astigmatism management, and correction. For astigmatism correction, surgeons can use intraoperative aberrometry to determine what power toric to use, and once the lens is in, it helps to determine where it can be left. For smaller amounts of astigmatism, by Ellen Stodola EyeWorld Staff Writer AT A GLANCE • " UeDIOology lJLe aCerroNeUry JT JNQorUaOU CeDaVTe UIe TUaUe of UIe eye JT DoOTUaOUly DIaOgJOg aT JU JT NaOJQVlaUed aOd oQeraUed oO. )aWJOg UIe NoTU VQ-Uo-daUe NeaTVreNeOUT wJll eOaCle UIe TVrgeoO Uo geU DloTeTU Uo UIe deTJred oVUDoNe. • 8IeO eOUerJOg JOforNaUJoO JOUo aO aCerroNeUry TyTUeN Ce aDDVraUe aOd aware of UIe QoTTJCJlJUy for IVNaO error. • *OQVUUJOg daUa JOUo UIeTe TyTUeNT DaO IelQ TVrgeoOT Uo JNQroWe OoNograNT aOd forNVlaT for UIe fVUVre wIeO UreaUJOg QaUJeOUT. VERION overlay to identify primary and secondary incisions VERION overlay showing axis for toric intraocular lens Source: Darcy Wolsey, MD continued on page 38