EyeWorld Asia-Pacific June 2016 Issue

38 June 2016 EWAP CATARACT/IOL aberrometry readings can be used to decide whether or not to open incisions or do a manual incision. Preoperative measurements are good and can get you in the ballpark, but surgeons are always trying to improve results, Dr. Weinstock said. Intraoperative aberrometry doesn’t replace any of these tools, but it’s another data point while in the operating room. Dr. MacDonald said it’s incredibly important that both the OR team and the surgeon are familiar with it in every part of the process. It helps to use the technology frequently to allow your team to develop a rhythm and streamline the process. By using it frequently and not just on special cases, you will get comfortable with the technology and improve your results. In order for the ORA to work properly, the patient’s preoperative measurements and IOL calculations must be entered into an online database. This creates an opportunity for human error, such as transcription error, patient data errors, and incorrect eye error when entering information. Dr. MacDonald said, surgeons have to be diligent to make sure correct data is being used. It’s possible that human error could be introduced at that point, so it’s important to be aware of this possibility and check the information. Electronic health records are another aspect to monitor when using a new technology, such as aberrometry. Always check for the patient’s name and birthdate when using test results and confirm medical record numbers before using the data, Dr. MacDonald said. “I think aberrometry is an evolving science for us, and I think the advantage to using it now is we’re getting comfortable with this real-time evaluation. But it’s important to realize that we’re entering data, so to get accurate results, you need accurate data,” she said. Dr. MacDonald advocates for using aberrometry as much as possible to collect information and track outcomes in order see how close the aberrometry was to the surgical goals. “There’s a learning curve with aberrometry, as there is to surgery and topography,” she said. “These are all only as valuable as the quality and ability to interpret it.” VERION and Callisto Dr. Wolsey said she has been using the VERION system (Alcon) for some time. She mainly depends on ORA when implanting toric lens; however, she noted that in the absence of ORA, VERION can be an important tool. There’s the challenge of getting the patient in the right position and trying to mark preoperatively, she said. VERION can help with those measurements, as well as provide iris registration and marks for incisions. VERION transfers data to the LenSx laser (Alcon), if you’re using that platform, Dr. Wolsey added. VERION and Callisto eye #arl :eiss -editec use a lot of preoperative info, but they’re not providing dynamic, accurate in vivo info, Dr. Weinstock said. Those are ways of marking the eye, which are good, but not extremely useable in terms of being streamlined or efficient, he said. Dr. MacDonald currently uses the ORA system but said that the VERION and Callisto eye systems are integrated systems that are trying to get all the preoperative information and put it into one place in the medical record so the doctor has all the information stored in one area. “I think VERION could help optimize case results by allowing surgeons to analyze their data,” she said. Following outcomes In terms of following up on outcomes, Dr. Wolsey said that she has all of her data in the ORA system, which is constantly improving the nomogram based on the data entered. “Surgeons can pull their numbers and see how well they’re doing,” she said. This can help the surgeon keep track of their cases, and they can compare outcomes with and without the ORA technology, Dr. Wolsey said. Dr. Weinstock said that he tracks all outcomes for patients receiving a refractive cataract package and looks at patient data for 1 month and 3 months postop. Looking for any outliers and constantly refining nomograms can be helpful in obtaining better outcomes. If surgeons collect data and feed it back to the ORA system, it will do this for you and optimize the “surgeon factor,” he said. “It’s always important when you’re doing something technical to get feedback,” Dr. MacDonald said, indicating that she examines patients at 1 week and 1 month postop to see how close they are to what she predicted prior to surgery. The analysis at 1 week after surgery is important because if a toric lens is implanted, it’s important to adjust it as soon as possible if necessary. Insider tips One key tip that Dr. Wolsey offered was to be conscious of positioning. “Make sure that the patient is flat and well positioned,” she said. Also, use a lid speculum that doesn’t have a lot of pressure because there’s some concern that the lid speculum would change astigmatism values, she added. The systems have improved, Dr. Wolsey said, so they’ll tell you when you’re getting a good reading. The ORA system will show a green light when the surgeon is getting a particularly good reading. Dr. Wolsey often does three readings to make sure there is consistency in the values. Dr. Weinstock said that one of the biggest tips he can offer is to make sure to have the preoperative information available in the operating room. Know what the astigmatism values are and compare them to ORA readings, he said. Surgeons can fine-tune with the ORA, he said, but if it is way off, the surgeon may not have the eye filled up enough with balanced salt solution or viscoelastic to have the right pressure or the cornea surface may be dried out. By having preoperative data available as a reference, surgeons can get a sense of how good the data is. “It takes time and experience using the machine and gaining confidence with it,” Dr. Weinstock said. Other small actions can be helpful, such as keeping the cornea wet during surgery, and ensuring the patient isn’t squeezing and the lid speculum isn’t wedged into the eye. EWAP Editors’ note: Dr. Wolsey has no financial interests related to this article. Dr. MacDonald has financial interests with Alcon. Dr. Weinstock has financial interests with Alcon, Abbott Medical Optics (Abbott Park, Illinois), and Bausch + Lomb (Bridgewater, New Jersey). Contact information MacDonald: Susan.M.MacDonald@lahey.org Weinstock: rjweinstock@yahoo.com Wolsey: dwolsey@theeyeinstitute.com Using aberrometry - from page 37