EyeWorld Asia-Pacific March 2016 Issue

20 March 2016 EWAP Feature D to –0.09 D at 3 months after surgery. In the study, 82.4% of eyes achieved uncorrected distance visual acuity of 20/20 or better monocularly, and 92.5% achieved this binocularly. 5 Finding ideal patients In the big picture of ophthalmic surgery, it’s rare to find a patient with a significantly irregular cornea, which is why Dr. Schallhorn thinks it’s important to consider the use of technological advances like the aberrometer with all patients. That said, this doesn’t mean everyone will qualify for surgery with use of the iDesign. “You have to make sure the patient is an otherwise good candidate for laser treatment and that he or she will likely achieve visual gain,” he said. There are patients with irregular corneas that can’t take advantage of excimer laser treatment, he said. This may include very irregular corneas that still cannot be captured with the new aberrometer. In the U.S., the system is approved to treat patients 18 and older with myopia and compound myopic astigmatism, Dr. Manche said. The system is approved to treat up to –5 D of astigmatism, an increase from the WaveScan, which was approved for –3 D. “I also use the platform for patients with myopia and compound myopic astigmatism who are undergoing photorefractive keratectomy,” Dr. Manche said. “We have begun using iDesign to perform LASIK and PRK retreatments. These are off-label uses of the technology.” In the short-term future, surgeons anticipate FDA approval for mixed astigmatism and hyperopia and compound hyperopic astigmatism, Dr. Manche said. Keratoconus treatment? Although some patients with keratoconus benefit from dual treatment with corneal crosslinking (CXL) and excimer laser treatment, this is not possible in the U.S. right now because CXL is not approved by the FDA. However, surgeons familiar with the iDesign platform are hopeful that it can one day be used in the U.S. for this purpose. “Outside the U.S., the iDesign has been used to treat eyes with stable keratoconus using a surface ablation technique combined with collagen crosslinking,” Dr. Manche said. Dr. Schallhorn is looking forward to incorporating full corneal curvature into the wavefront profile. EWAP References 1. Gulani AC. Corneoplastique: art of vision surgery. Indian J Ophthalmol . 2014;62:3–11. 2. Gulani AC. Using excimer laser PRK— not PTK—for corneal scars: Straight to 20/20 vision. Advanced Ocular Care . 2012 Sept/Oct:1–3. 3. Gulani AC. Corneoplastique. Video Journal of Ophthalmology . 2007;22(3). 4. Smadja D, et al. Safety and efficacy of wavefront-guided myopic laser in situ keratomileusis using a new wavefront sensor technology: First 100 cases. J Cataract Refract Surg . 2015;41:1588–1593. 5. Schallhorn SC, et al. Outcomes of wavefront-guided laser in situ keratomileusis using a new-generation Hartmann–Shack aberrometer in patients with high myopia. J Cataract Refract Surg . 2015;41:1810–1819. Editors’ note: Dr. Manche has financial interests with Abbott Medical Optics. Dr. Schallhorn has financial interests with Optical Express and Abbott Medical Optics. Dr. Gulani has no financial interests related to this article. Contact information Gulani: gulanivision@gulani.com Manche: Edward.manche@stanford.edu Schallhorn: scschallhorn@yahoo.com Eyeing more - from page 19