EyeWorld Asia-Pacific June 2018 issue

64 EWAP DEVICES June 2018 Dr. Carlson said it has been especially helpful in ruling out patients for certain procedures, like LASIK. “We have much better technology to pick up early kera- toconus, as well as the patients at risk for post-LASIK ectasia. It also gives us a better handle on stabil- ity of the refraction after contact lens wear. We see a lot of patients with hard lens wear, toric contact lens wear, and even soft lens wear in whom we want to make sure that they’ve been adequately out of their contact lenses. Topography and tomography together have been huge advances over the past 3 decades, but particularly over the past 10 years when it comes to refractive surgery and refractive cataract surgery,” he said. Wavefront analysis Dr. Hovanesian uses the Wave- Light Contoura system (Alcon, Fort Worth, Texas), which is topogra- phy-guided treatment that evalu- ates the whole eye. “It’s important because there’s clearly a demon- strable difference in refractive outcome when you treat higher order aberrations as opposed to just lower order aberrations,” he said. Dr. Waring uses high defini- tion wavefront on all laser vision correction patients. “Now, we have extraordinarily powerful high definition aberrometers with the iDesign suite [Johnson & Johnson Vision] that measure more than 1,000 points of refractive data per eye that also account for chromatic aberration. We have seen a boost in our patients that are 20/15 and 20/10 with the advent of this ad- vanced technology,” he said. Dr. Durrie agrees. “We use wavefront when we’re going to do wavefront-guided surgery. We were in the iDesign clinical trials, and that was a significant improve- ment over the WaveScan. We have moved into kind of a new era with the combination of WaveLight topography-guided ablation and the iDesign. I think both of these diagnostics have moved the bar up because we’ve seen more patients who are better than 20/20 with both of those,” he said. HD Analyzer and iTrace Dr. Hovanesian likes the HD Ana- lyzer (Visiometrics, Costa Mesa, California) for many of the same reasons that he likes LipiScan. “The HD Analyzer looks at the whole eye and its image quality. The OSI of the HD Analyzer is valuable because if you’re going to do LASIK on someone who is 50 and has sig- nificant scatter from a cataract, you want to know about that because they’re not going to be happy. There’s an OSI tracing over time that will tell you how the scatter in the eye is changing as the patient blinks, and if you see wide varia- tion there, you need to think more about the tear film as opposed to the static ocular media. Not only does the HD Analyzer give you an overall sense of the scatter in the patient’s eye but also the source of that scatter. I use it for every cata- ract patient, but not every LASIK patient,” he said. Dr. Waring thinks the HD Ana- lyzer represents a future paradigm in diagnostic testing because it’s one of the few devices that pro- vides objective data on quality of vision. “This has been an invalu- able tool for diagnosis, education, and management of the dysfunc- tional lens syndrome at its various stages. Also, for dry eye evaluation, it’s one of the few devices that can give an objective, functional analysis of the impact of dry eye on vision. For subtle complaints, objective complaints, such as diplopia, this can be useful because we can identify the multiple points of light as they fall on the retina,” he said. He has also found the iTrace (Tracey Technologies, Houston) to be useful for the ability to sepa- rate out internal aberrations from total aberrations and help surgeons determine whether the pathology is coming from the lens or the cornea. “It has a robust postopera- tive astigmatism program that can guide surgeons in evaluating post- op astigmatism, particularly for understanding etiology and how to address residual astigmatism, that is, whether a rotation of an IOL would be warranted and how much. We’ve found it to be the most useful commercially available tool to do this analysis,” he said. New technologies As a group, these technologies have brought a combination of tear film diagnostics that have made surgeons even more aware of who needs to have treatment both before and after surgery and the topography-guided and wavefront- guided treatments that allow sur- geons to achieve better than 20/20 vision. “It’s a fun time to be a refractive surgeon because we have good tools, and patients are getting good results,” Dr. Durrie said. “We know who to operate on and which one of the procedures in refractive surgery to do. It’s a great time for patients, and I think companies are now putting a more resources into refractive surgery, and practices are starting to head in that direction also.” EWAP Editors’ note: Dr. Hovanesian has financial interests with Alcon and TearLab. Dr. Waring has financial interests with Johnson & Johnson Vi- sion and Visiometrics. Drs. Carlson and Durrie have no financial interests related to their comments. Contact information Carlson: alan.carlson@duke.edu Durrie: ddurrie@durrievision.com Hovanesian: jhovanesian@harvardeye. com Waring: gwaring@waringvision.com Technologies that improve – from page 63