EyeWorld Asia-Pacific September 2018 Issue

EWAP FEATURE 17 September 2018 she wasn’t correctable to 20/20. With some manipulation, he was able to refract her to 20/20 but it fluctuated. Her cycloplegic refrac- tion didn’t match her manifest refraction in terms of magnitude and axis of astigmatism. Preopera- tive topography revealed 3.5–5 D of corneal astigmatism. With these indicators, Dr. De- sai examined her further, finding chronic underlying keratitis, dry eye, and a little bit of epithelial basement membrane dystrophy. Dr. Desai told the patient that he thought LASIK, at this time, was a bad idea due to her ocular surface disease and inconsistency of her preoperative measurements. “I told her that I’d rather do this the right way, regardless of what option we might choose, rather than do it the fast way,” he said. Establishing this trust with the patient, Dr. Desai moved for- ward with a superficial keratecto- my with a PROKERA (Bio-Tissue, Doral, Florida) graft placed for 3 days. By the time the graft was re- moved, 100% re-epithelialization was achieved. In the month fol- lowing, Dr. Desai put the patient on a tapering dose of steroids and lifitegrast (Xiidra, Shire, Lexing- ton, Massachusetts). After that month, the patient told him for the first time she could feel that her eyes were dry. This, Dr. Desai said, was actually a good sign because it indicated corneal nerve regeneration. The ocular surface disease was being treated and she was on her way toward candi- dacy for some possible refractive procedure. A month later her ocular sur- face was pristine with no keratitis and her topography revealed no astigmatism. “It occurred to me that if someone had done LASIK on her, her dry eye and ocular surface disease state would have been far worse off, and I may have been treating off a refraction that was so erroneous she would have been way off target,” Dr. Desai said. Discussing all of the different refractive options that were avail- able to her, the patient opted for clear lens extraction with Tecnis Symfony extended depth of focus IOLs (Johnson & Johnson Vision, Santa Ana, California). Postop she was 20/20, J2+, and “wildly happy,” he said. From a technological stand- point, Dr. Desai said this case shows that you don’t necessarily need some of the more advanced biometric devices to diagnose a patient with ocular surface dis- ease or corneal irregularities. You www.haag-streit.com LENSTAR 900 AI powered IOL calculation Artificial intelligence with Hill-RBF Big data analyzation based on artificial intelligence leading to highly accurate IOL predictions. Hill-RBF 2.0 The new version is based on a 3x bigger data- set for improved accuracy and confidence. In addition the Hill-RBF was complemented with the well-established Abulafia-Koch algorithm for torical applications. continued on page 18