EyeWorld Asia-Pacific September 2018 Issue

there is controversy about the strength of the rhexis created with femto platforms. But there is signif- icant evidence that these capsules are equally strong, he said. Meanwhile, Dr. Lubeck shared information on achieving greater accuracy in less predictable eyes, sharing a case presentation. He noted many advantages of the technology he used. With VERION, you can center the capsulorhexis and lens ablation on the visual axis, he said. The patient Dr. Lubeck was see- ing had an IOP of 28, and he noted that we “wouldn’t have been able to conceive of this before Centu- rion.” Dr. Lubeck also detailed how he uses the ORA intraoperative aberrometry system and the “rich amount of data” it provides. Lastly, Dr. Lawless shared some choices of advanced technologies to optimize patient outcomes. Dr. Lawless said that, in his practice, LenSx is fundamental in terms of accuracy and safety of the capsu- lotomy. He added that using the Centurion system also makes him comfortable because it can provide great chamber stability and safety. He said that he thinks these tech- nologies are incrementally better than he can do manually. He also highlighted the benefit of using the VERION system, particularly in toric cases, which are the majority of lenses that Dr. Lawless implants. Though Dr. Lawless noted that he’s not a better surgeon than he was 5 years ago, he said he’s get- ting better accuracy than he was 5 years ago, to the level that patients expect. He also briefly mentioned the Clareon lens with its injector, which he said is the best injector he’s used in terms of protecting the IOL and protecting the wound. Dr. Lawless concluded by sum- marizing his seven essentials for happiness: 1. Safe surgery: Centurion chamber stability 2. Safety and accuracy – LenSx 3. Conversation prior to surgery 4. Tear film optimization 5. Biometry with correct formulae 6. Toric IOLs in 90% of patients, which requires VERION and digital alignment 7. PanOptix trifocals in 25% of patients Keys to ‘Finding the Right Path’ in refractive cataract surgery As refractive outcomes in cataract surgery are increasingly sought, “Finding the Right Path: Predicting Outcomes in Cataract Surgery,” was a particularly relevant symposium for attendees. Cataract surgery has moved from being a rehabilitative surgery to a refractive surgery. As such, “it is my firm conviction that the same philosophy should be extended to glaucoma patients who need cata- ract surgery,” said Arup Chakra- barti, MD , Trivandrum, India. “Just because a patient has glau- coma, it does not mean he should receive a blanket ban for these advanced technology intraocular lenses.” However, there are special considerations that should be taken into account when selecting an IOL and calculating a power. Trabeculectomy can induce with- the-rule corneal astigmatism, and after successful trabeculectomy, when the IOP comes down, there can be a decrease in axial length. There can also be an increase in axial length in post-trab eyes after cataract extraction (a myopic shift) and a decrease in axial length in post-trab eyes after phaco (hyper- opic shift). When it comes to premium lenses, there is little in the pub- lished literature about the role of multifocal lenses in glaucoma patients. However, Dr. Chakra- barti pointed out, patients with moderate to advanced glaucoma can have reduced contrast sensitiv- ity and a decrease in other visual functions. These conditions could exacerbate some of the optical issues associated with multifocal lenses, such as dysphotopsias and optical aberrations. Though he would not recommend a multifocal lens for a patient with advanced glaucoma—recommending mono- vision with an aspheric lens for this group instead—he would consider these IOLs for glaucoma suspects, patients with ocular hypertension, and those with mild glaucoma who are stable and controlled with no signs of progression. Dr. Chakrabarti said he regu- larly implants toric IOLs in glau- coma patients but noted that he avoids them in patients having a combined phaco-trabeculectomy procedure due to the with-the-rule astigmatic shift that can be seen postoperatively. Dr. Chakrabarti noted the impact of the ocular surface on multifocal and toric IOLs. With the majority of glaucoma patients having some degree of ocular sur- continued on page 70