EyeWorld Asia-Pacific March 2019 Issue

corneal epithelium, excessive reflex tearing, and poor fixation; or fluid entry through suction ports or com- pressive forces against the contact glass resulting from intraocular gas/ bubble transposition. Physicians have to look at if the suction loss is during the lenticule cut. Sometimes, they may be able to restart. But if you have cut the lenticule past a certain point, you might have to abort the procedure or convert it into a femto flap, Dr. Sachdev said. The VisuMax software provides supporting information and guidance for the surgeon in case of a suction loss. For Dr. Sach- dev, suction loss is a rare occur- rence, around 1%. cuts. He does the laser in the right eye, laser in the left eye, then ex- tracts the lenticules in the right and left eye. He doesn’t use draping for laser cuts and places his hands on the patient’s forehead, which helps him to tell if the patient is tensing up; identifying when the patient is tensing up can help drive the suc- tion loss rate down to less than 1%. He also said to keep the eyes closed until the very last second. Dr. Chansue shared his routine for lenticule dissection and ex- traction. He said to minimize time spent dissecting, minimize distor- tion of the cap, and smooth the cap surface. Mahipal Sachdev, MD , New Delhi, India, presented “Challenges and Management of SMILE in Daily Practice.” There is a learning curve with SMILE, he said, adding that complications will be rare, manage- able, and usually there is no loss of best corrected visual acuity. Appro- priate knowledge of management is key. SMILE challenges may occur intraoperatively or postoperatively. Intraoperatively, these could include suction loss, incorrect dissection, minor epithelial abrasions, side cut extension, and lenticule fragmen- tation. Postop complications might include dry eye, epithelial ingrowth, unintended abandonment of the lenticule fragment, diffuse lamellar keratitis, ectasia, and regression. If you have something in the interface when docking, Dr. Sachdev warned against continuing with the procedure. He showed a case where a lash caused a problem. This could interfere with laser penetration and could leave an uncut area. If you have a large interface debris, don’t dock, he said. First, clean it. One complication that Dr. Sach- dev went into detail on was suction loss. There are a number of predis- posing factors: longer duration of suction required in SMILE compared to femtosecond LASIK; a loss of con- tact between the glass interface and cornea due to sudden eye or head movement; ocular factors including a small palpebral aperture, loose Sri Ganesh, MD , Bangalore, India, presented “Principle and Treatment – Laser Blended Vision.” He shared some of the principles of PRESBYOND laser blended vision, noting that it’s based on increased depth of focus and micro-monovi- sion (the dominant eye is targeted for emmetropia and non-dominant eye for myopia). Non-linear aspher- ic ablation profiles are used, incor- porating a pre-compensation factor. Postoperative spherical aberration falls within a range that provides an increased depth of field, without compromising contrast sensitivity and quality of vision. Dr. Ganesh shared information on patient selection: those suitable for LASIK, CDVA no worse than 20/25 in either eye, age 44 and above with presbyopia and depen- dence on reading glasses, a moti- vated patient, +1.5 D tolerance test pass, quick suppression and fusion, and tolerance of at least –0.75 D anisometropia. He recommends avoiding pa- tients with very high expectations and possibly those with low myopia (less than –2 D SE). During preop- erative counseling, Dr. Ganesh said to make sure patients know not to compare both eyes after surgery. It’s important to explain about adap- tation with time, the chances of enhancement in the future, early cortical cataract, and the need for cataract surgery in the future. To evaluate if a patient is suit- able for PRESBYOND, Dr. Ganesh gave five suggestions: verification of refraction and accommodation am- plitude to verify the functional age, eye dominance, +1.5 D tolerance test, check suppression and fusion, and planning with the CRS-Master (Carl Zeiss Meditec). He also discussed a micro- monovision assessment. The stan- dard micro-monovision protocol corrects the dominant eye to plano and non-dominant eye to –1.50 D, irrespective of age. Patients are test- ed for tolerance with the intended refraction in place, and the amount of cross-blurring reported by the patient during the simulation is evaluated. In conclusion, Dr. Ganesh said laser blended vision has high patient satisfaction with good func- tional vision, it is easily adjustable, and the result of the procedure can be optimized by a new one. There are no permanent visual effects, any side effects are correctable by glass- es, it closely simulates the natural condition existing in patients, and there is good contrast sensitivity and stereopsis. Dr. Ganesh added that patients can maintain blended vision even after cataract surgery later on in life, and it will not inter- fere with the surgery itself. Copyright 2019 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, ASCRS, or APACRS. Dr. Ganesh recommends treatment planning with the CRS-Master. Source: Sri Ganesh, MD Sponsored by Carl Zeiss Meditec Dr. Ganesh said laser blended vision has high patient satisfaction with good functional vision, it is easily adjustable, and the result of the procedure can be optimized by a new one.