EyeWorld Asia-Pacific December 2020 Issue

DEVICES 48 EWAP DECEMBER 2020 I don’t think it’s going to be possible to distill all of our collective information into a few thousand lines of code and make a machine that can do it better,” he said. Closing thoughts Dr. Wallace made some points about the use of the term “intelligence.” He said intelligence is “information that is thoughtfully used or innovatively assessed to create new ways of thinking or new ways of analyzing that weren’t possible or weren’t done before.” As such, he pointed out, a machine isn’t, in and of itself, “intelligent.” “We all know machines have extraordinary memory and processing power, but they don’t have intelligence. They have the ability to execute instructions programmed by humans,” he said, noting that’s why he prefers the terms “augmented intelligence” or “machine- enhanced analysis.” Dr. Wallace said that AI may not make doctors better at what they’ve spent their careers doing. “AI is not necessarily the answer. It’s the thoughtful use of information by thoughtful people gathering good data, the right way, and putting it together that helps the massive processing power of current computer technology to draw smart conclusions from much bigger datasets than humans could ever grasp and process,” Dr. Wallace said. EWAP References 1. Lopes BT, et al. Artificial intelligence A few AI papers at the 2020 ASCRS Virtual Annual Meeting • “Diagnostic Performance of an Artificial Intelligence Algorithm in Fuchs Endothelial Cell Dystrophy” found AI to be a viable option for Fuchs detection with “excellent accuracy, sensitivity, and specificity,” though prospective studies are still required to evaluate AI’s utility in assessing Fuchs progression. • “A Prospective Study for Autonomous Diagnosis of Dry Eye Syndrome Using an Artificial Intelligence Algorithm” found that the algorithm used with anterior segment OCT could be helpful in diagnosing dry eye disease. • “An Artificial Intelligence (AI) Algorithm for the Autonomous Diagnosis of Corneal Graft Rejection” determined that AI can accurately diagnose graft rejections. in corneal diagnosis: Where are we? Curr Ophthalmol Rep. 2019;7:204–211. 2. Esporcatte LPG, et al. Biomechanical diagnostics of the cornea. Eye Vis (Lond) . 2020;7:9. 3. Ambrosio JR, et al. Assessing ectasia susceptibility prior to LASIK: the role of age and residual stromal bed (RSB) in conjunction to Belin-Ambrósio deviation index (BAD-D). Rev Bras Oftalmol. 2014;73:75–80. Editors’ note: Dr. Ambrósio is Director of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrósio Rio de Janeiro, Brazil, and has interests with Oculus, Alcon, Carl Zeiss Meditec, Allergan, and Mediphacos. Dr. Wallace is Medical Director and CEO, LA Sight, and Founder and Managing Partner, Intelligent Diagnostics, Los Angeles, California. acrylic IOLs are malleable and easy to tilt to go under the optic with the I/A tip. His technique is to go under the IOL, then tilt and rotate 90 degrees. Tilting the optic allows you to get into the bag without putting stress on the zonules and rotating it helps to ensure both haptics are within the bag. EWAP Editors’ note: Dr. Davidson is Director of Refractive/Lens Replacement Surgery, Miramar Eye Specialists Medical Group, Ventura, California, and has interests with Alcon. Dr. Kim is a Partner at Professional Eye Associates and Clinical Assistant Professor of Ophthalmology, Medical College of Georgia, Augusta, Georgia, and declared no conflicting interests. Dr. Van is Medical Director, Duke Eye Center Operating Rooms, Durham, North Carolina, and has interests with Alcon. Where should you direct the IOL when inserting? The initial step with IOL insertion is complete expansion of the capsular bag with OVD, Dr. Kim said. As the cartridge is inserted, the single-piece acrylic IOL should be angled toward the capsular bag with the leading haptic injected into the bag while the remainder of the IOL is left in the anterior chamber, he said. The surgeon can then elect to use a second instrument to position the remainder of the IOL in the bag. “I prefer to use the I/A handpiece to manipulate the IOL into the bag because 1.) I need to irrigate the OVD out anyway, and 2.) I can take advantage of the irrigating fluid to inflate the capsular bag, which creates more room for me to position the IOL in the bag,” Dr. Kim said. “This stepwise approach also enables me to carefully inspect the IOL for scratches or defects, ensures the IOL is oriented properly (leading haptic points left), and allows me the time to ensure both haptics are released from the optic before the entire IOL is inserted within the bag.” How much larger than the cartridge should the corneal incision be? Dr. Kim provided general guidelines for the Alcon SN60WF AcrySof IOL using the Monarch injector system, A being the largest cartridge and D being the smallest: • D cartridge: 2.2–2.6 incision • C cartridge: 2.6–3.0 incision • B cartridge: 3.0–3.2 incision • A cartridge: 3.2–3.4 incision The only exception to this rule, he said, is for high-powered IOLs 28 D or greater, which require the B cartridge. Since these high powered IOLs are thicker, the surgeon will need to widen the incision if it is less than 3.0mm. Dr. Kim makes a 2.6-mm incision and primarily uses a D cartridge. “Every surgeon should consult the manufacturer’s recommendations and allow the phaco rep to give some guidance when choosing the best cartridge for a given incision size,” he said. Pearls for injecting single-piece IOLs - from page 45