EyeWorld Asia-Pacific June 2020 Issue

EWAP JUNE 2020 3 EDITORIAL Graham Barrett Chief Medical Editor EyeWorld ƂÈ>‡*>VˆwV O phthalmic surgery …>à Li˜iwÌÌi` from technological improvements over recent decades. Traditionally, the focus has been on therapeutic improvements ÃÕV…>à «…>Vœi“ՏÈwV>̈œ˜] femtosecond laser technology, and devices such as intraocular lenses. More recently, we have Li˜iwÌÌi` vÀœ“ ÌiV…˜œœ}ˆV> advances in diagnostic equipment, including biometry and OCT devices. The focus in this issue, however, is on the role of the technology in the operating theater. This has extended beyond improvements in the optics and ergonomics of operating microscopes to real-time diagnostic equipment, including aberrometry, intraoperative OCT, computer guidance for toric alignment, and 3D viewing systems as an alternative to optical microscopy. The advantages of these new technologies are presented with enthusiasm by several surgeons contributing to the topic, but as always Þi7œÀ` ƂÈ>‡*>VˆwV seeks to present a balanced opinion to our readers. The publication by Kerry Solomon in 2019 comparing the outcomes using traditional versus modern techniques to manage astigmatism is noteworthy in that there was no apparent advantage evident with the advanced technology. Dr. Solomon comments that this may well be due to the concurrent improvements in diagnostic technology and preoperative planning which is now available. The enthusiasm for some of the advanced technology is less >««>Ài˜Ì ˆ˜ ̅i ƂÈ>‡*>VˆwV region than in the U.S. and Michael Lawless presents a thoughtful commentary on this topic. Certainly, we do need improvements in managing unusual cases, in predicting outcomes. Keratoconus is an example of the challenges we face in selecting IOLs in this context at the time of cataract surgery and recent articles have highlighted the relatively poor prediction in this context. The reason for poor prediction in keratoconus is another example of the disruption of the normal relationship between the posterior and anterior corneal curvature. The change in the posterior cornea is quite different to that encountered in the cornea due to previous refractive surgery but equally challenging. To address the problem of predicting refractive outcomes in patients with keratoconus, I have updated the True K formula available online on the APACRS website recently. It now includes an option for keratoconus in addition to post myopic and hyperopic LASIK/PRK and RK. Analysis of data shows that selecting this option in the presence of keratoconus improves the prediction of ÀivÀ>V̈Ûi œÕÌVœ“ià È}˜ˆwV>˜ÌÞ and avoids unexpected hyperopia that commonly occurs in this context. I would recommend that the measured posterior cornea option be utilized using either Pentacam or swept-source OCT. When selecting Pentacam or swept-source OCT, one must ensure that the device selected is for keratoconus, and that the radius or corneal power is selected for data entry. I hope that this new option provides improved spherical outcomes for keratoconus and is a useful adjunct to the new intraoperative technologies that are becoming available. EWAP '[G9QTNF #UKC 2CEKƂE ,WPG 8QN 0Q