EyeWorld Asia-Pacific June 2021 Issue

REFRACTIVE EWAP JUNE 2021 33 the time of cataract surgery. “Typically, a single arc, pair of arcs, or even double pair of arcs were used to correct with a diamond blade,” he said. This was before toric IOLs were released. Dr. Weinstock noted that toric IOLs can be used to correct higher amounts of astigmatism, but he said that most patients tend to have lower amounts of astigmatism. Manual vs. femtosecond laser technique Dr. Donnenfeld said surgeons can employ a manual technique or use a femtosecond laser for LRIs/AKs. Both of these options may still be needed. The femtosecond laser gives access to a technology that allows surgeons to perform a surgery as efficaciously, as accurately, and as safely as they can, he said. Femtosecond lasers can do something that manual LRIs can’t do in that you can do intrastromal incisions with the femtosecond laser, Dr. Donnenfeld said. The incision is made in the stroma, and there is no pain, no disruption of the Femtosecond LRI. Source: Eric Donnenfeld, MD epithelium, no gaping wound, and it doesn’t cut the cornea nerve. There is also no need for topical antibiotics. However, Dr. Donnenfeld said he would use a manual technique for patients having cataract surgery who aren’t financially comfortable getting a premium IOL. For these patients, adding a manual LRI to surgery is an added value, he said. Dr. Donnenfeld said he will also use a manual technique for patients who’ve had LASIK or cataract surgery, and he will use a diamond knife at the slit lamp. “It’s a simple, 1-minute procedure,” he said. “The patient leaves the office seeing better almost immediately.” If you don’t have a femtosecond laser, a manual LRI is very reasonable to do, Dr. Donnenfeld said, as long as you understand the limitations of an LRI. These are wonderful for low levels of astigmatism, but for higher levels, there are other things that are better, he said. When the femtosecond laser came along, it became more accurate to use it to make these incisions to correct astigmatism, Dr. Weinstock said, adding that many surgeons use the femtosecond laser for the bulk of their patients. It’s important to have AKs/LRIs at the right axis, Dr. Weinstock said, and many laser companies are including features to help with this. He added that ORA (Alcon) and Callisto eye (Carl Zeiss Meditec) can be used during surgery for placement at the right axis (or a marking pen can be used preoperatively). Some surgeons prefer to open the incisions up at the time of surgery to give them more effect, he said, while others like to open up afterward, depending on how the patient is doing. “Sometimes the arcuate incision alone does the