EyeWorld Asia-Pacific June 2021 Issue

REFRACTIVE 46 EWAP JUNE 2021 Contact information Nikpoor: nnikpoor1@gmail.com Walter : kwalter@wakehealth.edu Williamson : blakewilliamson@weceye.com W hen it comes to premium lenses, patients have high expectations for great outcomes. Neda Nikpoor, MD, Keith Walter, MD, and Blake Williamson, MD, discussed some of the technologies that they use preoperatively, intraoperatively, and postoperatively to help achieve excellent outcomes. Preoperative technologies and testing Dr. Nikpoor said that every patient who comes into her office for a refractive lens exchange (RLE) or cataract evaluation gets the same testing. This includes a preoperative macular OCT, topography, RNFL analysis, and aberrometry. She will also use the HD Analyzer by Ellen Stodola Editorial Co-Director This article originally appeared in the March 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. (Keeler) on every patient, which she said helps by giving an objective assessment of the tear film. “Comparing this index with the iTrace Dysfunctional Lens Index [Tracey Technologies] helps me grade the impact of very early lens changes,” she said. She noted that having a high-quality biometer is helpful for measuring posterior astigmatism; she uses the IOLMaster 700 (Carl Zeiss Meditec). She will also obtain a LipiScan (Johnson & Johnson Vision) on every patient and likes to use epithelial mapping. “We don’t use it on everyone, but we’ll use it if someone is post-refractive or if we think they have OSD or early keratoconus,” Dr. Nikpoor said. This preoperative plan, Dr. Nikpoor said, is used for all cataract patients, even those getting standard IOLs. Additionally, for cataract patients getting premium lenses, she performs a standard OSD optimization protocol that includes warm compresses, lid scrubs, and artificial tears. She will add in more treatments as needed, including LipiFlow (Johnson & Johnson Vision) and/or pharmaceutical dry eye treatments. Dr. Nikpoor said measurements used for the IOL calculation—topography, aberrometry, and IOLMaster —are repeated so there are two sets. All of this information is consolidated into a grid with the astigmatism measurements. RLE in an RK patient with +5 D hyperopia; placed Light Adjustable Lens (RxSight) OU. Source: Neda Nikpoor, MD Technologies for achieving better outcomes