EWAP MARCH 2022 3 EDITORIAL Graham Barrett Chief Medical Editor EyeWorld Ƃsia*acific • China • Korea • India EyeWorld Asia-Pacific • March 2022 • Vol. 18 No. 1 T his issue contains an interesting discussion of intraoperative refractive guidance systems and their clinical use. Cataract surgery practice patterns are usually similar in the Asia-Pacific region compared to other regions; occasionally, however, there is a divergence such as the increased use of toric I"Ls in the Asia-Pacific compared to other regions. Intraoperative aberrometry is another technology rarely found in our practices compared to the U.S. Published data comparing the utility of intraoperative abberometry to predict the refractive outcome is inconsistent and recent publications suggest that accurate preoperative measurements with modern formulas is equal if not better than intraoperative aberrometry for spherical power. The accuracy of toric IOL prediction is not superior and using intraoperative aberrometers to determine the alignment axis is relatively infrequent despite the enthusiasm of some U.S. surgeons. The difference could in part be explained by the relative frequency of low toric IOLs. Low toric IOL powers such as T2s are not yet available in the U.S. but are more common in countries like Singapore and Australia. In this context, surgical disturbance of the ocular surface and the speculum may impact the reliability of axis alignment by intraoperative aberrometry. In situations where toric lenses of higher cylinder powers dominate, intraoperative refraction may be more reliable. Predicting the outcome of patients with a previous history of refractive surgery can be challenging and intraocular aberrometry has been recommended. Once again, there is no indication that it is more accurate than careful biometry with modern post refractive surgery formulas. Differences in reimbursement and the opportunity to charge additional fees may also influence the popularity of intraoperative aberrometry. Image-guided alignment, however, is quite popular in the Asia-Pacific region. Different systems are available, including Calisto and Verion, and are an efficient method of determining the correct axis for toric IOL alignment. Unexpected registration issues are relatively rare but surgeons should be cautious to avoid misalignment due to erroneous image acquisition. Simple methods using apps such as toricCAM to accurately determine the reference axis are in my opinion are more reliable. It is my practice to use both methods to avoid technical issues with image-guided systems and surgeon error in setting the alignment axis. Using both techniques provides greater confidence in ensuring the toric lens alignment is accurate and not a major issue in unexpected residual astigmatism after toric IOL implantation. This issue of ye7orld Ƃsia*acific marks 2 years in the ongoing COVID-19 pandemic. There is an element of fatigue as we deal with the Omicron variant, but fortunately it does appear to be less serious than previous variants. Our news journal has been a constant during this pandemic, keeping us informed and in contact as we have resorted to virtual meetings. We are therefore looking forward to our next meeting in Korea in June where we can renew acquaintances and friendships in person.
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