of corneal astigmatism. He excluded patients with mature intumescent cataract “because creating the capsulorhexis is difficult. Postoperative astigmatism dropped to 0.21±0.33 D from a preop level of –1.92±1.04 D. “None of the eyes showed any signs of pigment dispersion, as intraocular pressure stayed around 15 mmHg from postop Day 1 through postop Month 1,” Dr. Ganesh said. The lens offered better centration and less tilt than other toric IOLs, and “no special instruments or training is needed to insert the lens,” he said. Clinical trials at multiple sites are expected to begin by the end of the year, he said. The exceptional stability would allow the lens to be used in cases of zonular dialysis or aphakia, he said. “You don’t need to have a standby lens,” Dr. Ganesh said, adding that he plans to put the same haptic design onto a multifocal lens as well. The ESCRS Perspective The world is becoming more and more digitized, and so are ophthalmic operating rooms, said Thomas Kohnen, MD, Measurements, refractive corneal surgery, cataract surgery, and IOL calculations are all digitized, making what once were novel techniques such as microkeratomes for LASIK and manual biometers obsolete. “Photorefractive keratectomy (PRK)’s time has passed,” Dr. Kohnen said. Almost 20 years ago, pure femtosecond laser-based technology was introduced, first in 2006 with femtosecond lenticule extraction (FLEx) and then in 2008 with small incision lenticule extraction (SMILE). In cataract surgery, rotational stability is crucial to the success, and “toric IOLs have become dominant worldwide,” he said, and axial marking techniques have improved with the advent of digital markers. Femtosecond laser-assisted cataract surgery (FLACs) are no longer considered novel, but there remains hesitancy in adopting this technology. A meta-analysis of 73 studies reviewed 12,769 eyes that underwent FLACS and 12,274 eyes that underwent conventional cataract surgery. Results indicated anterior capsular ruptures are more frequent with FLACS, but FLACS used less ultrasound energy and produced more precise treatments. The two techniques were similar in efficacy, safety, and visual outcomes. IOL formulas are also becoming more digitized, with several using artificial intelligence (AI) or ray tracing. The latest ESCRS calculator is a web-based application that simultaneously uses seven common formulas (https:// iolcalculator.escrs.org). “Advantages to the calculator is that it saves time and reduces manual input errors,” he said, “but currently toric calculations are not possible.” Finally, he said AI will become more prevalent in ophthalmology. To that end, Bruce Allan, MD, said AI has already made inroads. “ChatGPT and the like have tremendous potential in helping coding and creating consent forms,” he said. To make deep learning, a type of AI that teaches computers to process data in a way that is inspired by the human mind, viable in ophthalmology, “you need to have the data,” he said, noting that its use can help further promote the idea of protocol-managed care. As an example of its potential, Dr. Allan said with deep learning, the computer can tell the age (± 3 years), gender, cardiovascular risk, blood pressure, body mass index, and HbA1c levels, as well as predict the risk of developing diabetic retinopathy from a single fundus photo. “Even more relevant, the system outperformed trained specialists,” he said. “So far, deep learning has been retina’s monopoly, but we’re to move it to the anterior segment.” NEXUS CoNNECtiNg EvEryoNE & EvErythiNg
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