NEWS & OPINION 50 EWAP MARCH 2023 “We’ve known that a smaller pupil decreases higher order aberrations and increases quality of vision because with a smaller pupil you’re filtering out those peripherally scattered rays, so you’re getting more focused, well-defined rays that enter to the back of the macula. That’s what I wanted from a pupil- modulating drop,” she said. After VUITY became available, Dr. Zhu said she’s been prescribing it to patients off label with success in lessening their symptoms (usually positive dysphotopsias). “I think among refractive surgeons, we don’t want to jump straight to surgery. … Give [VUITY] a try and if it works, you’ve avoided a surgical intervention,” Dr. Zhu said. EWAP References 1. Eton EA, et al. Rhegmatogenous retinal detachment following initiation of pilocarpine hydrochloride ophthalmic solution 1.25% for treatment of presbyopia. Retin Cases Brief Rep. 2022. Online ahead of print. 2. Al-Khersan H, et al. Retinal detachments associated with topical pilocarpine use for presbyopia. Am J Ophthalmol. 2022;242:52–55. 3. Amarikwa L, et al. Vitreofoveal traction associated with pilocarpine for presbyopia. Ophthalmic Surg Lasers Imaging Retina. 2022;53:410–411. 4. Alpar JJ. Miotics and retinal detachment: a survey and case report. Ann Ophthalmol. 1979;11:395–401. 5. Waring GO, et al. Safety and efficacy of AGN-190584 in individuals with presbyopia: the GEMINI 1 Phase 3 randomized clinical trial. JAMA Ophthalmol. 2022;140:363–371. Editors’ note: Dr. Zhu practices at NVISION Eye Centers, Rowland Heights, California. She has interests with Allergan. the study included different IOL manufacturers and types, as well as different surgeons. This is both a weakness and a strength because the results may then be applied to a wider group of surgeons and IOL types. During our Journal Club discussion, residents pointed out that additional strengths include the large number of post-hyperopic ablation eyes in the study, 47 eyes from 34 patients, when much of the literature focuses on patients with post-myopic ablations. All patients had both Atlas and Pentacam (Oculus) imaging, thus allowing for more formulas to be used and averaged (only the Galilei [Ziemer] and OCT-based formulas were not used). We noted that by forgoing the ASCRS calculator, we lose the range of recommended IOL powers in favor of a single IOL power generated by the Barrett True-K. While there is no way to test the benefit of having a range of values, it may be reassuring to see a range to decrease the risk that any one formula would create an outlier. An outlier analysis was performed on 12 myopic and 6 hyperopic outliers; however, this outlier sample size may be insufficient to reassure against seeing a range of calculators. We also noted the that the study included the Barrett True-K in the ASCRS average to which the Barrett True-K was compared with. For future directions, we are interested in the results of a similar analysis in post-RK eyes as well as a comparison with the Barrett True-K Total Keratometry. Conclusion The authors demonstrated that for eyes with previous myopic or hyperopic laser refractive surgery, the Barrett True-K formula built into the biometer was equal or non-inferior to the multiple method approach using the ASCRS online calculator. The advantages of using the Barrett True-K formula built into the biometer include elimination of transcription error risk and reduced time and personnel needed. EWAP References 1. Wang L, Koch DD. Intraocular lens power calculations in eyes with previous corneal refractive surgery: review and expert opinion. Ophthalmology. 2021;128:e121–e131. 2. Randleman JB, et al. Intraocular lens power calculations after laser in situ keratomileusis. Cornea. 2002;21:751–755. 3. Wen D, et al. Network meta-analysis of no-history methods to calculate intraocular lens power in eyes with previous myopic laser refractive surgery. J Refract Surg. 2020;36:481–490. 4. Wang L, et al. Evaluation of intraocular lens power prediction methods using the American Society of Cataract and Refractive Surgeons post-keratorefractive intraocular lens power calculator. J Cataract Refract Surg. 2010;36:1466–1473. 5. Pantanelli SM, et al. Intraocular lens power calculation in eyes with previous excimer laser surgery for myopia: a report by the American Academy of Ophthalmology. Ophthalmology. 2021;128:781–792. 6. Vrijman V, et al. Evaluation of different IOL calculation formulas of the ASCRS calculator in eyes after corneal refractive laser surgery for myopia with multifocal IOL implantation. J Refract Surg. 2019;35:54–59. 7. Abulafia A, et al. Accuracy of the Barrett True-K formula for intraocular lens power prediction after laser in situ keratomileusis or photorefractive keratectomy for myopia. J Cataract Refract Surg. 2016;42:363–369. Editors’ note: Dr. Challa is Residency Program Director, Department of Ophthalmology, Duke University, Durham, North Carolina. IOL power calculations - from page 46
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