EyeWorld India March 2012 Issue

35 EW CATARACT/IOL March 2012 « The One Use-Plus SBK microkeratome is: •simple, easy to use and safe •comparable to FemtoSBK (accuracy and predictability) •without intraop and postop femtolasers complications •and at a significant less cost. » LASIK Surgery 025,$ 6 $ UXH *HRUJHV %HVVH $QWRQ\ )5$1&( 3KRQH )D[ PRULD#PRULD LQW FRP ZZZ PRULD VXUJLFDO FRP • Thin, 100-micron, planar flaps • Accuracy and predictability equivalent to Femto-SBK • Smoother stromal bed • No femto-complications • … At a fraction of the cost Think Thin SBK without compromise $KPHG (O 0DVVU\ 0' $OH[DQGULD (J\SW El-Massry A. Comparative study between One Use- Plus SBK and FemtoLASIK flaps. Keynote lecture, 68 th annual congress of the AIOC, Jan 21-24, 2010; Kolkata, India. Dr. El-Massry has no financial interest and is not a paid consultant for Moria. 'RZQORDG ORQJ YHUVLRQ WHVWLPRQLDOV RQ ZZZ PRULD VXUJLFDO FRP 5RXQGWDEOH ZLWK LQWHUQDWLRQDO 6%. H[SHUWV % &RPSHQGLXP RI FOLQLFDO DQG ODERUDWRU\ FDVHV (1 6%. QHZVOHWWHUV QRZ RQ OLQH .HUDWRPH 2QH 8VH 3OXV 6%. 0RULD ,QWUD/DVH Š N+] $EERWW 0HGLFDO 2SWLFV 9LVX0D[ Š N+] &DUO =HLVV 0HGLWHF 1E RI H\HV )LUVW /DVW /DVW )ODS WKLFNQHVV “ “ “ 2%/ DOZD\V DOZD\V 9*% RFFDVLRQDOO\ RFFDVLRQDOO\ 3XSLO WUDFNLQJ HDV\ GLIÀFXOW GLIÀFXOW 9LVXDO UHFRYHU\ IDVW VORZHU VORZHU )ODS UH OLIW HDV\ IRU \HDUV GLIÀFXOW GLIÀFXOW disagrees with that theory. “They don’t just get used to it,” he said. “It would be like trying to get used to having a ball and chain attached to your foot. You might learn to live with it, but you wouldn’t ever get used to it or act like it’s not there. I don’t think there are patients getting used to it or neuroadapting to it. I think it actually goes away.” Dr. Miller believes ND disappears because lens epithelial cells begin to pack into the space between the front and back capsule at the edge of the lens, reducing the difference in refractive index between the inside lens and just outside the lens. “They make the edge of the lens leaky to light,” he said. “The light that leaks out illuminates the nasal retina and the shadow goes away.” Because ND could simply go away, all surgeons interviewed recommended waiting at minimum 3 months, but ideally 6 months to a year, before trying anything surgically. During that time period, having the patient wear thick- framed glasses might alleviate the symptoms. “We always try to get patients out of glasses, but this is one case where glasses do help,” said Dr. Davison. “Glasses can obscure the image so it makes it less distracting. It puts the shadow in the same category as a frame, and [the patient] doesn’t notice it anymore.” “Anything that will block a source of light on the temporal side, like a pair of spectacles, will reduce the symptoms,” said Dr. Masket. “Unfortunately, that’s not a satisfactory answer for many patients. If you can get thick-framed glasses, it’s a good suggestion. It’s worthy of a try.” If a patient bucks at wearing glasses, it’s time to consider surgery. Dr. Miller’s preference is to do a full lens swap, taking out the offending IOL and replacing it with a rounded-edge or plate haptic lens in either the bag or the sulcus. “I’ll put in a plate haptic lens like a STAAR Surgical collamer lens [Monrovia, Calif., USA] and will orientate the plate haptic in the 3 to 9 o’clock orientation,” Dr. Miller said. “The optic is continuous with the haptic, so there’s no lens edge to cause that problem anymore.” Inserting a “piggyback” IOL, which was first reported by Paul H. Ernest, MD , associate clinical professor, Kresge Eye Institute, Wayne State University, Detroit, Mich., USA, is another surgical technique that’s proven successful. Dr. Masket explained this technique in detail in the September 2011 issue of EyeWorld (page 16). “It’s a simple surgery that brings with it a high degree of both technical success and the alleviation of symptoms,” said Dr. Masket. “I have heard reports where it hasn’t helped 100% or even at all. Nothing is 100%, although in our research, we had either complete or significant reversal of symptoms. “The problem is you have a condition on which people don’t have good facts, and they have a lot of emotions so you get a lot of opinions,” Dr. Masket said. With so little clinical understanding of ND, it’s easy to see why the phenomenon both frustrates and captivates physicians. Even with a physical intervention, there will be the occasional patient that surgery won’t help. In those cases, said Dr. Davison, it’s up to the doctor to be a physician instead of a surgeon. “A surgeon repairs things, but a physician sits and listens to the patient and councils him through problems,” said Dr. Davison. “You can explain all the wonderful advances we have, and there are miraculous techniques and materials that we work with, but they are not like the good Lord’s original equipment. There are limits to what we can do.” EW Editors’ note: The doctors interviewed have no financial interests related to this article. Contact information Davison: jdavison@wolfeclinic.com; via RN Carol Loney cloney@wolfeclinic.com Masket: sammasket@aol.com ; via assistant Ann McLean: avcweb@aol.com Miller: kmiller@ucla.edu Uncovering - from page 33