EyeWorld India December 2014 Issue

61 EWAP NEWS & OPINION December 2014 cataract surgery with multifocal IOLs and ended up with 2 diopters of hyperopia in both eyes. Assuming that the patient’s post-LASIK vision was acceptable, Dr. Espiritu, who took the cataract approach, recommended an IOL exchange to an aspheric monofocal IOL centered closest to the visual axis. Dr. Gatinel, taking the refractive approach, recommended relifting the LASIK flap and performing a hyperopic laser ablation, saying that a laser corneal procedure would be better in efficacy and predictability in this type of situation. A flap relift is always easy when the initial procedure was uneventful, he said, and this option has the fewest risks in terms of safety. Live surgery with Alcon’s refractive cataract suite Saturday morning’s first session featured 4 surgeons performing live surgery at the Centre for Sight in New Delhi, India, using the latest technology from Alcon’s refractive cataract suite. Dr. Mahipal Sachdev, New Delhi, India; Mathew Kurian, MD , Bangalore, India; Lee Mun Wai, MD , Ipoh, Malaysia; and Alan Crandall, MD , Salt Lake City, Utah, U.S., demonstrated depth-of-focus (EDF) IOL or a Carl Zeiss Meditec (Jena, Germany) trifocal IOL. In his opinion, lens- based surgery is a permanent solution to the patient’s problem that provides better benefits with fewer risks. Dr. Chan took the refractive surgeon’s approach, and said that as a Bollywood star, this patient’s activities are not highly visually demanding—stereopsis is not crucial, the patient only has to drive occasionally, and needs reasonably good vision for distance and near. In addition, as a film star, this patient would want a quick fix for his hectic lifestyle and could be a high litigation risk. To Dr. Chan, the best surgical option for this patient would be femto LASIK with monovision. What would happen if a 62-year-old woman with monofocal IOLs implanted in both eyes 3 years prior came into the office wanting to be completely spectacle-free for an expedition to climb Mt. Everest? As this patient sees 20/20 (6/6) and only needs glasses for reading, the physicians debating this case agreed that the best option would be to do nothing. However, if the patient was insistent upon surgery, Fam Han Bor, MD , Singapore, took the cataract surgeon’s approach and recommended either a piggyback IOL or refractive IOL exchange with monovision. From the refractive side, Robert Ang, MD , Makati City, Philippines, said that he would discuss other aspects of the patient’s life outside of this expedition to guide his decision. If the patient wanted surgery, Dr. Ang would recommend a KAMRA corneal inlay, because it improves intermediate and near vision without sacrificing distance vision due to the pinhole effect. What about a myopic and astigmatic 59-year-old ophthalmologist undergoing cataract surgery who also flies planes for recreation? In this scenario, Mohan Rajan, MD , Chennai, India, took the cataract perspective, and said his first choice would be to implant a monofocal toric IOL. He believes that this procedure is the best option because it is easy, cheap, has few complications, and will allow the patient to retain the contrast sensitivity needed for flying. Taking the refractive perspective, Michael Knorz, MD , Mannheim, Germany, said he would combine laser cataract surgery with an EDF-IOL in this patient. The patient needs excellent contrast, full stereopsis, and good near vision to fly, he said, which leaves an EDF-IOL as the only choice. All surgeons want to avoid refractive surprises, but what happens when they come up? Dr. Espiritu, Metro Manila, Philippines, and Dr. Gatinel, Paris, France, debated the best course of action for a 52-year-old patient who had LASIK 15 years ago to correct 10 diopters of myopia and who had recently undergone bilateral the capabilities of the latest technologies from Alcon and the techniques they use when working with them. Panelists Dr. Vasavada, Ahmedabad, India; Dr. Yeoh, Singapore; Dr. Barrett, Perth, Australia; Dr. Espiritu, Metro Manila, Philippines; and Robert Cionni, MD , Salt Lake City, Utah, U.S., discussed the benefits of the technologies with the operating surgeons and offered pearls for getting started. During his surgery, Dr. Sachdev demonstrated the capabilities of Alcon’s femto cataract surgery suite with the LenSx laser and the CENTURION Vision System. He used the laser to perform the capsulotomy, fragment the lens, and generate the primary incision. The docking of the LenSx laser has greatly improved since its debut in 2011, Dr. Cionni said, offering a very quick procedure with a short learning curve. Dr. Sachdev agreed, saying that docking with the laser is a breeze, patients are comfortable, and the total time the laser is docked, from suction on to suction off, is less than 2 minutes. Drs. Yeoh and Cionni added that the LenSx is a very forgiving system in that tilt is well accommodated. A flat dock will translate to a shorter capsulotomy time and more nucleus that can be fragmented, Dr. Cionni said, but with this system, the surgeon can still achieve a good outcome even without a dock that is perfectly flat. “Even with a lot of tilt you can have a successful procedure,” Dr. Cionni said. continued on 61