EyeWorld Asia-Pacific September 2014 Issue

47 EWAP CATARACT/IOL September 2014 done in a different room could present a hurdle that’s not easily surmountable,” Dr. Wiley said. Ideally, practitioners would want to take advantage of both the precision of the femtosecond AK incisions and intraoperative aberrometry, he said. New femtosecond technology could make that possible. For example, with the LDV 8 (Ziemer Ophthalmic Systems, Port, Switzerland) the delivery mechanism for the femtosecond laser is in a small handpiece that can be incorporated into the operating room underneath the scope, he said. “You can, in theory, take advantage of the accuracy of the diagnosis of astigmatism with the intraoperative readings plus the accuracy of the femtosecond laser to make very precise aligned incisions based on that information,” Dr. Wiley said. Toric considerations Practitioners must also wrestle with when to use AK incisions or when the use of toric IOLs may be preferable for correcting astigmatism. Dr. Thompson leans toward toric IOLs for more significant astigmatism. He views femtosecond AK as great for someone who has a very small amount of astigmatism. “When we have a patient who is going for quality uncorrected vision and has 0.5 D of astigmatism and we can take that patient from an OK 20/25 to a crisp 20/20, we like the idea of going after that astigmatism,” Dr. Thompson said. Meanwhile, Dr. Slade sees AK incisions with the femtosecond as a tool for an array of lower astigmatism. While the toric IOL could be used for anyone, it is cheaper and faster to use AK for lesser astigmatism amounts, he said, adding that in the U.S. there is no toric option for the multifocal ReSTOR lens (Alcon, Fort Worth, Texas, U.S.). For those astigmatic patients who would like multifocality in an IOL, Dr. Slade will often use a traditional ReSTOR lens together with femtosecond AK. The AK is not necessarily as accurate for higher amounts, he said, so he limits this to approximately 2 D of astigmatism. Overall, Dr. Slade views the femtosecond AK as a wonderful option. “Some people say, ‘The femtosecond laser hasn’t proven itself to be better than manual cataract surgery’; I think it has in terms of precision and astigmatism outcomes,” Dr. Slade said. “In our patients, laser is better than manual astigmatic keratotomy— it is more accurate and achieves better results.” EWAP Editors’ note: Dr. Donnenfeld has financial interests with Alcon, Abbott Medical Optics (Santa Ana, Calif., U.S.), and Bausch + Lomb (Bridgewater, NJ, U.S.). Dr. Slade has financial interests with Alcon, Bausch + Lomb, and Novartis (Basel, Switzerland). Dr. Thompson has financial interests with Abbott Medical Optics, Alcon, WaveTec Vision (Aliso Viejo, Calif., U.S.), and Carl Zeiss Meditec (Jena, Germany). Dr. Wiley has financial interests with Abbott Medical Optics and WaveTec Vision. Contact information Donnenfeld: ericdonnenfeld@gmail.com Slade: sgs@visiontexas.com Thompson: vance.thompson@vancethompsonvision.com Wiley: drwiley@clevelandeyeclinic.com MORIA S.A. 15, rue Georges Besse 92160 Antony FRANCE Phone: +33 (0) 1 46 74 46 74 - Fax: +33 (0) 1 46 74 46 70 moria@moria-int.com - www.moria-surgical.com Moria complete offer for the Big Bubble technique in DALK Single-Use Vacuum Trephine Reusable Instruments Depth adjustment ring New instruments developed with Dr. Fontana and Pr. Busin (Italy) • Ready to use: ultra-sharp pre-loaded blade • Top lateral window • Vacuum evenly distributed over the cornea • Diameters 6 to 9.5 mm • Precise, straight-walled and uniform cuts • No parallax errors • Limbial suction for better vacuum • Diameters from 6 to 10 mm Single-Use Donor Punch New Visit us at ESCRS, London Booth #F06