EyeWorld India March 2016 Issue

17 March 2016 EWAP FEATURE Getting the lay of topographic ablation landscapes by Maxine Lipner EyeWorld Senior Contributing Writer A look at how physicians can effectively use this innovative machinery M ore and more practitioners in the U.S. have equipment capable of topographic ablation waiting in the wings or already in use. Practitioners such as Stephen A. Wexler, MD , professor of clinical ophthalmology, Washington University School of Medicine, St. Louis, are now beginning to put such new technology to use. As a full-time refractive surgeon, Dr. Wexler views topography-guided ablations with his new WaveLight Allegretto Wave Eye-Q Excimer Laser (Alcon, Fort Worth, Texas) as something that is going to make a difference in his practice. “The FDA study was a normal eye study wherein they looked at myopia and astigmatism and had incredibly good results,” Dr. Wexler said. Raymond Stein, MD , medical director, Bochner Eye Institute, Toronto, and associate professor, University of Toronto, AT A GLANCE • Those getting used to topographic machinery may first want to become versed in taking scans. • Unlike wavefront, which uses one image, the topo-guided approach uses a compilation of images. • For those just beginning, choosing cases wisely is advised. has been using the topography- guided technology for some time now and sees it as a step forward. “I think it’s a significant advance in refractive surgery when dealing with patients with irregular astigmatism, especially keratoconus patients,” Dr. Stein said. “We have been using topography- guided PRK and crosslinking for 5–6 years, and it’s an opportunity to improve best corrected spectacle acuity by decreasing irregular astigmatism.” It can also help treatment of hyperopia where a patient’s visual axis is usually not centered on the pupil, he said, explaining that topo-guided PRK or LASIK ablations can be centered over the line of sight, which can improve the quality of vision. In addition, topography-guided ablation can be used to manage prior refractive surgery complications such as a small optical zone or glare and halos, Dr. Stein said, but stressed that such treatments are not for those just beginning with the technology. Beginning use Dr. Wexler noted that while he has not yet begun using the laser himself, his technicians have been trained by the company in taking WaveLight Topolyzer (Alcon) scans. “It seems fairly easy and very similar to other instruments we use to acquire images,” Dr. Wexler said. The idea is to get the technicians used to taking the scans, but there are no plans to use the laser itself before early 2016, he explained. “Whenever we introduce new technology in our practice, we approach it cautiously,” Dr. Wexler said. In addition to focusing on training technicians, the practice is honing in on outcomes using Zubisoft IBRA software (Oberhasli, Switzerland). “We introduced wavefront-guided technology to OCULUS Asia Ltd. Hong Kong Tel. +852 2987 1050 • Fax +852 2987 1090 www.oculus.de • info@oculus.hk OCULUS Pentacam ® / Pentacam ® HR New! Keratoconus staging based on corneal tomography NEW! Belin ABCD Keratoconus Staging: Keratoconus grading & classification system based on anterior and posterior corneal curvature, pachymetry and visual acuity. Now included in the basic Pentacam ® software. Reference: Global Consensus on Keratoconus and Ectatic Diseases Cornea; Volume 34, Number 4, April 2015 http://www.ncbi.nlm.nih.gov/pubmed/25738235 continued on page 18