EyeWorld India September 2016 Issue

48 September 2016 EWAP CATARACT/IOL he’s determining how much astigmatism he wants to correct. “There are a lot of things you need to pay attention to when you’re using the ORA,” he said. “The first thing is the ORA has a reticle, which tells you where the different angles are in relation to the eye, so you need to set up your microscope so that the reticle matches the patient’s eye. You want to make sure 0 and 180 degrees on the patient’s eye matches 0 and 180 degrees on the reticle. It would be very easy to have the microscope oriented so that the ORA was not quite aligned with the patient’s eye, so when the ORA reads out a certain axis, it may look like it totally disagrees with your preoperative measurements, but it could just be the way the microscope is aligned on the patient’s eye.” Dr. Weikert also said that the ocular surface must be kept hydrated to protect the corneal epithelium. “If your corneal epithelium gets damaged during surgery, it can throw off your ORA measurements,” he said. “This advice goes to any machine,” Dr. Weikert continued, “You don’t want to blindly trust any device. You want to understand the nuances of it, but you also have to know when things don’t make sense. If they don’t make sense, you want to understand why.” When it comes to choosing to do an LRI or use a toric IOL, Drs. Weikert and Lee said they would prefer a toric IOL in most cases. “I think that incisions are inherently a little bit more unpredictable,” Dr. Weikert said. “I think incisions made with the femtosecond laser are more predictable than with a manual blade, but I think even then, compared with toric lenses, they’re less predictable.” Dr. Weikert said he gravitates toward the AcrySof IQ toric IOL (Alcon), but has also used the TECNIS (Abbott Medical Optics, Abbott Park, Illinois). Although he has not had rotational issues with the TECNIS, he noted that some surgeons have and advised those using it to make sure the size of the capsulorhexis is not too large, remove viscoelastic from behind the lens, and leave it a bit under rotated until the end. Dr. Lee uses both of these as well, but leans toward the TECNIS for patients getting a toric in only one eye and the AcrySof for those getting a toric in both eyes. He does not go behind the IOL to remove viscoelastic, but does an “aggressive rock and roll” instead, also spending extra time to remove the viscoelastic in the equator of the capsular bag along the haptics. “After the viscoelastic is out, I give the IOL a gentle posterior ‘love tap,’” he said. Dr. Yeu said she uses the full range of toric IOLs, including more recent incorporation of the Trulign (Bausch + Lomb, Bridgewater, New Jersey) as a toric offering to patients. Regarding single vision toric IOLs, Dr. Yeu leans toward the AcrySof toric because of her extensive experience with this family of IOLs and, as a result, finds she has predictable outcomes. When it comes to LRIs, she primarily performs femtosecond laser arcuate incisions and does not open the incisions until postop if she needs to titrate and enhance the astigmatic correction. As for addressing surgically induced astigmatism, Dr. Yeu said she accounts for 0 in her surgically induced astigmatism because although it averages about 0.1 D, she has found it to be quite variable in range from patient to patient. Dr. Weikert said he Managing - from page 46 CALENDAR OF MEETINGS 2017 DATE Meeting VENUE March 1-5 32 nd Asia-Pacific Academy of Ophthalmology Congress (APAO) www.apaophth.org/ Singapore May 5-9 ASCRS-ASOA Symposium and Congress (ASCRS) www.ascrs.org Los Angeles USA June 1-3 30 th Asia-Pacific Association of Cataract and Refractive Surgeons Annual Meeting (APACRS) www.apacrs.org Hangzhou China June 23-25 32 nd Annual Meeting of the Japanese Society of Cataract & Refractive Surgery (JSCRS) www.jscrs.org Fukuoka Japan October 7-11 XXXV Congress of European Society of Cataract and Refractive Surgery (ESCRS) www.escrs.org Lisbon Portugal November 11-14 Annual Meeting of American Academy of Ophthalmology (AAO) www.aao.org New Orleans USA factors in 1/10th of a diopter in the astigmatism estimation, but noted that surgically induced astigmatism seems to be becoming less of an issue with smaller incision sizes. In all of this, Dr. Weikert said managing patient expectations is still an important factor. “Despite all of the different methods and all of the technology that goes into this, you still can have errors that enter into the calculations,” he said. “There’s a chance [patients] may need a touchup after surgery.” Although the physicians mentioned some relatively sophisticated technology used to make intraoperative management of astigmatism more successful, Dr. Lee pointed out that you don’t need it to achieve excellent outcomes. He cited “careful preoperative measurements” and “meticulous surgical technique in marking and alignment” as the keys to succes. EWAP Editors’ note: Dr. Yeu has financial interests with Alcon, Abbott Medical Optics, Bausch + Lomb, and i-Optics. Dr. Lee and Dr. Weikert have no financial interests related to their comments. Contact information Lee: bryan@bryanlee.pro Weikert: mweikert@bcm.tmc.edu Yeu: eyeulin@gmail.com