EyeWorld India March 2017 Issue

March 2017 16 EWAP FEATURE The Callisto as seen by the surgeon during the procedure Source: Oliver Findl, MD Advanced technology sharpens astigmatic outcomes after cataract surgery by Vanessa Caceres EyeWorld Contributing Writer Five tips to maximize technology use T he advanced technology that refractive cataract surgeons have at their disposal can help sharpen outcomes for astigmatic patients, according to physicians well versed in the technology. From intraoperative aberrometry to femtosecond lasers to guidance systems to toric IOLs, patients experience better outcomes—and surgeons find that the various technologies work synergistically. “The technology has made everything more accurate,” said Robert Weinstock, MD , Eye Institute of West Florida, Largo, Florida. Refractive enhancements for Dr. Weinstock now occur in fewer than 4% of patients. AT A GLANCE • Advanced refractive technology for astigmatic patients can help improve outcomes, make surgery more efficient, and guide surgical decisions. • Cutting-edge technology is not necessarily needed to start using toric IOLs and better address astigmatic concerns. • Provide solid training to staff on advanced technology for astigmatism, and have backup plans in place when technology does not work. • Incorporate posterior cornea measurements into your data for astigmatic patients. “I attribute a lot of that to great biometry but also to the utilization of these devices and software to make sure astigmatism management is as accurate as possible.” Advanced refractive technology also eliminates some of the preoperative steps once needed, said Oliver Findl, MD , Department of Ophthalmology, Hanusch Hospital, Vienna, Austria. For instance, preop marking of the eye was once crucial—and occasionally forgotten. Now with the Callisto system (Carl Zeiss Meditec, Jena, Germany), it isn’t necessary, he said. Various technology he has available now can transfer data among his systems without the risk of human transcription errors that were sometimes made before. Technology such as intraoperative aberrometry can be a “tiebreaker” in driving final surgical decisions, Dr. Weinstock said. He has an ORA System (Alcon, Fort Worth, Texas) and uses it to help assess his laser-created arcuate incisions and whether or not to modify them. He also uses ORA to guide toric IOL placement. Published reports have shown that the use of intraoperative aberrometry can improve results by 5% to 10%, said Stephen Lane, MD , medical director, Associated Eye Care, and adjunct clinical professor, University of Minnesota, Minneapolis. That said, Dr. Lane encourages cataract surgeons to make the leap to using toric IOLs in astigmatic patients even if they don’t have all of the cutting-edge technology now available. “While we have incredible tools to help us, we don’t need all of those tools for excellent results. You can improve good results to become excellent, but you shouldn’t sit on the sidelines waiting to use toric IOLs because you don’t feel the technology is good enough yet or is too expensive. … The first step is being involved in implanting toric IOLs,” he said. Dr. Lane gave the analogy of prescribing glasses for a patient and always making sure to address a patient’s astigmatism—it makes sense that a cataract surgeon would give the same consideration when implanting IOLs in patients by addressing astigmatism. It’s important to look beyond outcomes when you select technology for astigmatic correction, Dr. Findl said. In fact, having advanced technology to help treat astigmatic patients has not really changed his outcomes. He was involved with a trial that compared manual markings with the Callisto; although the Callisto did show more precision, it was not a significant difference. “At the end of the day, if you do manual markings with a focus on precision, it works well,” he said. Consider other ways that technology may help you, such as by making surgery more efficient or eliminating some human errors. As you start to incorporate advanced refractive technology into your cataract surgery, keep these pearls in mind for achieving better astigmatic outcomes.