EyeWorld India December 2018 Issue

EWAP FEATURE 11 December 2018 (required high bottle height, limited AFR/vacuum, more limited working space, more fluid use, more turbu- lence, and more attention to AC and capsular depth). However, Active Fluidics auto- matically and instantaneously com- pensates to prevent surge, allowing redefinition of procedure goals, Dr. Lubeck said. You can operate at near physiologic IOP, reduce balanced salt solution use to less than 50 mL per procedure, reduce procedure time, re- duce turbulence to maintain the pupil and protect the endothelium, simplify removal of soft and very dense cata- racts, and successfully and efficiently manage complications. “Having this technology has al- lowed me to go back and reconsider fluidics from a different perspective,” he said. Dr. Lubeck noted that with Cen- turion and Active Fluidics, physicians can safely operate at a lower IOP. The system provides the capability to perform physiologic IOP phaco and allows physicians to achieve their procedure goals comfortably. An adjustable parameter compensates for fluid egress through different sized incisions. He shared that one of his favorite features is the IOP ramp, which varies the speed at which the pressure in the eye rises up to the preset IOP. Dr. Lubeck moved on to discuss ORA, which he said offers improved clinical results, especially in spherical and toric IOL placement following refractive surgery and with femtosec- ond laser-assisted cataract surgery. In his practice, Dr. Lubeck has found improved clinical results with ORA in many clinical situations. Preoperative data can be entered remotely or in the operating room. ORA’s algorithms are regularly optimized for clinical sites individually and across global databases through entered pre- and postoperative data. Dr. Lubeck thinks that the existence of a large global da- tabase will further improve accuracy of cataract surgery outcomes. Soon Phaik Chee, MD , Singa- pore, presented “Clinical Experience with PanOptix and PanOptix Toric Trifocal IOLs.” She first discussed the unique approach by Alcon with the trifocal and the quadrifocal diffractive platform. The PanOptix has 15 rings. It transmits 88% of light at 3 mm pu- pil size to the retina and allocates half of the light to distance and splits the rest evenly between near and interme- diate. It is a non-apodized diffractive multifocal, which sends energy to Innovations for Precision in Cataract Refractive Surgery A symposium at the 2018 APACRS Annual Meeting sponsored by Alcon covered a variety of topics in cataract refractive surgery. The session was moderated by Michael Lawless, MD , Sydney, Australia. Rohit Shetty, MD , Bangalore, India, presented on “Taking the Leap in Laser Vision Correction with Contoura Vision.” He discussed the evolution of looking at the cornea. In the early 1990s, it was all about myopia/hyperopia. Anywhere close to emmetropia was considered a success, but then physicians started looking at being within +/–0.5 D. This is when the development of different profiles, blend zones, and laser energies were factored in. “But still, the quality of vision was always an enigma,” he said. Dr. Shetty said we’re currently in an era of customization of LASIK. To achieve this, we have to achieve true customization. He discussed customized ablation profiles and regularizing the corneal surface. Dr. Shetty said he knew wave- front-optimized is good, but he was keen on the quality with Contoura. Dr. Shetty said it’s important to look beyond the corneal aspects of quality of vision because you need to understand that the lens mirrors the cornea. Whatever happens on the cornea before or after surgery shows up on the lens. He noted that coma is important to identify because the lens will not accommodate the same way in these instances because it has to balance what’s happening in the corneal plane internally. What’s important is making the cornea regular in one step, but you also have to keep the refractive error from becoming myopic. Nowadays, Dr. Shetty said pa- tients want good quality of vision, quality of life, safety and predictabil- ity, and less complications, and using technology like Contoura can aid in this. David Lubeck, MD , Homewood, Illinois, presented “Thinking Differ- ently About Cataract Surgery to Opti- mize Patient Outcomes.” He covered next generation phacoemulsification with Centurion and Active Fluidics and intraoperative aberrometry with ORA. He shared some of the aspects that he finds valuable with Centurion and Active Fluidics. With gravity- based fluidics, all parameter adjust- ments were made to mitigate surge three focal points in small and large pupil conditions. She detailed studies with the PanOptix and PanOptix toric lenses from the Singapore National Eye Cen- tre (SNEC). The first PanOptix study, con- ducted from October 2015 to June 2017, featured 50 eyes of 29 patients (21 bilateral implants and eight unilateral implants) with 1-month follow-up and 6-month follow-up. The second PanOptix toric study was conducted from April 2017 to March 2018 on 57 eyes of 33 patients (24 bilateral and nine unilateral) with 1-month follow-up. The study found that the Pan- Optix/PanOptix toric in the SNEC experience delivers excellent range of vision from 35 cm through to dis- tance unaided, Dr. Chee said. Refrac- tive predictability is very good (90% within +/–0.5 D); binocular photopic contrast sensitivity is normal at 1.5, 3, 6, 12, and 18 cycles/degree; and glare is mild and halos are moderate. Copyright 2019 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, ASCRS, or APACRS. Rohit Shetty, MD Chee Soon Phaik, MD, and David Lubeck, MD David Lubeck, MD Sponsored by Alcon