EyeWorld India December 2018 Issue

September 2017 3 EWAP EDITORIAL Dec 8 In the Pipeline D ear friends, products that could change how you “practice” is a headline that demands attention. In this issue of EyeWorld Asia-Pacific we have drawn from many different areas in the field to highlight examples of new technology which could alter the way we practice cataract and refractive surgery. The technologies range from improved methods of capsulotomy to goggles that could be of assistance in managing low tension glaucoma in a noninvasive fashion, using the goggles to alter the balance between intraocular pressure and cerebrospinal fluid (CSF) pressure. The topic of a light adjustable lens is certainly one area that could have a dramatic impact on cataract and refractive surgery. The issue also contains further discussion on new formulae to improve predictability as well as addressing the increasing use of toric lens to correct astigmatism. Unexpected refractive outcomes after cataract surgery are becoming less common but a simple solution to correct residual refractive error without resorting to corneal refractive procedures is indeed attractive. A light adjustable lens based on a photopolymer has finally received FDA approval. The refractive power of this lens can be adjusted with the use of UV light to adjust sphere and cylinder, improving refractive accuracy. The specific technology however may be challenging in that patients do need to avoid exposure to UV light with appropriate sunglasses until the final refraction is locked in and may require more than one treatment. In addition, this technology does not address an issue which is far more common than unpredictable refractive outcome in the immediate postoperative period, which is the change in refraction which often ensues in the years following cataract surgery. We are all familiar with the tendency to develop against-the-rule astigmatism in the years following cataract surgery and indeed the spherical refraction can alter with time. The potential for technologies that could adjust the power of an intraocular lens in situ any time after cataract surgery is therefore attractive. Although investigational, early laboratory work suggests that this may indeed be possible with femtosecond laser technology as reported by Liliana Werner and Nick Mamalis in their award-winning video recently at our APACRS meeting in Chiang Mai. Another avenue that is being explored is intraocular lenses with optics that can be exchanged for different powers even in the late postoperative period. Piggyback lenses placed in the ciliary sulcus are already available and can be utilized to correct both sphere and cylinder errors. In addition, piggyback lenses incorporating multifocal implants are now available as reported in this issue. The latter allows potential removal of the multifocal element with greater facility than an intraocular lens exchange. It is gratifying to note that new technologies and techniques that have always characterized the field of cataract and implant surgery continue to develop. This aspect is one of the reasons why cataract and implant surgery has always been fascinating and rewarding as we continue to enhance the visual outcomes of our patients. EWAP T his new issue of the scientifically enriched EyeWorld Asia-Pacific is out for the month of December with interesting articles conveying innovative facts. Our cover issue will familiarize you with the products in the pipeline that could change how you practice. Read our article on the light adjustable lens, which uses light exposure following implantation to adjust refraction. Now dry eye specialists can adjust to the addition of TrueTear to their treatment toolbox. This is a neurostimulation device that helps patients produce their own tears. The noninvasive, nonpharmacologic, nonsurgical glaucoma therapy with IOP lowering goggles is also discussed here. Read an interesting article on MKO melt as an emerging option for cataract anesthesia. In our glaucoma section, experts discuss how MIGS may decrease the role of traditional glaucoma procedures. Surgeons emphasize MIGS combinations to expand surgical options for glaucoma patients. The article on trabecular outflow addresses the growing number of trabecular outflow options. In our cataract section, read an exciting article about how proper planning and practice for anterior vitrectomy can result in positive surgical outcome. There is also an exhilarating article about special nucleofractis approaches for different types of nuclei to help preserve the integrity of the capsule and improve surgical efficacy. The in-depth discussion about various preoperative diagnostics for cataract surgery is a must read. One surgeon describes how to overcome challenges in pseudoexfoliation cataract surgery. Effectiveness of supplementary IOLs for secondary enhancements and primary duet implantation is discussed here to deal with biometric surprises. Meanwhile, “Real-world spin on toric lenses” pinpoints their performance in everyday practice. In our refractive section, we have a very clinically relevant comparison between two trifocal IOLs and the opinion of three surgeons on SMILE, PRK, and LASIK. This is followed by an interesting take on refractive surprise in glaucoma patients. We then discuss newer methods of calculating IOL power and the Iluvien intravitreal implant—a non bioerodible variant. Lastly, we conclude this issue by highlighting the immensely underestimated ocular microbiome and linking the current research around it to common eye conditions. As always, I would like to conclude with a quote from Tirukkural: All men that live are one in circumstances of birth; Diversities of works give each his special worth. (Tirukkural, Chapter 98, Quote 972) S. Natarajan, MD Regional Managing Editor EyeWorld Asia-Paci c Graham Barrett Chief Medical Editor EyeWorld Asia-Paci c