EyeWorld India June 2020 Issue

EWAP JUNE 2020 3 EDITORIAL Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific Abhay Vasavada Deputy Regional Editor EyeWorld Asia-Pacific O phthalmic surgery has benefitted from technological improvements over recent decades. Recently, we have benefitted from technological advances in diagnostic equipment, including biometry and OCT devices. The focus in this issue, however, is on the role of the technology in the operating theater. This has extended beyond improvements in the optics and ergonomics of operating microscopes to real-time diagnostic equipment, including aberrometry, intraoperative OCT, computer guidance for toric alignment, and 3D viewing systems as an alternative to optical microscopy. The advantages of these new technologies are presented with enthusiasm by several surgeons contributing to the topic, but as always EyeWorld Asia-Pacific seeks to present a balanced opinion to our readers. The enthusiasm for some of the advanced technology is less apparent in the Asia-Pacific region than in the U.S. and Michael Lawless presents a thoughtful commentary on this topic. Certainly, we do need improvements in managing unusual cases, in predicting outcomes. Keratoconus is an example of the challenges we face in selecting IOLs in this context at the time of cataract surgery. The reason for poor prediction in keratoconus is another example of the disruption of the normal relationship between the posterior and anterior corneal curvature, quite different to that encountered in the cornea due to previous refractive surgery but equally challenging. To address the problem of predicting refractive outcomes in patients with keratoconus, I have updated the True K formula available online on the APACRS website recently. It now includes an option for keratoconus in addition to post myopic and hyperopic LASIK/PRK and RK. Analysis of data shows that selecting this option in the presence of keratoconus improves the prediction of refractive outcomes significantly and avoids unexpected hyperopia that commonly occurs in this context. I would recommend that the measured posterior cornea option be utilized using either Pentacam or swept-source OCT. When selecting Pentacam or swept-source OCT, one must ensure that the device selected is for keratoconus, and that the radius or corneal power is selected for data entry. I hope that this new option provides improved spherical outcomes for keratoconus and is a useful adjunct to the new intraoperative technologies that are becoming available. EyeWorld India. June 2020. Vol 16 No. 2 The technology you use impresses no one, the experience you create with it is everything. – Sean Gerety T his issue of the EyeWorld Asia- Pacific deals with new imaging technology that is very pertinent to cataract surgeons around the globe today. Whenever any new technology is introduced, we as scientists owe it to ourselves and our patients to study its worth. Of particular interest are the intraoperative guidance and imaging systems. In my opinion, these systems are more automated and therefore more precise in judging the astigmatism axis preoperatively, and also help surgeons place and align their toric IOLs intraoperatively without depending on manual forms of marking that are subject to human errors. These are user- friendly, precise, and have been shown to improve outcomes in the hands of several high-volume users. Making an investment in these digital guidance systems therefore is probably a step forward in practices aiming at giving the best refractive and quality vision outcomes following cataract surgery. The other promising and, in my opinion, still evolving technology is 3D visualization systems, very useful to trainee surgeons, assistants, and even surgeons in practice as it helps to critically appreciate and assess every step of surgery. Debatably, it may mean less light exposure for patients and better ergonomics for surgeons. Intraoperative OCT, also becoming a very useful research and practice tool, is being used to explore newer dimensions such as lamellar corneal surgeries and interactions of the anterior vitreous interface–lens capsular bag. Although intraoperative aberrometry came with a lot of promise, modern diagnostic machines and accuracy in IOL calculation with newer formulae as well as the high cost and difficulty of use have restricted its routine use to special situations outside of the United States. This issue also discusses the finer nuances of intrascleral haptic fixation technique, now a very popular and effective option for IOL fixation in select situations. We are privileged to have access to a variety of pre- and intraoperative imaging and guidance systems for refining the precision in our surgical techniques and outcomes, and enhancing teaching and research. The contributors have really done a great job in dissecting and analyzing each of these technologies, but every surgeon needs to make a prudent choice based on their individual practice and experience to reap the benefits.