EyeWorld India June 2021 Issue

REFRACTIVE 32 EWAP JUNE 2021 Contact information Donnenfeld: ericdonnenfeld@gmail.com Weinstock: rjweinstock@yahoo.com W ith many new premium lens technologies and increased patient expectations, astigmatic keratotomy (AK) and limbal relaxing incisions (LRIs) are tools that can be used by surgeons to help correct low levels of astigmatism. Eric Donnenfeld, MD, and Robert Weinstock, MD, discussed how they use these to improve outcomes. LRIs are made to widen the cornea in certain areas to reduce astigmatism, Dr. Donnenfeld said. The purpose is to reduce astigmatism by flattening the steep axis of the cornea. “The analogy I make to patients is it’s similar to cutting the laces on a football,” he said. “If you do that, it would round out to become more basketball shaped, which is similar to what you want to do to reduce astigmatism.” Dr. Donnenfeld said that he’s using LRIs more than ever in his practice because patients have higher expectations. “They expect better uncorrected vision after LASIK and cataract surgery.” Dr. Donnenfeld said that over the last several years, his use has shifted. Previously, these incisions could be used for higher levels of astigmatism. Now, there are specific technologies, like toric IOLs, that can be used to correct higher levels of astigmatism. However, he noted that LRIs are still valuable to correct astigmatism from 0.5 D up to 1–1.25 D. “I use them in patients who’ve had LASIK who have a spherical equivalent close to plano but have astigmatism,” he said, adding that he also uses them for patients who had cataract surgery and have astigmatism after. “It’s a simple procedure, and you get an almost instantaneous response.” According to Dr. Weinstock, astigmatism management has become one of the hottest topics in cataract and refractive surgery. As cataract technology has improved, IOL implants have improved, as well as biometry, he said, adding that it’s approaching standard of care to address astigmatism at Using AK/LRIs to correct astigmatism by Ellen Stodola Editorial Co-Director This article originally appeared in the March 2021 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Manual LRI performed at the slit lamp. Source: Eric Donnenfeld, MD