FEATURE EWAP JUNE 2022 9 that “accounting for 50% of the observed error of predicted refraction in the first eye reduced the error of predicted refraction in the second eye.” 2 If a patient doesn’t want to move on to their second eye until they are happy with the vision in their first, Dr. -alâ said options include IOL exchange (his preference in the immediate postop period unless there are issues precluding it), laser vision correction, or a piggyback lens (the latter is the least used of all the options, he said). How to avoid misses in the first RNCEe Dr. Salz said he always performs measurements on a different day than when the patient comes in for an exam or evaluation. “It’s important for the cornea to be as pristine as possible. … If you put drops in the eye, you’re going to distort the surface,” he said, adding that if the patient is found to have dryness or blepharitis, that should be well treated before performing measurements. He said if a patient has posterior subcapsular cataracts, it can be difficult to obtain accurate axial length measurements with optical biometry. Dr. Salz said if the patient wants to defer surgery for later, he’ll get axial length measurements earlier so he doesn’t need to do immersion A-scan later. Dr. Shammas also noted that most misses are due to errors in axial length measurements, often due to advanced cataracts that cannot be measured with optical biometry. “Newer biometers based on swept-source OCT, such as Argos [Alcon] or IOLMaster 700 [Carl Zeiss Meditec], have a much higher rate of acquisition, thus decreasing the need for ultrasound biometry. Also, these new biometers will display a two-dimensional B-scan image that can be used to ensure an accurate measurement has been performed,” he said. Dr. Shammas said surgeons should review their measurements preoperatively and ensure the correct IOL power is used during surgery. This “cannot be underestimated,” he said. EWAP Reference 1. Jivrajka RV, et al. Improving the second-eye refractive error in patients undergoing bilateral sequential cataract surgery. Ophthalmology. 2012;119:1097–1101. 2. Covert DJ, et al. Intraocular lens power selection in the second eye of patients undergoing bilateral, sequential cataract extraction. Ophthalmology. 2010;117:49–54. Editors’ note: Dr. Salz is in practice with The Eye Specialists, Bridgewater, New Jersey, and declared no relevant financial interests. &r. 5JaOOas Rractices at 5JaOOas '[e /eFical %enter .[nYQQF %aliHQrnia anF Jas interests with Alcon and Oculus. The Next Generation NEW Pentacam® AXL Wave The first device to combine Scheimpflug Tomography with Axial Length + Total Wavefront + Refraction + Retroillumination The new Pentacam® AXL Wave is a reliable partner for your refractive and cataract practice, creating the best prerequisites for surgery, based on pre-op metrics, and providing post-op measurements for reliable monitoring, in just one device ! With high-end hardware and software for optimum treatment and satisfied patients, the new Pentacam® AXL Wave makes no compromises on quality. OCULUS Asia Ltd. Hong Kong pentacam.com/axl-wave • info@oculus.hk
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