EWAP MARCH 2022 3 EDITORIAL EyeWorld Asia-Pacific • March 2022 • Vol. 18 No. 1 Graham Barrett Chief Medical Editor EyeWorld Asia-Pacific Abhay Vasavada Deputy Regional Editor EyeWorld Asia-Pacific Negative dysphotopsia can be a bug bear in an otherwise successful outcome. While the incidence remains low and most patients adjust eventually, we should be equipped to deal with it whenever it arises. We know some risk factors yet most times we are unable to predict who will develop these symptoms. Foremost when dealing with such patients is to listen and acknowledge their complaint, showing confidence that these things happen and solutions are available if it persists. Reverse optic capture of the IOL optic or placing an IOL in the sulcus often helps. One must be extra careful when performing cataract surgery in the fellow eye. The patient should be counseled on the possibility of negative dysphotopsia and an IOL amenable to reverse optic capture should be chosen. Dr. Samuel Masket has designed an IOL that reduces negative dysphotopsia. The space for presbyopia-correcting IOLs is being populated with more and more options for different candidates. With the reported success of extended depth of focus IOLs, we feel more confident advising these lenses in eyes that are less than pristine. Similarly, for refractive lens exchange, many eyes may have retinal or macular issues due to higher refractive errors preoperatively. Performing a thorough preoperative assessment of their ocular surface and retina including an OCT should be mandatory. Subtle pathologies such as epithelial basement membrane dystrophy can be missed if you are not looking for them. Using technologies such as highresolution OCT epithelial mapping can raise suspicion in patients with unexplained symptoms such as blurry vision, fluctuating vision, or even diplopia. This issue also discusses other challenging intraoperative scenarios. If there is one take away, it is that as a surgeon you need to keep your ego aside and be ready with different options depending on how things play out. An issue growing to monstrous proportions is myopia in children. The Asia-Pacific region is like the epicenter of the myopia pandemic. A whopping 73% of school-going children were reported to be myopic in a study from East Asia. Low dose atropine has been shown to be useful in preventing progression of myopia, but it also becomes our responsibility as eyecare providers to create awareness for positive lifestyle changes that can help stem the myopia pandemic. This issue also provides useful updates regarding the management of corneal diseases, particularly less invasive therapies such as the use of rhokinase inhibitors and Descemetorhexis in patients with early and localized Fuchs dystrophy. These non-surgical treatments, which have been discussed for several years, may now become more widespread. Finally, discussions from the ASCRS Journal Club, where young authors present and dissect studies focusing on clinically relevant problems, are very encouraging. I firmly believe that such platforms offer visibility and will encourage our budding surgeons to take up these areas more seriously, and thereby contribute more meaningfully to the betterment of our science. T his issue contains an interesting discussion of intraoperative refractive guidance systems and their clinical use. Cataract surgery practice patterns are usually similar in the Asia-Pacific region compared to other regions; occasionally, however, there is a divergence such as the increased use of toric IOLs in the Asia-Pacific compared to other regions. Intraoperative aberrometry is another technology rarely found in our practices compared to the U.S. Published data comparing the utility of intraoperative abberometry to predict the refractive outcome is inconsistent and recent publications suggest that accurate preoperative measurements with modern formulas is equal if not better than intraoperative aberrometry for spherical power. The accuracy of toric IOL prediction is not superior and using intraoperative aberrometers to determine the alignment axis is relatively infrequent despite the enthusiasm of some U.S. surgeons. The difference could in part be explained by the relative frequency of low toric IOLs. Low toric IOL powers such as T2s are not yet available in the U.S. but are more common in countries like Singapore and Australia. In this context, surgical disturbance of the ocular surface and the speculum may impact the reliability of axis alignment by intraoperative aberrometry. In situations where toric lenses of higher cylinder powers dominate, intraoperative refraction may be more reliable. Predicting the outcome of patients with a previous history of refractive surgery can be challenging and intraocular aberrometry has been recommended. Once again, there is no indication that it is more accurate than careful biometry with modern post refractive surgery formulas. Differences in reimbursement and the opportunity to charge additional fees may also influence the popularity of intraoperative aberrometry. Image-guided alignment, however, is quite popular in the Asia-Pacific region. Different systems are available, including Calisto and Verion, and are an efficient method of determining the correct axis for toric IOL alignment. Unexpected registration issues are relatively rare but surgeons should be cautious to avoid misalignment due to erroneous image acquisition. Simple methods using apps such as toricCAM to accurately determine the reference axis are in my opinion are more reliable. It is my practice to use both methods to avoid technical issues with image-guided systems and surgeon error in setting the alignment axis. Using both techniques provides greater confidence in ensuring the toric lens alignment is accurate and not a major issue in unexpected residual astigmatism after toric IOL implantation. This issue of EyeWorld Asia-Pacific marks 2 years in the ongoing COVID-19 pandemic. There is an element of fatigue as we deal with the Omicron variant, but fortunately it does appear to be less serious than previous variants. Our news journal has been a constant during this pandemic, keeping us informed and in contact as we have resorted to virtual meetings. We are therefore looking forward to our next meeting in Korea in June where we can renew acquaintances and friendships in person.
RkJQdWJsaXNoZXIy Njk2NTg0