hexis is well centered.” As attendees watched the eye moving left and right, up and down, Dr. Tan pointed out the consistently “very, very good red reflex.” He recommends using ProVisc (Alcon) viscoelastic as it’s “much easier to remove and reduces rotation when you're putting in toric IOLs.” Because the Clareon material is a “bit softer” than the AcrySof, surgeons should use the Monarch IV injector for implantation. Once the surgery was completed, Dr. Michael LAWLESS (Australia) talked about lens choice, noting that Alcon has eight different IOLs in powers from +6D to +40D, with five toric lenses ranging from T2 to T9. In clinical studies on the PanOptix, “more than 96% of the 109 patients reported never needed glasses).” 2-5 With the Vivity lens, “you get a monofocal type profile in terms of visual disturbances; the Vivity registry study showed 91% of subjects report no visual disturbances.” In his own practice — which performs 19,000 surgeries per year across all surgeons — the use of EDOF IOLs has steadily increased from 2020 to 2023, now comprising almost 14% of lens implantations, while the use of trifocal IOLs has decreased slightly in that time, from 25% to 20.5%, as has the use of monofocal IOLs, from 69% to 66%. In his own hands (he performs about 400 surgeries per year), “Vivity has quickly come to take up around 65% to 70% of the lenses I use,” he said. “It’s my default lens. I have to find a reason NOT to use it.” “The trend inexorably is to presbyopia-correcting lenses,” he said. “Not using them now is starting to be unusual in Australia. The Vivity lens is a good entry point, and whether you use the Vivity or the PanOptix trifocal lenses will likely be determined by your own personality, your risk profile, and your patient base." Panelists Dr. Allan FONG (Singapore) and Dr. Lubeck weighed in; Dr. Fong said his use of the Vivity is about 30% to 40% and his multifocal use is about 20% to 30%. Dr. Lubeck said his use of the Vivity is mostly in patients “who were initially inclined toward a monofocal toric; stepping up to the Vivity toric adds a significant advantage for them with really no downside.” non-focused, “our maculas can tolerate a longer period of exposure to the LuxOR microscope compared to some of the competition.” The ACTIVE SENTRY component of the Centurion allows surgeons to operate at normal to low IOPs, low surge, and full control of the chamber fluctuation, Dr. Yeoh said. “That's largely due to the presence of the sensor in the handpiece, which allows a more rapid response time, resulting in reduced occlusion break surge,” he explained. In the Asia-Pacific region, the latest IOL is now the PanOptix toric on the Clareon platform, “which will be glistening-free,” Dr. Yeoh said, and includes a new handpiece delivery system, the Monarch IV. “While you’ll have all the inherent benefits of the PanOptix, we’re now hearing patients are getting better contrast sensitivity as well.” Dr. Tan’s patient was a 54-year-old Chinese female who presented with a moderately dense nuclear sclerosis; Dr. Tan planned on implantation with an Alcon Clareon PanOptix toric lens. As he started the surgery, he said the VERION “can help you ensure the capsulorLive Surgery For the first time since the global pandemic, luncheon attendees were treated to a live surgery demonstration, incorporating all of the above technologies and devices. Dr. Gavin TAN (Singapore) demonstrated the use of the Alcon LuxOR Revalia microscope, the Centurion phaco machine with ACTIVE SENTRY, and the new Monarch IV injector for the Clareon PanOptix toric lens. Dr. Ronald YEOH (Singapore) discussed the Alcon Vision Suite, “a suite of products ranging from the acquisition of data and biometry typified by VERION and the new ARGOS system to the LuxOR Revalia microscope, the Centurion phaco machine with ACTIVE SENTRY and the full range of IOLs.” The Revalia marks Alcon’s first venture into the field of optical microscopes, he said, and it succeeds by offering “better visualization and the largest depth of field.” In his opinion, “the most useful feature” of the microscope is its larger and more stable red reflex, a point reiterated while Dr. Tan performed the surgery. From the surgeon’s perspective, Dr. Yeoh said that because the microscope’s light is technicians is that if the view of the retina is blurred and the first measurement is difficult, the technician knows not to spend time constantly re-capturing and to move directly to the ERV mode. Once the measurements are done, a “single click” sends the biometry information to the surgical planner that already has surgeons’ preferred lenses, preferred formulas, surgically induced astigmatism incision placement, etc., “so with minimal effort, you can choose your lens in Alcon’s Vision Planner and not even need paper if you’re digitally inclined,” Dr. Lubeck said. The system currently uses multiple IOL formulas, including the updated Barrett Suite. 12 For post-refractive surgery cases, the Vision Planner allows manual entry of the posterior keratometry data and use of the Barrett Total K formula. “I’m achieving over 90% accuracy in all patients,” Dr. Lubeck said, “but especially in the post-refractive surgery cases.” Busy surgeons can also take advantage of the remote Vision Planner software, which Dr. Lubeck has started to use in hotels, at home, among other locations. For surgeons who use the Alcon’s LenSx laser, ARGOS provides image-guided integration to the Alcon cataract refractive suite, reducing the risk of transcription errors, accurately accounting for cyclotorsion, reducing the variability from manual marking, and enhancing surgical precision and refractive outcomes. “Anatomic or pupil center may be acceptable for routine cases, but I believe for presbyopia-correcting lenses, we will aim towards centering on the patient’s visual axis,” he said. Finally, he said for those who use Alcon’s ORA intraoperative biometer, “the difference now between the ARGOS predicted outcomes and the ORA predicted outcomes has become much, much, much smaller. I'm a big fan of both technologies.” Dr. Lubeck told attendees the ARGOS “is something which is going to have an overarching impact on our current and future ability to accept and integrate new technologies, new lenses, new technologies in surgery, and will provide better outcomes and less surgeon stress, less surgeon fatigue, and more room to think broadly and widely and create new things.” Figure 4. The LuxOR Revalia uses proprietary illumination technology Figure 5. Dr. Lawless' trends from 2019 to 2023 show increasing use of EDOF lenses. Alcon at APACRS 2023: IOLs, Microscopes, Live Surgery, and Glaucoma Devices APACRS The news magazine of the Asia-Pacific Association of Cataract & Refractive Surgeons Copyright 2023 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. Not all products, services or offers are approved or offered in every market and approved labeling and instructions may vary from one country to another. The statements of the authors of this supplement reflect only their personal opinion and experience and do not necessarily reflect the opinion of Alcon or any institution with whom they are affiliated. Alcon has not necessarily access to clinical data backing the statements of the authors. The statements made by the authors may not yet been scientifically proven and may have to be proven and/or clarified in further clinical studies. Some information presented in this supplement may only be about the current state of clinical research and may not be part of the official product labeling and approved indications of the product. The authors alone are responsible for the content of this supplement and any potential resulting infringements resulting from, in particular, but not alone, copyright, trademark or other intellectual property right infringements as well as unfair competition claims. Alcon does not accept any responsibility or liability of its content.
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