Advancements Made Possible with ZEISS Workflow Solutions Supplement to EyeWorld Asia-Pacific September 2023 APACRS The routine 3-step technique for manual toric intraocular lens (IOL) marking consists of marking the eye at the horizontal meridian on the slit lamp or other various marking devices, intraoperatively using another device with angular gradations, and marking the limbus or cornea at the desired angle of alignment with a marking pen or needle. With this routine technique using a bubble marker, the mean error in axis has been found to be 2.48 while the total error in toric IOL alignment is 4.98. “This is where the CALLISTO eye® comes into the picture,” Dr. Shetty said. “It is a markerless system where you get an intraoperative overlay in your microscope.” The CALLISTO eye® provides this intraoperative reference point, compensates for cyclotorsion, and provides access to all the markings. One feature of the markerless system is the incision assistant feature which can superimpose the exact position and size of incisions to ensure precise surgery. Another feature is performing capsulorhexis by superimposing the exact shape and size of the rhesus to ensure IOL centration of the optical axis of the eye. Finally, the CALLISTO eye® also has automated eye tracking to ensure the position of the superimposed assistance functions are properly aligned on the eye. “In all my patients, I implant a capsular tension ring (CTR),” Dr. Shetty said, “because it expands the bag, and it brings the anterior and posterior capsule closer together so 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. Using the EQ Workplace provides a more efficient experience compared to using a manual workflow for cataract surgeries. that it increases the contact between the IOL and the bag.” This process can be validated using the OPMI LUMERA® 700. “Comparing marker and markerless systems, when you look at quality of vision, markerless systems are significantly better, especially if you’re implanting trifocal or extended depth of focus (EDOF) IOLs,” Dr. Shetty said. “The slightest rotation can lead to a significant drop in visual quality.” In terms of the evolution of the microscope, the ZEISS ARTEVO 800 Digital Microscope has become a key player in the field of cataract surgery. This system was designed to take care of three primary people: doctors, patients, and trainees. At the 2023 APACRS Singapore, leading experts gathered during Thursday’s lunch symposium to share their knowledge of how the power of integrated workflow solutions improves patient care and cataract surgery outcomes. Enhancing Cataract Workflow Efficiency with Digital Technology Naren SHETTY, MD, India “All of us aim to be efficient to save time and indirectly save money,” Dr. Naren Shetty, MBBS, MD (India) said as he began his presentation on enhancing the cataract workflow. Many clinicians have traditionally been using manual markers for toric marking, using tools such as the pre-operative toric reference marker, the Barrett dual axis toric marker, and the Whitman axis marker among many. However, there are many common issues with manual toric marking that clinicians may face. At times, there may be no reference point, head tilt, cyclotorsion, or removal of the mark due to excessive corneal wash. Furthermore, for every one degree of misalignment, toric lenses lose 3% of their corrective effect.
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