Eyeworld

I MARCH 2020 | EYEWORLD | 67 by Vanessa Caceres Contributing Writer the direction I thought it would logically go. We got a great result," he said. He also shared a scenario in which wrong data were uploaded onto the website he usually uses for IOL calculations. However, with aber- rometry, he was able to catch that and identify an appropriate IOL power. In addition to these common uses, Dr. Henderson has found several other reasons to choose intraoperative aberrometry, including with irregular corneal pathology (such as scar- ring) where measurements may not be accurate, cases of macular pathology or staphylomas, and eyes with long or short axial lengths. "In my practice, intraoperative aberrometry has replaced the use of immersion A-scan in many of these unusual eyes," she said. W ith increasing precision in IOL calculation formulas, surgeons may wonder if there is still a role for intraoperative aber- rometry. Those currently using the technology say it is helpful, especially in certain patients. "I think there's a nice role for aberrometry to confirm or modify IOL power. It still has a place," said Douglas Koch, MD. The key is knowing when to use it. Best uses of aberrometry There are several ideal scenarios for intraoper- ative aberrometry. One of those is when trying to achieve a specific refractive target. "It's ideal for toric and multifocal lenses and in patients with prior refractive surgery," said John Berdahl, MD. Among toric IOL patients, many surgeons will use intraoperative aberrometry for IOL orientation and alignment. "They think it does the best job of aligning the posterior and an- terior cornea," said Dr. Koch, who previously introduced the importance of posterior cornea measurements. Intraoperative aberrometry is useful in post-refractive surgery eyes because it can be harder to achieve accuracy with this patient group. However, it's important to consider the type of surgery a patient had. "Although it can be helpful in radial keratotomy patients, they can have significant fluctuations," Dr. Berdahl said. "It's not necessarily unhelpful, but that needs to be taken into account with the full picture." Another use for intraoperative aberrome- try is to confirm what you may already have in mind for IOL power. "Using it decreases errors from inadvertently implanting the wrong IOL due to clerical errors," said Bonnie Henderson, MD. Dr. Koch shared the example of a patient of his who needed an IOL exchange and had a toric IOL. Using the website AstigmatismFix. com, Dr. Koch didn't get the IOL choice that he expected. "At the time of surgery, I used intraoperative aberrometry, and it pointed me in Intraoperative aberrometry's role in guiding IOL decisions At a glance • Intraoperative aberrometry can help guide a surgeon's IOL choices. • This type of technology is valuable in eyes that have had refractive surgery or those receiving toric IOLs. • The use of newer IOL formulas may change or lessen the role of aberrometry. • Appropriate hydration and fixa- tion can help improve results. continued on page 68 View from the ORA (Alcon) as seen in the surgeon's right ocular of the microscope Source: Samuel Masket, MD

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