Eyeworld

MAR 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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March 2012 Refractive February 2011 EW FEATURE 85 tients have] to understand they will likely still need spectacles," he said. Dr. Raizman agreed. "No pa- tients will be happy with a hyper- opic outcome, but they'll be OK if there's minor myopia." He also opts for a three-piece lens and a slightly larger capsulorhexis in this group. "There's no magic bullet for- mula" for IOL calculations in post- surgical eyes, Dr. Ashrafzadeh said. He uses Haigis L, Holladay II IOL Consultant, and the ASCRS calcula- tor. "[Using a combination of] the modified Masket on the ASCRS cal- culator along with the other two seems to give the best predictions." In post-hyperopic LASIK pa- tients, "be very careful about treat- ing 'astigmatism' in these eyes," Dr. Devgan said. "You may mistakenly treat what's not really there." "Laser surgery did not correct only the corneal abnormalities, but also likely a not-so-infrequent lentic- ular component that will lurk when the crystalline lens is removed," Dr. Ashrafzadeh said. Former myopes can have "practically all forms of implants, including multifocal IOLs," he said, but he excludes mul- tifocal options for former hyperopes. The post-RK eye Dr. McDonald said a study showed the flatter keratometric values be- tween K and the 2-mm zone from the Orbscan (Bausch + Lomb, Rochester, N.Y.) have provided the best calculations. "The 2-mm spot has been the closest for us," he said. "In post-RK, we'll still take the lowest K reading. I shoot for a –1 in these patients." Calculators "will always remain a vital part of pre-op evaluation," Dr. Ashrafzadeh said. "Live aberrometry may augment the information. With the advent of optical coherence tomography technology and the ability to better image the anterior segment with greater accuracy, our precision in calculating the effective lens position will greatly increase." Post-RK "has to be treated differ- ently," Dr. Devgan said. "There aren't as many methods to calculate IOL powers for post-RK. They're not stable eyes—the diurnal fluctuation in post-RK can be as much as 2 D different at the time of surgery." "The post-RK eye is often impos- sible to calculate," Dr. Raizman said. "It may be impossible to get an esti- mated corneal power. In those eyes, Whether you're just beginning or experienced in cataract and refractive surgery, ASCRS is the professional society that's right for every stage of your career. Established Anterior Segment Ophthalmologists Mid-career is perhaps the most challenging period for today's ophthalmologist. The clinical and technological changes have never come faster and the regulatory concerns have never been greater. ASCRS' Annual Sympo- sium and Winter Update offer the education and networking needed to help your practice excel, and our ASCRS MediaCenter provides targeted online content addressing the issues most pressing to you. ASCRS' monthly Journal of Cataract and Refractive Surgery reports on all aspects of anterior segment surgery, and our meetings are focused, well-organized, and highly interactive. eyeCONNECT, ASCRS' online clinical service, lets you share questions and answers with like-minded peers in a private and supportive environment. ASCRS' commitment to fostering excellence through collaborative exchange is unmatched by any other ophthalmic organization. Join ASCRS today! The Society for Surgeons AMERICAN SOCIETY OF CATARACT AND REFRACTIVE SURGERY 4000 Legato Road, Suite 700, Fairfax, VA 22033 • 703-591-2220 • www.ASCRS.org I like to think ahead and be prepared for an IOL exchange." EW Editors' note: Dr. Ashrafzadeh has financial interests with Carl Zeiss Meditec. Dr. Devgan has no financial interests related to this article. Dr. McDonald has financial interests with Bausch + Lomb and WaveTec Vision (Aliso Viejo, Calif.). Dr. Packer consults for industry and holds an equity stake in WaveTec Vision. Dr. Raizman has no financial interests related to this article. Contact information Ashrafzadeh: drash@modestoeyecenter.com Devgan: 800-337-1969, devgan@gmail.com McDonald: 479-521-2555, mcdonaldje@mcdonaldeye.com Packer: 541-687-2110, packer@finemd.com Raizman: mraiz@comcast.net An ASCRS Membership For every stage of your career

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