Eyeworld

EW REFRACTIVE 60 April 2018 by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer Combining single step transepithelial PRK with accelerated CXL The keratoconus diagnostic map shows inferior asymmetry with a mild value of posterior elevation, with a minimal corneal thickness of 485 microns. Outcomes of a new study demonstrate reduced coma and high refractive stability in borderline eyes after combined procedures E yes that don't make the cut for LASIK now have another viable option for safe and effective refrac- tive correction. Patients treated with single step transepi- thelial photorefractive keratectomy (PRK) combined with simultaneous high energy accelerated corneal crosslinking (CXL) (transPRK Xtra) with smart pulse technology (SPT) using the Schwind Amaris 1050RS (Schwind eye-tech-solutions, Kleinostheim, Germany) achieved reliable refractive outcomes 1 year after the procedure, per the results of a study. "Single step transPRK for myopic astigmatism on borderline corneas that are not good can- didates for LASIK using corneal vertex centration with asymmetric offset is safe and predictable," said Presentation spotlight how the scatter in the eye is chang- ing as the patient blinks, and if you see wide variation there, you need to think more about the tear film as opposed to the static ocular media. Not only does the HD Analyzer give you an overall sense of the scatter in the patient's eye but also the source of that scatter. I use it for every cataract patient, but not every LASIK patient," he said. Dr. Waring thinks the HD Analyzer represents a future para- digm in diagnostic testing because it's one of the few devices that provides objective data on quality of vision. "This has been an invalu- able tool for diagnosis, education, and management of dysfunctional lens syndrome at its various stages. Also, for dry eye evaluation, it's one of the few devices that can give an objective, functional analysis of the impact of dry eye on vision. For sub- tle complaints, objective complaints, such as diplopia, this can be useful because we can identify the multiple points of light as they fall on the retina," he said. Dr. Durrie agreed. "We use wavefront when we're going to do wavefront-guided surgery. We were in the iDesign clinical trials, and that was a significant improvement over the WaveScan. We have moved into a new era with the combination of WaveLight topography-guided ab- lation and the iDesign. I think both of these diagnostics have moved the bar up because we've seen more patients who are better than 20/20 with both of those," he said. HD Analyzer and iTrace Dr. Hovanesian likes the HD An- alyzer (Visiometrics, Costa Mesa, California) for many of the same reasons that he likes LipiScan. "The HD Analyzer looks at the whole eye and its image quality. The OSI of the HD Analyzer is valuable because if you're going to do LASIK on some- one who is 50 and has significant scatter from a cataract, you want to know about that because they're not going to be happy. There's an OSI tracing over time that will tell you Technologies continued from page 58 Dr. Waring has also found the iTrace (Tracey Technologies, Hous- ton) to be useful for the ability to separate out internal aberrations from total aberrations and help surgeons determine whether the pathology is coming from the lens or the cornea. "It has a robust post- operative astigmatism program that can guide surgeons in evaluating postop astigmatism, particularly for understanding etiology and how to address residual astigmatism, that is, whether a rotation of an IOL would be warranted and how much. We've found it to be the most useful com- mercially available tool to do this analysis," he said. New technologies As a group, these technologies have brought a combination of tear film diagnostics that have made surgeons even more aware of who needs to have treatment both before and after surgery and the topogra- phy-guided and wavefront-guided treatments that allow surgeons to achieve better than 20/20 vision. "It's a fun time to be a refractive surgeon because we have good tools, and patients are getting good results," Dr. Durrie said. "We know who to operate on and which one of the procedures in refractive surgery to do. It's a great time for patients, and I think companies are now put- ting more resources into refractive surgery, and practices are starting to head in that direction also." EW Editors' note: Dr. Hovanesian has financial interests with Alcon and TearLab. Dr. Waring has financial interests with Johnson & Johnson Vision and Visiometrics. Drs. Carlson and Durrie have no financial interests related to their comments. Contact information Carlson: alan.carlson@duke.edu Durrie: ddurrie@durrievision.com Hovanesian: jhovanesian@harvardeye.com Waring: gwaring@waringvision.com

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