Eyeworld

EW MEETING REPORTER 68 November 2018 EyeWorld/ASCRS reports from the ASCRS Young Eye Surgeons Advanced Cataract Training, September 15–16, San Francisco EyeWorld/ASCRS reports from the ASCRS Young Eye Surgeons Advanced Cataract Training, September 15–16, San Francisco In summary, Dr. Greenwood said that manual LRI and femto AKs are both excellent options for astigmatism correction. Astigmatism management at the time of cataract surgery is an essential component to providing high uncorrected quali- ty of vision, he said, and surgeons striving to achieve refractive out- comes should be comfortable with manual LRIs and femto corneal incisions. Editors' note: Dr. Chamberlain has no financial interests related to his presen- tation. Dr. Greenwood has financial in- terests with Alcon (Fort Worth, Texas). Optimizing the ocular surface A panel during the Saturday morn- ing session covered optimizing the ocular surface. Ashley Brissette, MD, New York, Marjan Farid, MD, Irvine, California, Nicole Fram, MD, Los Angeles, Samuel Lee, MD, Sacramento, California, and Sumit "Sam" Garg, MD, Irvine, discussed the topic. Dr. Garg stressed the importance of looking at the meibomian glands. You want to push on the glands, he said, and using a Q-tip or finger to push on the glands can help the physician see how easy or hard it Astigmatism essentials Kicking off the first session of the day on astigmatism, Winston Chamberlain, MD, Portland, Or- egon, discussed how to accurately identify anterior and posterior cor- neal astigmatism. He offered several pearls on this topic. First, he suggested talking to your patients. This could include asking patients about their specific needs and expectations with cataract surgery, asking them about their favorite activities, asking about dif- ficulties with their current activities and daily living, and asking if they mind wearing glasses. Next, Dr. Chamberlain said to "talk to yourself." He said it's im- portant to consider if a certain IOL choice makes sense for the patient, and he said that he often considers if he would make the same decision for a family member. Other important points Dr. Chamberlain highlighted were to do a careful slit lamp exam, not to rely on a single device, look at the anterior curvature, and look at the posterior corneal curvature. He added that direct measure- ments will be better than assump- tions, and adjustable lenses or exchangeable IOLs may be options in the future. Michael Greenwood, MD, Fargo, North Dakota, discussed astig- matic keratotomy, highlighting fem- tosecond and manual AKs. He first mentioned the statistic that 52.5% of patients with cataracts have more than 0.75 D of clinically significant pre-existing corneal astigmatism. He noted it's important to make sure the astigmatism is regular, rule out any confounding corneal patholo- gy, and plan treatment based on a nomogram. For manual AKs, Dr. Green- wood noted several steps, partic- ularly stressing that it's important the patient is sitting upright when marking. He then highlighted the differ- ence between manual and femto. With femto, it's the same planning process, Dr. Greenwood said, but the laser does the cutting for you. There is a precise depth and placement, continuous curvature, and the abili- ty to titrate the incision with femto as well. He also stressed that femto is photodisruptive, you can't use the same nomograms (you may get over- correction if using a manual nomo- gram with femto), and centration is the most critical step in femto (decentration can be an issue). EyeWorld/ASCRS reports from the ASCRS Young Eye Surgeons Advanced Cataract Training

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