Eyeworld

18 | EYEWORLD | MAY 2019 ASCRS NEWS how the surgeon marks his manual LRI and to- ric IOL patients preoperatively when not using VERION and intraoperative aberrometry. The VERION Image Guided System and intraop- erative aberrometry account for cyclorotation. There is also a lack of information on how intraoperative aberrometry was used to change management. It is unclear if any changes were made in IOL power selection or axis alignment based on intraoperative aberrometry recom- mendations. Additional studies that document the modifications suggested by intraoperative aberrometry and analyze the correlation be- tween intraoperative aberrometry and VERI- ON recommendations would be beneficial. Lastly, the article describes the use of different formulas between the groups (Barrett Universal II vs. Holladay 2), which may also affect the outcomes. Overall, we find this to be a fascinating study that sheds light on multiple facets of modern cataract surgery. In this study, the re- sults of precise manual astigmatic axis identifi- cation and placement of a toric intraocular lens or corneal astigmatic incision using modern formulas to identify correct spherical and net the VERION Image Guided System and the VERION planner in combination with intraop- erative aberrometry did not improve astigmatic outcomes when compared to manually creat- ed corneal astigmatic incisions and standard cataract surgery utilizing modern formulas to determine spherical and net cylindrical cor- rection. Though it is tempting to think that technologically advanced tools should automat- ically lead to improved astigmatic outcomes, this study highlights that this is not always the case. This study also confirmed prior reports of toric IOLs being a more accurate way to correct astigmatism than CAIs. The contralateral eye and randomized na- ture of the study design where subjects are used as their own controls is ideal. Correcting smaller amounts of astigmatism with arcuate incisions and higher amounts with toric intraocular lenses is common practice and enhances the appli- cability of the study. The number of patients included in the study, however, is relatively low, possibly leading to an inadequate power to establish a statistically significant difference in the residual astigmatism measured between the surgical groups. The article needs to mention continued from page 17 Correcting astigmatism at the time of cataract surgery: comparing results with toric intraocular lenses and corneal relaxing incisions planned with an image guidance system and intraoperative aberrometer versus manual planning and surgery Kerry Solomon, MD, Helga Sandoval, MD, Richard Potvin, OD J Cataract Refract Surg. 2019;45(5):569–575. n Results: A total of 38 eyes were treated with toric IOLs and 40 eyes with corneal astigmatic incisions (CAIs). Toric IOLs resulted in almost 0.25 D less cylinder than CAIs on average (p<0.01) with no difference between groups (p=0.41). There was no statistically significant difference in the MRSE by group (p=0.51). At 3 months, 11% of eyes (4/38) were more than 10 degrees of absolute orientation away from intended, two in Group A and two in Group B. The Verion mean keratometry was 0.16 D higher than for the LENSTAR. The vector difference between the two measures for all eyes was 0.5 D or lower. n Conclusion: The combined use of an image guided system and intraoperative aberrometry did not significantly improve outcomes when compared to the surgeon's standard of care. There was good agreement in the corneal astigmatism measurements between Verion and LENSTAR Ks. n Purpose: To evaluate outcomes when comparing the combination of an image guided system and intraoperative aberrometer to the surgeon's standard of care in correcting astigmatism using toric intraocular lenses (IOLs) or corneal incisions. n Setting: One site in the U.S. n Design: Prospective randomized contralateral eye study. n Methods: Contralateral eyes of subjects undergoing uncomplicated bilateral cataract surgery and astigmatism correction were randomly assigned to Group A or Group B. Group A received the surgeon's preferred standard of care. Group B had preoperative planning using an image guidance system, intraoperative aberrometry and laser-assisted cataract surgery. The primary endpoint was the residual refractive astigmatism at 3 months.

• Blank Page
• Blank Page (1)
• Blank Page (2)