Eyeworld

I TECHNOLOGY & INNOVATION MAY 2019 | EYEWORLD | 41 wire loop that delivers heat to cut a consistent, perfectly round capsulotomy. "This capsulot- omy happens faster than a femtosecond laser, which gives less time for liquified cortex to interfere with the cut when the capsule is under pressure." Phaco machines have also seen advances. Dr. Donaldson said that these machines now have more efficient fluidics, with custom energy cycles such as modified burst and pulse settings, and improved machine tubing that allows opti- mization of phaco parameters. Advances in biometry One existing technology that has steadily improved through the years is the biometry device. All the physicians interviewed for this article cited the IOLMaster 700 swept source OCT biometer (Carl Zeiss Meditec) as one of the more significant innovations. In addition to working with almost any grade of cataract and improving accuracy, the device incorporates the latest IOL calculation formulas created by experts such as Warren Hill, MD, and Graham Barrett, MD. These formulas, Dr. Weinstock said, improve on existing formulas, incorporating artificial intelligence into the nomograms that drive intraocular lens power selection. Dr. Donaldson added that the IOLMaster 700 "provides an image of the macula that is a very helpful screening tool for macular patholo- gy in preparation for cataract surgery." Dr. Garg noted that the IOLMaster 700 can also be combined with the CALLISTO eye system (Carl Zeiss Meditec) to provide a refer- ence image to guide toric IOL placement. Acknowledging these advances in biometry, Dr. Lee noted that "[t]he question is, which Juvene IOL immediately after implantation About the doctors Kendall Donaldson, MD Professor of clinical ophthalmology Bascom Palmer Eye Institute Plantation, Florida Sumit (Sam) Garg, MD Vice chair of clinical ophthalmology Gavin Herbert Eye Institute Irvine, California Bryan Lee, MD Altos Eye Physicians Los Altos, California Robert Weinstock, MD The Eye Institute of West Florida Largo, Florida continued on page 42 Deployment of miLOOP under anterior capsular edge Source (all): Summit Garg, MD technology will do the best job of measuring the posterior cornea? And that is something that will require more research to determine." Intraoperative advances Ultrasound energy is one intraoperative param- eter that has been the target of improvement for a number of technologies. "I have enjoyed using both the femtosecond laser and the miLOOP device [Carl Zeiss Meditec] to help reduce the amount of ultrasound energy I use, particularly during dense cataract cases," Dr. Donaldson said. "Both devices help pre-frag- ment the lens in preparation for phacoemulsifi- cation." Like the Zepto, the miLOOP consists of a nitinol ring but is inserted into the lens capsule to bisect and chop the cataract. "The miLOOP is useful for the very dense lens," Dr. Garg agreed. "It allows for segmen- tation of very hard nuclei with relatively little effort." In his experience, the miLOOP helps in cases in which even the femtosecond laser was not sufficient to fragment the dense nucleus. "Additionally, it allows for easy cortical removal as the process of deploying the miLOOP loos- ens cortex from the capsular bag," he said. Dr. Lee noted that the miLOOP can stress the zonules, and he doesn't use it for cataracts with weak zonules, which is often the case for the type of dense cataracts the miLOOP is used for. Intraoperative precision is an obvious target for improvement. Dr. Weinstock uses the NGENUITY 3D Visualization System (Alcon), recently combined with other technologies such as the ORA System (Alcon). "This allows for

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