Eyeworld

Contact information Name: by Vance Thompson, MD EyeWorld Refractive Editor AUGUST 2019 | EYEWORLD | 3 Nuances of cataract surgery post-LVC © 2019 Novartis 1/19 US-ORA-18-E-2623a ORA SYSTEM ® Technology - IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to the sale by or on the order of a physician. INDICATIONS: Federal (USA) law restricts this device to sale by, or on the order of, a physician. INTENDED USE: The ORA SYSTEM ® technology utilizes wavefront aberrometry data to measure and analyze the refractive power of the eye (i.e. sphere, cylinder, and axis measurements) to support cataract surgical procedures. WARNINGS AND PRECAUTIONS: The following conditions may make it difficult to obtain accurate readings using the ORA SYSTEM ® technology: • Patients having progressive retinal pathology such as diabetic retinopathy, macular degeneration, or any other pathology that the physician deems would interfere with patient fixation; • Patients having corneal pathology such as Fuchs', EBMD, keratoconus, advanced pterygium impairing the cornea, or any other pathology that the physician deems would interfere with the measurement process; • Patients for which the preoperative regimen includes residual viscous substances left on the corneal surface such as lidocaine gel or viscoelastics; • Visually significant media opacity, such as prominent floaters or asteroid hyalosis, will either limit or prohibit the measurement process; or • Patients having received retro or peribulbar block or any other treatment that impairs their ability to visualize the fixation light. • Use of iris hooks during an ORA SYSTEM ® technology image capture will yield inaccurate measurements. In addition: • Significant central corneal irregularities resulting in higher order aberrations might yield inaccurate refractive measurements. • Post refractive keratectomy eyes might yield inaccurate refractive measurement. • The safety and effectiveness of using the data from the ORA SYSTEM ® have not been established for determining treatments involving higher order aberrations of the eye such as coma and spherical aberrations. • ORA SYSTEM ® technology is intended for use by qualified health personnel only. • Improper use of this device may result in exposure to dangerous voltage or hazardous laser-like radiation exposure. DO NOT OPERATE the ORA SYSTEM ® in the presence of flammable anesthetics or volatile solvents such as alcohol or benzene, or in locations that present an explosion hazard. ATTENTION: Refer to the ORA SYSTEM ® Operator's Manual for a complete description of proper use and maintenance, as well as a complete list of contraindications, warnings and precautions. 106581 US-ORA-18-E-2623a_PI EW.indd 1 5/29/19 10:44 A patient who enjoyed a crisp refractive surgery result years ago may have higher expectations than the typical cataract patient. They think that the process and efficiency of seeing great without glasses after cataract surgery will be like their prior precision laser vi- sion correction. As such, it's important to understand the nuances in education, setting pre-cataract journey expec- tations, diagnostics, implant choice, surgery, and enhancement for these pa- tients. This issue's In Focus series helps us better understand cataract surgery in those who have experienced refractive surgery vs. those with an untouched cornea. Many prior laser vision correction patients who now have an early cata- ract present in our offices asking for treatment to "fine tune" their vision. Slit lamp exam might reveal an easily identifiable cataract, but as you work them up to rule out or rule in early lens changes as the culprit, remember that their lens can look deceptively clear and still be the reason for the blur. In these situations—refractive error plus a lens that is not obviously cataractous—I find patient history to be extremely important. If nighttime image quality is reduced and they have refractive error, I tell them that we do not understand how much of their blur is residual refractive error and how much is a potential lens issue. If their nighttime vision is crisp with glasses, they do not have a visually significant lens change. However, if their nighttime vision is not crisp with glasses and I have ruled out dry eye or corneal irregularity, then the lens is suspect. If dry eye or corneal irregularity is the culprit, the gas perme- able contact lens over refraction will be crisp, and that information is so helpful. If the blur is not from residual re- fractive error (as ruled out with glasses), dry eye/corneal irregularity (as ruled out with gas permeable contact lenses over refraction), or a retina/optic nerve problem, then the cause of blur starts to look like an aging crystalline lens. Many post-refractive patients think they are too young for cataract to be their problem. In the past, technology did not support an early cataract diag- nosis, but it does now, as the sources in this issue teach us. Even though nothing replaces being a good listener, a quality exam today uses these current technol- ogies to diagnose and quantify optical scatter from an aging optical system. Then there is the all-important implant. I think that the two biggest developments in my career have been laser refractive surgery to change corneal shape and the intraocular lens developments that help restore func- tions the lens lost—reading range and clarity. It is worth learning the details of modern-day implant options and how to maximize patient joy with them, be it a corneal adjustable implant, such as a multifocal that needs a PRK or LASIK enhancement at 3 months, or a Light Adjustable Lens (RxSight). The doctors interviewed for this series are world leaders in post-refrac- tive cataract surgery, and the insights they teach are so helpful to learn more about these nuances that are special to post-refractive cataract surgery. Thank you to everyone who contributed to this exciting issue dedicated to this import- ant topic.

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