EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/115557
March 2013 VISIT US AT THE ASCRS 2013 IN SAN FRANCISCO The future of crosslinking T A hot topic in the "Cornea Conundrums" session was crosslinking and its status in the United States. Clara Chan, M.D., Toronto, said crosslinking has been in use for more than five years in Canada. However, the process has not yet been approved by the FDA and is therefore not able to be widely used in the United States. Doyle Stulting Jr., M.D., Atlanta, said he became interested in crosslinking some time ago. "This is a technology that doesn't have an enormous amount of intellectual property," he said. He said there are clinical trials, however, those participating are often limited to the number they can do. "I'm becoming more and more convinced that we ought to be offering crosslinking to people at the time of their diagnosis of keratoconus," Dr. Stulting said. The potential benefits are significant, and the procedure itself seems to be very safe, he said. Dr. Stulting said that it is unfortunate that even 10 years after the first print publications on the topic, the procedure still hasn't been approved by the FDA. But he noted that crosslinking is a superb option that can make a difference in anterior segment work in the future. MARK PRECISE CORNEA rincon.de MARKING FOR PREMIUM TORIC IOLs Editors' note: Dr. Chan has financial interests with Alcon, Allergan (Irvine, Calif.), and Bausch + Lomb (Rochester, N.Y.). Dr. Stulting has financial interests with Abbott Medical Optics, Alcon, Allergan, and Bausch + Lomb. Monday, February 18 Pearl: Topography key to postLASIK premium IOL results · FLEXIBLE: Variable use either on slit lamp or with hand-held pendulum instrument · PRECISE: Highly accurate pre-operative marking of the fnal torus position · EASY: Fast and reliable handling due to simple degree setting and easily readable scale WWW.GEUDER.COM In post-LASIK patients who need to undergo cataract surgery and are interested in a presbyopia-correcting IOL, topography is important in determining best postoperative results, physicians said. Dr. Donnenfeld presented a case of a 63-year-old male. The patient had been myopic, underwent LASIK and was now plano, but had developed a cataract and needed cataract surgery. The patient had heard of premium IOLs and wanted to know if he was a candidate. Dr. Donnenfeld asked the panel of the "Refractive Surgery for the Comprehensive Ophthalmologist" session what they would do in such a case, and requested a pearl for proceeding from Richard M. Awdeh, M.D., Miami. "The first thing is, you want a little more data," said Dr. Awdeh. "In these patients, I want to look at a preoperative topography, to see what the cornea looks like post-LASIK, and also do an OCT of the retina to make sure there's no maculopathy." Dr. Donnenfeld agreed, saying Dr. Awdeh's comment, "really hit the nail on the head." Higher-order aberrations can be an issue in such cases, Dr. Donnenfeld said. "To me, it's all about topography. If the topography looks good, generally they're very good," he said. He showed the patient's topography results, which were symmetric. The patient had a well-centered aspheric ablation. "In my mind, these patients need to have informed consent, but generally do very well with presbyopic IOLs," he said. Dr. Cionni also shared his experience, which has been extensive in postLASIK patients who need cataract surgery. He uses the Atlas placido topographer (Carl Zeiss Meditec, Dublin, Calif.) because of how it displays corneal aberrations. He said coma and high spherical aberrations are important to know in these cases. "We look for coma," he said. "Anything greater than 0.3, I caution the patients that they're not a very good candidate because they're unlikely to be happy with multifocal IOLs." Choosing between a monofocal and multifocal lens During another part of the refractive session, Dr. Donnenfeld introduced a case in which a 37-year-old patient had a traumatic cataract in just one eye. The patient was relatively young, there was a cataract in only one eye, and the other eye probably would not need attention for this for quite some time. Dr. Donnenfeld stressed the importance of considering all types of lenses and talking to the patient to see what would work best for personal preferences and ac-