OCT 2019

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/1171786

Contents of this Issue


Page 47 of 78

OCTOBER 2019 | EYEWORLD | 45 R Contact information Holladay: holladay@docholladay.com Shammas: HShammas@aol.com electronic medical record (EMR). The software already imports di- rectly from Optical Biometers (IOL- Master, LenStar, …) avoiding data entry errors, but integrating with the scores of EMRs is a monumental task. How do you incorporate clinical research into your practice without compromising clinical flow? Dr. Shammas: I personally find clinical research to be a challenging part of my pro- fessional life. As a busy ophthalmologist, I rarely have time to do any research during clinic hours. I have always taken a half day per week to teach or to work on my research projects. Delegating data collection to medi- cal assistants is not a good idea. They do not understand the importance of data accuracy, for example, separating monofocal from multifocal IOLs or transcribing the astigmatism in nega- tive or positive values. A lot of the data analysis is done by myself at home during the evening hours and the weekends. In the past few years, this process has been facilitated by having our EMR data in the cloud, which I can access from my home computer. Dr. Holladay: It takes time and personnel to enter the data for now, and that costs mon- ey. However, patients want to be spectacle-free and determining you PLC improves out- comes. This is not the only factor; you must have monocular and binocular screening in place to identify patients preoperatively who are at the highest risk for having a refractive sur- prise. Monocular screening requires a standard deviation of the keratometry less than 0.20 D (0.030 mm or 30 µm) and a signal-to-noise ratio of the axial length greater than 2.0. Binocular screening requires the axial length difference to be less than 0.3 mm between eyes and the keratometry and recommended IOL power for a specific target be less than 1.0 D difference between eyes. the (average difference x 1.35). If the aver- age difference is a positive value, then the A constant has to be increased by (the average difference x 1.35). Dr. Holladay: The optimization (or per- sonalization) is performed for each surgeon, each IOL, and each procedure for a specific IOL. For example, you may have surgeon1, IOL1, and manual and femto as proce- dures. The personalized lens constants for manual and femto are usually different. Anoth- er common procedure is post-refractive. This keeps these cases separate for analysis. Do you have any tips to improve the accu- racy and reliability of data collection for outcome analysis and clinical research? Dr. Shammas: Data collection for outcome purposes cannot be indiscriminate. In other words, you cannot include all surgeries. My personal opinion is to include the cases that achieve a stable postop refraction with a cor- rected visual acuity of 20/40 or better. Do not include eyes with co-morbidities such as macu- lar degeneration, advanced glaucoma, or corneal scarring. Diabetics present a challenge since the refraction fluctuates if the diabetes is out of control. Eliminate any cases with advanced diabetic retinopathy. Dr. Holladay: Simply entering the surgical and postoperative data is all you need, but you must have a system setup to do this. As we move forward, the Holladay IOL Consultant Software will obtain this information directly from the Reference 1. Hayashi K, et al. Changes in corneal astigmatism during 20 years after cataract surgery. J Cataract Refract Surg. 2017;43:615–21. Relevant financial interests Holladay: Holladay Consulting Inc Shammas: Shammas post-LASIK formulas are licensed to optical biometers and ultrasound units

Articles in this issue

Links on this page

Archives of this issue

view archives of Eyeworld - OCT 2019