Eyeworld

I MANAGING IRREGUR CORNEAS PRIOR TO CATARACT SURGERY N FOCUS 40 | EYEWORLD | NOVEMBER 2019 Contact information Aldave: aldave@jsei.ucla.edu Beckman: kenbeckman22@aol.com Trattler: wtrattler@gmail.com Relevant financial interests Aldave: None Beckman: Avedro Trattler: Avedro, CXLO, Oculus continued from page 39 Source (all): William Trattler, MD severe corneas, that the topography can really fluctuate, and you tend to find a hyperopic sur- prise in postop refraction," Dr. Beckman said. Therefore, he usually targets slight myopia in these patients to get them closer to plano. If you're going to be doing a premium procedure on a patient, you have to take into account that the accuracy, forgetting about all the aberrations of the lens, of the power calcu- lation may be off, he said. Intacs, crosslinking, or topography-guided ablations are all good options, Dr. Beckman said, adding that he personally does not use topography-guided ablation at the time of crosslinking, because he doesn't know if the cornea is going to change. "I would rather treat the cornea, let it stabilize, and then see if they need refractive surgery later," he said. Dr. Beckman pointed out that Intacs do not slow progression, but they can significantly reshape the eye. "Their benefit is correcting residual astigmatism to give a patient better uncorrected or spectacle corrected vision," he said. Crosslinking is going to remodel the cornea for months and months, Dr. Beckman said. "I'd probably lean towards getting the cataract out and seeing where I am and then determining if I want to crosslink," he said, adding that if you had a pediatric cataract and the patient is progressing rapidly, you may want to crosslink first and then do that cataract. When there are this many options, it's be- cause none of them are perfect, Dr. Beckman said, but he believes the techniques are getting better and insurance coverage is getting better, so there's more access. Which lens options are available for these patients? When looking at lens options for these patients, Dr. Aldave said that if the patient was satisfied with glasses-corrected visual acuity prior to the development of the cataract, he will usually place a monofocal IOL targeting emmetropia based on the measured keratometry values. However, if the patient is a contact lens wearer or may need a corneal transplant in the future, he usually places a spherical monofocal IOL targeting emmetropia based on his average ker- atometry values after a corneal transplant.

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