Eyeworld

R DECEMBER 2019 | EYEWORLD | 39 of getting intraoperative OCT in the U.S., and I don't think we realize all the benefits it could give us." Predicting the size of an ICL to put in the eye is currently done based on white-to-white diameter, Dr. Hovanesian said, which is not very accurate. This study performed intraop- erative OCT and compared it to postoperative OCT ICL vault at different benchmarks out to 90 days postop on 42 eyes of 24 patients. There was a slight decrease in vault from postop day 1 over the course of 3 months. Intraoperative measurement, Dr. Hovane- sian said, may provide a better idea of what lens to use before implanting and may have many other benefits for routine cataract surgery. Development, use, and results of novel analytic software to improve the accuracy of topography-guided LASIK Mark Lobanoff, MD Topography-guided LASIK should, in theory, improve the accuracy of LASIK outcomes, but Dr. Hovanesian said the challenge is toleranc- es among differences between topographic Dr. Waring: This wonderful conversation is around a premium procedure, but you have to have a premium eye to have success in the pre- mium procedure. Whether that's biometric— there is great peer-reviewed data to support the biometry accuracy if you do not have a dry eye. It's not a stretch to think that patients are going to have a better healing process if they are optimized and they're going to see better. We've actually objectively demonstrated in our center that you have less fluctuation and better retinal image quality; it's worse if you're dry. But we got fancy fixing their cataract but we're leaving them with poor retinal image quality with dry eyes, so that just doesn't make sense. measured astigmatism and subjective (manifest) astigmatism. The recommendation is there be less than 0.75 D difference between the two to use the Contoura topography-guided LASIK system (Alcon). Only about 10% of patients fit this criteria, Dr. Hovanesian said. This research used a mathematical model that takes the surface topography and puts it together with other information in the hope of improving visual acuity with consistent results (Phorcides), Dr. Hovanesian said. The system factors in topography, cylinder, and a nomo- gram. One-month postop results of patients treat- ed with the information from the Phorcides nomogram showed 56% of patients achieved 20/15 or better, 93% of patients achieved 20/20 or better, and 99% 20/25 or better. "The idea is that this software will allow us to take the engine of topographic-guided ablation and pair it with some math that allows better accuracy for treatment," Dr. Hovanesian said. Editors' note: The session is available on demand at as- crs.org/clinical-education/2019ondemand for those who attended the 2019 ASCRS ASOA Annual Meeting. Dr. Thompson: I agree 100%. We need to remember the most powerful focusing element of the eye is the air/tear interface. And if the tear is breaking up there is light scatter and thus reduced image quality. Whether they are having a premium procedure or not we need to make sure the optical properties of the tear film are pristine. The companies have blessed us with amazing EDOF, multifocal, and light adjusting optics but those optics degrade quickly if there is light scatter occurring at the air/tear interface. continued from page 37

• Blank Page
• Blank Page (1)