EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/1312630
86 | EYEWORLD | DECEMBER 2020 R EFRACTIVE by Liz Hillman Editorial Co-Director In patients with keratoconus who have not been crosslinked and in whom you are just identifying keratoconus, do you worry about placing a toric IOL, even if the central astigmatism is fairly regular? Dr. Trattler: Patients with keratoconus and pel- lucid marginal degeneration who have relatively regular central astigmatism can consider a toric IOL. Typically, the rate of progression is slow in this age group. If progression is identified, crosslinking can be performed. I typically like to see two to three diagnostic devices arriving at a similar degree of astigmatism magnitude and axis to be most comfortable placing a toric IOL. If there is significant irregular astigmatism, or if the axis is not identifiable or repeatable, I will not recommend a toric IOL. Prepping the ocular surface for cataract surgery continued on page 88 "I n the day and age of refractive cata- ract surgery, optimizing outcomes is extremely important," said Kathryn Hatch, MD, as she introduced a we- binar hosted by the ASCRS Refrac- tive Surgery Clinical Committee earlier this year. "We have increasing patient expectations, and it's extremely important that we obtain ideal bi- ometry measurements. To do so, we need to pay specific attention to the ocular surface, especial- ly when treating astigmatism and presbyopia." The webinar, "Prepping the Ocular Surface for Refractive Cataract Surgery," specifically discussed diagnosis and management of EBMD, Salzmann's nodules, pterygium, dry eye disease, blepharitis, ectasia, and irregular astigmatism. It also included several case presentations. The audience was given the opportunity to ask some questions of the presenters as well, and the following is a portion of that Q&A. About the doctors Ashley Brissette, MD Assistant Professor of Ophthalmology Weill Cornell Medicine New York, New York Jessica Ciralsky, MD Associate Professor of Ophthalmology Weill Cornell Medicine New York, New York Kathryn Hatch, MD Director, Refractive Surgery Service Massachusetts Eye & Ear Waltham, Massachusetts William Trattler, MD Center for Excellence in Eye Care Miami, Florida This is a 63-year-old female with pellucid pattern keratoconus; because the astigmatism is orthogonal centrally, she is an appropriate candidate for a toric IOL. Source: William Trattler, MD Cyl.: 3.58 D @ 172 o