Eyeworld

MARCH 2021 | EYEWORLD | 79 R Most important technologies Dr. Walter said biometry is the standard of care and absolutely needs to be done. "The days of A-scans and manual Ks are over and are below the standard," he said. He added that "macular OCT has saved me so many times in picking up ERMs or macular holes that it must be done on every patient." The last thing you want is to do a perfect sur- gery and the patient is unhappy because they can't see, he said. They typically will think that you "caused" the problem, even though it was pre-existing. Dr. Williamson said it's possible that not all ophthalmologists have access to all the advanced technologies that he's using. Most may just be getting a biometry, he said, and if concerned about something they see on the slit lamp exam, they probably have the capability to get an OCT. "I don't know if we can say it's standard of care to get a topography/OCT on every cataract patient. But I do think it should be simply because the OCT can see much finer details than the human eye at the slit lamp," he said. Intraoperative tools Dr. Walter said he likes to use the CATALYS laser (Johnson & Johnson Vision) for his premium lens patients. "It reduces complications and increases the chances they will get the premium lens they paid for," he said. "The capsulorhexis is geomet- rically perfect, which ensures centration. Small amounts of astigmatism can be treated, which helps ensure elimination of all refractive error." Dr. Williamson has used ORA intraoperative aberrometry (Alcon) for the past 5 years. He noted that it's rare for him to have to change the spherical power, though he said he will routine- ly change the power of a toric lens. Dr. Nikpoor said that she uses the LenSx laser (Alcon) with VERION (Alcon) in surgery. This can also help with marking the cornea and planning her axis. She uses ORA for every premium case. "When I'm implanting a lens, if toric, I'll use VERION and ORA axis alignment with my own marks," she said, adding that she'll use all three and see where the lens needs to go. She also uses the VERION system for centration of any presbyopia-correcting IOL, adding that she's been using it to center the Light Adjustable Lens (RxSight) and Vivity (Alcon) as well. She noted that her practice also has Callisto eye (Carl Zeiss Meditec), which she uses infre- quently, and OPMI Lumera (Carl Zeiss Meditec), which can help center the lens. Postop tools Dr. Williamson said postop enhancements in his practice are done infrequently. If he does have to enhance, he will use iDesign (Johnson & Johnson Vision), as well as an aberrometer and OPD-Scan III (Nidek). "The YAG laser is your friend with premi- um lens patients," Dr. Walter said of postop interventions. "I think too often we shy away from the YAG treatment for fear that it might not help and will make the IOL exchange more difficult." Dr. Walter has found that if the pa- tient tolerated the typical dysphotopsias initially but then had more or reduced reading vision, a YAG capsulotomy can turn them into a happy patient. Dr. Nikpoor's practice uses the Alcon WaveLight Refractive Suite for enhancements. She said it's important to make sure any ocular surface disease is under control and refraction is stable before proceeding with laser vision correction. She finds the PanOptix (Alcon) to be more sensitive to any PCO or residual refractive error than prior lenses, so she has a low thresh- old to YAG and enhance if it is going to benefit the patient. RLE in an RK patient with +5 D hyperopia; placed Light Adjustable Lens (RxSight) OU Source: Neda Nikpoor, MD continued on page 80 Contact Nikpoor: nnikpoor1@gmail.com Walter: kwalter@wakehealth.edu Williamson: blakewilliamson@weceye.com Relevant disclosures Nikpoor: None Walter: Johnson & Johnson Vision Williamson: Johnson & Johnson Vision

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