Eyeworld

46 | EYEWORLD | DECEMBER 2021 ATARACT C Contact Lee: bryanslee@gmail.com Miller: kmiller@ucla.edu Martinez: drmartinez@eplb.com television screen 30 degrees to your left," Dr. Miller said. Despite the ergonomic challenge, he said he thinks digital microscopy is the way of the future. Take-home messages Dr. Martinez said his biggest message is for physicians to understand that when there is cyclotorsion of the eye, it is difficult to compare preop measurements taken when the patient was sitting to intraoperative measurements lying down. "Realigning ORA to VERION is huge. … It makes the delivery of astigmatism correction much easier and more predictable," he said. Dr. Miller said he thinks there is a benefit to these technologies but acknowledged they are still in their infancy and they do take time. "If you wanted to bang out cases, this is not for you because it will take time for you to get used to and there are a lot of little tricks you have to learn to make this work," he said. Dr. Miller noted that patients like the tech- nologies and said he has had no problem with them signing up for intraoperative refractive guidance, even though there is an extra cost associated with it. Dr. Martinez said he uses the coordinate system on VERION in the OR and moves his scope until ORA and VERION agree. Doing this, he said, helps him know exactly where the steep axis is and compare the ORA axis measured in a recumbent position to the axis of the preop- erative data obtained in an upright position. He also uses the capsulorhexis function on VERION. "Sometimes I would do a beautiful surgery and my capsulorhexis would be a little wide in one place. It would sit against the edge of the lens and move the lens a little as it contract- ed. That no longer happens [with VERION]," he said. "I use my capsulorhexis overlay and I can overlap the lens perfectly. … I know where the visual axis is, I know where to center my capsulorhexis, and I know how big to make it. It makes it quite predictable." Dr. Lee said he finds digital marking helpful because the cornea can change intraoperatively, reducing the accuracy of aberrometry. "[B]eing able to line the treatment up with the preoperatively determined axis is more accurate and more efficient than manual mark- ing," he said. "However, the Light Adjustable Lens changes this entire paradigm because you don't have to worry about alignment, rotation, or imperfections in IOL calculations." Dr. Miller described CALLISTO as similar to VERION, but he noted that you have to use the suite of Carl Zeiss Meditec products with it. Overall, Dr. Miller said using image guid- ance "takes a lot of extra time and planning. … It's faster to manually mark." But he said using these technologies is more accurate. He thinks the results with manual marking are good, but intraoperative guidance is the way things are going. NGENUITY can perform many of the same functions as VERION and CALLISTO (and pro- vides the surgeon additional information) in a heads-up display. Dr. Miller finds the ergonomics of NGENUITY awkward, with the camera at- tached to the microscope in front of the surgeon and the monitor off to the side. "You want to look straight ahead, but you have to watch a continued from page 45 What about intraoperative OCT? None of the physicians EyeWorld spoke with used intraoperative OCT in cataract or anterior segment surgery in general. All understood the utility it would have for posterior segment procedures, but Dr. Miller said it doesn't add anything to his anterior segment practice. He played with an intra- operative OCT device and said it can help determine if there is good attachment of an endothelial graft to the back of the cornea. He didn't find it necessary for that though, and he couldn't justify the expense of the machine for this use.

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