Eyeworld

22 | EYEWORLD | SEPTEMBER 2022 EYEWORLD JOURNAL CLUB ASCRS NEWS by Anthony Mai, MD, Mike Murri, MD, and Jeff Pettey, MD, MBA experience or skill level) who implants the AcrySof lens as compared to the TECNIS lens, which we agreed was unlikely. A potential weakness that was not mentioned by the au- thors but was raised by our panelists was the potential for conflict of interest given the finan- cial relationship between Alcon and the study's authorship. Regarding younger age as a risk factor for realignment, our panelists hypothesized that perhaps surgeons have a lower threshold to take younger patients back to the operating room given that they are, on average, a healthier pop- ulation better able to withstand anesthesia and a second surgery. Finally, in terms of future directions, given that the TECNIS lens in the study had already been redesigned at the close of the study, our group was particularly interested in future stud- ies comparing the newly modified TECNIS II lens with the AcrySof lens. The new generation of TECNIS toric lenses are designed to enhance rotational stability to address the very issue discussed herein. Conclusions Proper astigmatic axis alignment is critical for the visual outcomes of patients implanted with toric IOLs. The rate of surgical realignment of monofocal toric IOLs was compared using the real-world data of the IRIS Registry, confirming prior reports of greater frequency of realign- ment associated with the TECNIS monofocal toric IOL as compared to the AcrySof monofocal toric IOL. astigmatism and therefore have the toric placed vertically. The main differentiating factor of this article compared to prior studies with similar conclusions is its use of real-world data from the IRIS Registry, purportedly better reflecting the actual experience of surgeons of a variety of experience levels and practice settings as compared to controlled trial conditions. Sev- eral limitations are also discussed. First, eyes were identified using a CPT code associated with surgical IOL realignment, though they acknowledged that a lens may need realignment for reasons other than astigmatic axis rotation (though the authors pointed out that the latter is responsible for most surgical realignment cas- es in toric IOLs). Other limitations are inherent to the nature of this being a retrospective data- base study, namely that factors like method of intraoperative axis alignment and pre- and post- operative measurements were not available to the authors. Further, there was no standard for what requires surgical realignment, which was instead pursued based on mutual agreement by surgeon and patient that it would enhance visual outcomes. During the Journal Club discussion, the strengths and limitations of this work were weighed. Regarding the limitations, it was discussed that many, if not all, of the posited weaknesses should apply equally to both groups (i.e., AcrySof and TECNIS). These suggested weaknesses therefore should not detract from the validity of the study, unless there is an inherent difference in the type of surgeon (e.g., continued from page 21 for pain, infection, longer recovery time, and corneal haze. 2,3,4,5 Recutting may cause a free cap, button hole, or displaced slivers of stromal tissue. 7,8,9 Compared to recutting, relifting may yield fewer complications and better long-term stability of refractive error and visual acuity. 7,10 Although flap relifting years after LASIK has been questioned, recent studies show success L aser-assisted in situ keratomileusis (LASIK) has become the refractive procedure of choice over the past few decades. LASIK enhancements are com- monly performed for residual refractive errors, regression, or surgically induced astig- matism. 1 Enhancement is done by direct surface ablation, cutting a new flap, or relifting the old flap. Direct surface ablation has increased risk Review of "Effect of time since primary laser-assisted in situ keratomileusis on flap relift success and epithelial ingrowth risk" continued on page 25 Anthony Mai, MD Resident Moran Eye Center University of Utah Salt Lake City, Utah Mike Murri, MD Resident Moran Eye Center University of Utah Salt Lake City, Utah Jeff Pettey, MD, MBA Residency Program Director Moran Eye Center University of Utah Salt Lake City, Utah

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