Eyeworld

34 | EYEWORLD | JULY 2023 ATARACT C Mitchell Weikert, MD Cataract Editor they discuss the preoperative workup for these patients, which includes counseling them on the issues presented by their prior corneal surgery. As we know, IOL calculations are particularly challenging in these patients, and the formula choice can be confusing. Dr. Fram provides a detailed review of the formulas that currently provide the best outcomes. IOL choice requires careful consideration but starts with tailoring the spherical aberration of the IOL to the type of refractive ablation. They also examine the other options available, such as EDOF, multifo- cal, and light adjustable lenses, and discuss the factors that determine which IOLs are suitable for which patients. The ins and outs of IOL exchange are addressed by a panel of experienced anterior segment surgeons, including Morgan Micheletti, MD, Samantha Schockman, MD, and Joshua Teichman, MD. While IOL exchange may be considered "uncommon" overall, it certainly feels like its need is increasing in frequency (possibly due to the myriad presbyopia-cor- recting IOLs now available or the increasing incidence of late IOL-capsule complex disloca- tion as our patients undergo cataract surgery earlier and live longer). Recommendations for the workup of an IOL exchange patient are pre- sented, such as what etiologies to look for, what tests to run, and how to prepare the patient for surgery. Multiple surgical pearls are presented for opening the capsule, freeing up the optic and haptics, cutting and removing the IOL, managing capsular issues, and placing the new IOL. They also provide tips for calculating the new IOL power and counseling these typically challenging patients. We hope you enjoy this issue of EyeWorld and take away useful pearls from these best practices. Useful pearls for best practices T his issue of EyeWorld is fresh on the heels of another great ASCRS Annual Meeting, which was in one of my favorite locations, San Diego, California. What a great city to gather, hang out with friends and colleagues, and soak up the sun and ophthalmic knowledge. As always, I learned a ton and picked up some great pearls, such as the use of an anterior segment trocar for irido- dialysis repair in Ashvin Agarwal, MD's, Golden Apple Award-winning video from the Complicat- ed and Challenging Cases video session. It's impossible to list all the highlights of the meeting in this limited space, but a few notable ones include the Binkhorst Lecture from Eric Donnenfeld, MD, the Lindstrom Lecture from Marlene Moster, MD, the Innovator's Lecture from William Link, PhD, the sustainability session, and the changing of the guard with the introduction of the new ASCRS president, Elizabeth Yeu, MD. With all the great meeting content, it's always a challenge to catch ev- erything you want to see. But you're in luck because much of the 2023 Annual Meeting content is available online, so I encourage you to check it out on the ASCRS website. What better theme for the EyeWorld issue that follows the ASCRS Annual Meeting than "Best practices"? In this issue, the cataract section focuses on best practices for posterior capsulotomy, management of post-refractive cataract patients, and IOL exchange. Alanna Nattis, DO, Stephen Weinstock, MD, and Robert Weinstock, MD, review the history of posterior capsulotomy from initial surgical approaches to the game-changing introduction of the YAG laser. They provide tips for performing this very common procedure, including ways to improve patient comfort, maximize control of the capsule opening, and minimize post-procedure floaters. They also discuss the timing of the procedure with special consideration for patients with presbyopia-correcting IOLs. Nicole Fram, MD, and Warren Hill, MD, address cataract surgery in patients with prior corneal refractive surgery. In similar fashion, We hope you enjoy this issue of EyeWorld and take away useful pearls from these best practices.

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