EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/153099
A S C R S World view Getting aligned with the best technology C ataract surgeons have long understood the importance of minimizing postoperative astigmatism in our patients. The desire to decrease incision-induced astigmatism was a major factor in the conversion from large incision ECCE to phaco, and then later in moving our incision location from superior to temporal. We in turn tried running sutures, X-sutures, single horizontal sutures, and David F. Chang, MD, then no sutures—all with the hope of curbing chief medical editor suture-induced astigmatism. Finally, a few of us dared to try paracentral astigmatic keratotomy, while many more later adopted peripheral "limbal" corneal relaxing incisions—but never more than approximately half of us really adopted this as a primary approach. This explains why one of the most welcome developments in intraocular lens design has been the toric IOL. Concerns about rotational stability of a silicone plate haptic lens limited early adoption of the STAAR toric IOL after it was approved in 1998, and it would be seven more years until the Alcon Acrysof toric platform was approved by the FDA in 2005. Just a few months ago, the Abbott Medical Optics Tecnis toric IOL and the Bausch + Lomb Trulign toric Crystalens were approved, further expanding patient options within the fastest growing segment of the premium refractive IOL market. When I recall my first foray into astigmatic keratotomy in the 1990s, I am embarrassed to think how crude the diagnostic evaluation was at the time. Despite using only preoperative keratometry and marking the supine patient's eye under the microscope, we succeeded on average at reducing pre-existing astigmatism relative to no treatment at all. Fortunately, our understanding and ability to measure, analyze, and guide astigmatism treatment has become far more sophisticated in time to meet our patients' ascendant expectations for good uncorrected eyesight. In this issue of EyeWorld we present four complementary feature articles relating to different diagnostic technologies for correcting astigmatism at the time of cataract surgery. What preoperative measurement is most reliable for astigmatism planning? Jeffrey Horn, MD, Kevin Waltz, MD, Sonia Yoo, MD, Bill Trattler, MD, and Bruce Wallace, MD, share their pearls relating to keratometry, topography, post-keratorefractive eyes, and when to offer astigmatic keratotomy versus a toric IOL. What is the best way to align the toric IOL along the preoperatively determined axis? Bob Osher, MD, Sonia Yoo, MD, Kevin Waltz, MD, Oliver Findl, MD, and Mark Packer, MD, share their experiences with a host of new cutting-edge technologies that can help us to properly register the toric axis to preoperatively captured images. What benefits would intraoperative aberrometry provide and what advances are anticipated with this pioneering technology? Bret Fisher, MD, Sydney Tyson, MD, and Bob Cionni, MD, join me in discussing the two newest iterations for this promising application. Finally, how do we factor posterior corneal astigmatism into our game plan? The longstanding mystery of why the postoperative keratometry didn't always accurately reflect the postoperative refractive cylinder has been solved by Doug Koch, MD, Li Wang, MD, and their colleagues at Baylor. Mitch Weikert, MD, and Rex Hamilton, MD, provide us with practical advice based on their respective clinical studies of posterior corneal astigmatism at Baylor and UCLA. With so many technologic advances in the reduction of astigmatism at the time of cataract surgery, there has never been a better time to be a refractive cataract patient or surgeon. David F. Chang, MD, chief medical editor The official publication of the American Society of Cataract & Refractive Surgery August 2013 Volume 18 • No. 8 P U B L I S H I N G S TA F F Publisher Matt Young don@eyeworld.org Enette Ngoei Donald R. Long Editorial Editor Jena Passut jena@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Senior Staff Writer Erin Boyle erin@eyeworld.org Malaysia Dublin Rich Daly Arlington, Virginia Senior Contributing Writer Maxine Lipner Nyack, New York Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 ellen@eyeworld.org 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Production Advertising Sales Graphic Designer Jeff Brownstein Julio Guerrero jeff@eyeworld.org julio@eyeworld.org 703-788-5745 Production Manager Paul Zelin Staff Writer Ellen Stodola Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Daniela Galeano daniela@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Florida Michelle Dalton Reading, Pennsylvania paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EYEWORLD (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. 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