Eyeworld

SUMMER 2025

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/1536325

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26 | EYEWORLD | SUMMER 2025 ATARACT C Contact Ahmad: aahmad@harvardeye.com Epitropoulos: eyesmd33@gmail.com Fram: nicfram@yahoo.com Holz: drhuckholz@gmail.com Weinstock: rjweinstock@yahoo.com Zhu: dagny.zhu@gmail.com Relevant disclosures Ahmad: Bausch + Lomb Epitropoulos: None Fram: None Holz: None Weinstock: Consultant to most ophthalmic companies Zhu: Alcon, Bausch + Lomb, Johnson & Johnson Vision lot of human power in running people through different machines. You also need space for these machines in the practice, they're expen- sive, and you need staff to operate them. "Every time you need to get a test on a patient preoper- atively, you have to move the patient from one machine to another," he said. Dr. Weinstock said that what would be great is a single machine for cataract surgeons to help their clinic throughput. In an ideal world, one machine would have many functionalities for testing. He would like one machine that did a slit lamp photo, epithelial mapping, corneal analysis (hopefully with two different technol- ogies like Placido and ray tracing), as well as cataract density imaging to help show patients the density of the cataract, an internal aber- ration of the eye with wavefront scanning of the optical system, OCT biometry, and a retina quality image of the posterior segment to give a good view of the macula. If it did a widefield photo of the retina, that would be a bonus, Dr. Weinstock said. "If we had all of that as a one-stop shop machine, that would be a tremendous improve- ment to efficiency in the clinic and allow us to see more patients and do more surgeries," he said. From an industry perspective, Dr. Wein- stock said it may not be desirable to have one machine doing everything, but he suggested that this one machine could come with a heftier price tag since it would be accomplishing many tests. The doctor would have everything they needed by the time they saw the patient. A tech- nology like this could cut down on appointment times. Adding his thoughts from a surgery per- spective of new technology he would like, Dr. Weinstock said, "I don't think we've cracked the code on the perfect IOL." Every generation of multifocal optics are good but not perfect, he said. "We need to continue to innovate and come up with optic designs that have less side effects and dyspho- topsias, that provide the full freedom from glasses that patients want, and that we can use in more patients even if they have pathology," he said. Ashraf Ahmad, MD Dr. Ahmad is looking for an adjustable extended depth of focus (EDOF) and multifocal IOL. He said that this product would be useful because the ability to fine tune the lens power or focal range post-implantation would be a game changer. "It would allow for customized visual outcomes, reducing the need for enhance- ments and improving patient satisfaction—es- pecially for those with challenging or borderline preop measurements." Dagny Zhu, MD Dr. Zhu had several suggestions on products that she'd like to see from industry, based on complaints she gets in her practice. 1. A single-piece, hydrophobic acrylic IOL with a near zero chance of causing temporal negative (and secondarily positive/edge glare) dyspho- topsias. She said increasing the optic size to 7 mm and reducing the index of refraction (and increasing Abbe value) would help to achieve this. 2. A low-cost, small footprint laser that can obliterate visually significant vitreous floaters more efficiently and safely than a YAG and less invasively than a pars plana vitrectomy. "Negative dysphotopsia and floaters are the top two complaints in my premium IOL practice (more annoying than positive dysphotopsias, which are expected and limited by current optical design)," she said, adding that she thinks these are two issues that can be fixed. Robert Weinstock, MD Dr. Weinstock is looking for a one-stop shop ma- chine to help make his clinic more efficient. "From the clinic perspective, we're increas- ingly in a situation where there's less staff avail- able, but there are more and more patients we need to see," he said. "Clinic efficiency needs to catch up with what we've been able to accom- plish in the operating room with efficiency." In the era of premium cataract surgery and trying to get patients out of glasses, we need a lot more information preoperatively, he added. Industry has developed machines to help analyze the anterior segment and the posterior segment, Dr. Weinstock said, but this involves a continued from page 25

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