Eyeworld

64 | EYEWORLD | SPRING 2026 R EFRACTIVE Reference 1. Keshav V, Henderson BA. Astigmatism management with intraocular lens surgery. Oph- thalmology. 2021;128:e153–e163. by Karolinne Rocha, MD, PhD Refractive Editor what parameters to be aware of, and discuss possible etiologies. It's important to educate patients about their ocular anatomy. I find using a common language and the support of visuals, including diagnostic images and 3D reconstruc- tion, to be beneficial in communicating what astigmatism is and the results patients can expect from surgical correction. More than 1/3 of patients undergoing cataract surgery have corneal astigmatism. 1 In "Options for managing astigmatism in cataract surgery," Eric Donnenfeld, MD, and Rahul Tonk, MD, take readers stepwise through treating these patients. I appreciate Dr. Tonk's mention of the Light Adjustable Lens (RxSight), and I agree that this is a great option to refine vision in the case of refractive surprises. I'm excited to bring readers "From Insights to Impact" with this talented group of clinician scientists—and just in time for the ASCRS Annual Meeting in Washington, D.C. I'd like to wish all of my colleagues a wonderful, educational good time! Perhaps I'll catch you as part of Subspecialty Day or during the main programming. W hen keratom- etry mea- surements are not reproduc- ible, issues with the ocular surface are the first place to look. Addressing issues of dry eye disease and dry eye-masquerading con- ditions, such as epithelial basement membrane dystrophy, conjunctivochalasis, and neurotroph- ic keratitis, ahead of refractive and cataract surgery can avoid patient dissatisfaction and if necessary after surgery, can pinpoint solutions for quality visual outcomes. Twenty percent of patients need to return for repeat biometry in the practice of Nicole Fram, MD, as she probes for dry eye and ocular surface diseases that will wreck patient satisfaction post-refractive and cataract surgery, she shared in "When the Ks don't align." To meet the needs of these patients, sur- geons must recognize the type of astigmatism (regular versus irregular), the magnitude, and the axis. Dr. Fram and Douglas Koch, MD, take readers through how they evaluate these param- eters and apply next steps in their practice. Our colleagues end on a key point, which is to avoid diffractive technologies for patients who have an irregular astigmatism or inconsistent mea- surements. As a provider at a tertiary care cen- ter at the Medical University of South Carolina, I regularly see patients who are unhappy after surgery, particularly among patients who are revealed to have irregular astigmatism on the topography missed preoperatively. While Drs. Fram and Koch make the case for keratometry to be part of preoperative procedures, topogra- phy or tomography, corneal epithelial mapping, and other technologies that help to assess corne- al irregularities are tools to employ to maximize chances for positive surgical outcomes. In another article in this issue's Refractive section, we have Stephen D. Klyce, PhD, FARVO, Marguerite B. McDonald, MD, FACS, and William Trattler, MD, weighing in on "Irreg- ular astigmatism: what we're missing—and how to find it." These powerhouse clinicians walk readers through how to make the diagnosis, All over the "Ks" Jonathan Rubenstein, MD, EyeWorld Cataract Editorial Board member, shared what he is looking forward to at the 2026 ASCRS Annual Meeting: "I have been coming to the ASCRS Annual Meeting every year for more than 35 years, and I would not miss it. Seeing and interacting with my colleagues and friends combined with the excellent educational experiences that occur with Subspecialty Days, Main Stage programs, symposia, the ASCRS Film Festival, and Skills Transfer Labs make the Annual Meeting a valuable and memorable experience that I look forward to every year."

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