SEP 2013

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

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Page 49 of 98

September 2013 Refractive challengesFebruary 2011 and innovations Potential topographic red flag causes Topographically, atypical patterns suggestive of corneal instability generally lead clinicians to look for asymmetrical astigmatism, or subclinical keratoconus, or forme fruste keratoconus (FFKC). "Those will also show up on an Orbscan [Bausch + Lomb, Rochester, N.Y.] because that device also has Placido rings," Dr. Probst said, and the Pentacam is likely to discern those same abnormalities. "For every good topographic image you see, there might be 15 in the garbage that were unreadable if the patient has a very poor tear surface," Dr. Buznego said. If the technician has to work really hard to get a good topographic image but doesn't convey that, it's possible the surgeon will believe he/she has a straightforward case. Many still believe topography is the "the most valuable tool in screening for keratoconus," Dr. Probst said, but others will swear the Pentacam is the only device necessary. While no one would argue topography is helpful in diagnosing ocular surface disorders, geography may play a part in a poor reading, Dr. Devgan said. For instance, some patients with dry eye changes will have worse topography readings in the dry, arid summer months in Los Angeles than in other months. Dr. Devgan will often postpone those patients' surgeries until fall to prevent exacerbating the dry eye situation during those hot months, he said. Dr. Chu educates the patient about the diagnostic dilemma to jointly determine how to proceed. "Technology is not an absolute answer," he said. "There is still some LOOKING part that has to apply the science, and that's a personal choice for each surgeon and patient to make together if there is any kind of refractive dilemma." Especially when it comes to dry eye, Dr. Buznego said when he's in doubt, "it's OK to give patients a pass and tell them that right now there may be procedures that are better given the significant dry eye or ocular surface issues present." Dr. Probst said he believes both topography and tomography need to be used—topography for the anterior surface and tomography to determine changes and progression of anything deemed abnormal. Potential tomographic red flag causes Although tomography "is certainly a very detailed analysis," it's not concentrating on the anterior curvature of the cornea, Dr. Probst said. EW FEATURE 47 Tomography can help identify inferior steepening or mild FFKC, Dr. Devgan said, and those scenarios elevate a patient's risk for complications. "PRK may be safer than LASIK, but there are still grey areas. I'd rather err on the side of caution and not operate on a patient with suspicious corneas." Dr. Chu said the technology is still relatively new, and even 15 years after the Orbscan was first introduced clinicians are still trying to understand it. "People debated its worth years ago, and now we're debating the level of accuracy we need to measure the posterior corneal surface," he said. "Everyone is trying to avoid ectasia, and we're all trying to find the one magic diagnostic tool that will do that for us." When all the various tomographers and topographers match, it's an ideal situation; a mild discrepancy needs to be discussed with the patient before continued on page 48 BUSINESS FOR NEW OPPORTUNITIES? 34 AMERICANS OVER MILLION HAVE HEARING LOSS THEY WALK INTO YOUR PRACTICE EVERYDAY ADD A HEARING CENTER TO YOUR PRACTICE ICE Avada Vision & Hearing is a program designed to generate incremental sales and provide seamless integration with your practice. ce e. To learn more about adding a hearing center and the potential ntial ti l impact for your practice call us today! Visit the Us at nce re Confe AAO Orleans New H BOOT 1 1 # 24 1-888-982-8232 www.avada.com/vision Avada Hearing Care Partnering Vision & Hearing © 2013 Hearing Healthcare Management, Inc.

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