OCT 2013

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

Issue link: https://digital.eyeworld.org/i/194331

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October 2013 Saturday, Aug. 10 PAAO ended Saturday with a full day of learning opportunities for attendees, including main symposia on cataract and refractive surgeries. In a cataract session, Gustavo Victor de Paula Baptista, MD, Brazil, presented a history and physical attributes of the femtosecond laser. He explained the difference between the long and short pulses from the laser. "Higher energy lasers have more collateral damage," he told the audience. Angela Maria Gutierrez Marin, MD, Colombia, gave her results with PresbyMax, a presby-LASIK technique. With the technique, there was minimal induction of astigmatism, she asserted. "Corneal spherical aberration is turned negative," she said. "Patients are very satisfied with the procedure." Carmen Barraquer-Coll, MD, Brazil gave her results of 3–4 years of study of MicroK vs. femtosecond LASIK correction. LASIK was performed on 133 eyes using the MicroK Moria CB electric (51 eyes), the MicroK Pendular (34 eyes), or the femtosecond IntraLase (48 eyes). Average age of the patients was 19 (16–58), with 89 being women and 44 being men. Spherical equivalent was –4.24 D (–1.0 to –10.0 D) and defocus was 5.02 (1.0 to 12.0 D). They were randomly selected to their corrections. In the end, researchers found no statistical significance in the stability of the refractive or visual acuity results. "It does not matter if we cut a flap of 100 or 300 microns," she said. "The result is going to be the same. The shape doesn't influence stability. The one that was the most reproducible and cuts better is the femto." In his talk, Armando Stefana Crema, MD, Brazil, offered his keys for success in toric IOL implantation, including reliable K readings, vertical/horizontal meridian measurements taken with the patient seated, and correct surgical techniques. "The best indication is regular astigmatism, but why not also use it in patients who have irregular astigmatism," he asked. Dr. Crema showed several cases in which he used toric lenses. In one patient with marginal pellucid degeneration, the use of toric lenses improved the vision "a lot," Dr. Crema said Visual acuity improves with glasses and contact lenses, he added. "He has very reasonable vision now. He benefitted a lot from the toric lenses," he said. Another patient who was postpenetrating keratoplasty also benefitted from the lenses and now has 20/30 vision without correction. "He's very happy," Dr. Crema said. Post-RK patients might also do well will toric lenses, he added. Another patient had a keratotomy and was hexagonal for seven years and now enjoys 20/50 vision after placement of the lenses. "It is worthwhile placing toric lenses," Dr. Crema said. "When we consider toric lenses, we have to consider special indications that are sometimes controversial." He has used the lenses in patients with iris and zonular coloboma, as long as the disease isn't progressive. When dealing with pseudophakic presbyopia, one of the best devices surgeons have in their armamentariums are multifocal lenses, another surgeon said. Some oft talked about "side effects" from the lenses can be overcome, advised George Beiko, MD, Canada. "When you're giving the options of presbyopia correction to your patients, the options being using monofocal IOLs, doing minimonovision, or using accommodative IOLs or multifocals, multifocals at this time produce the greatest range of vision and the greatest patient satisfaction with the caveat that there is a price that they have to pay for this, and that is minor symptoms of glare, halos, and starbursts." Compared to mini-monovision, multifocal IOLs have some decrease in contrast sensitivity, Dr. Beiko said. However, the good news is you can improve it. "The symptoms decrease typically at six months. There is some neuroadaptation that patients have to endure with multifocal IOLs." At the end of his talk, Dr. Beiko told the audience not to forget that multifocal lenses are not artificial. "There are some multifocal lenses that exist in nature," he said. EW MEETING REPORTER 115 "There are some animals that have it, and even in some humans you can see multifocal lenses." The fear of them is unfounded, he continued. "People are reluctant to put in multifocals because of the fear of the symptoms, and I'm saying that you shouldn't fear that. They do perform well in patients." EW

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