EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/220233
66 EW MEETING REPORTER Reporting live from the 2013 European Society of Cataract & Refractive Surgeons Congress, Amsterdam November 2013 ment, especially in light of the work of the ESCRS and ASCRS. Dr. Schallhorn gave the talk "Clear lens extraction: is it plain greed?" He concluded that the procedure has a low risk of threatening vision with high efficacy and patient satisfaction. "I think it's a credit to both societies that we're at the stage we're at in technology, in understanding and acceptance of the type of work that we've done, like putting intraocular lenses in eyes, which 40 years ago, was viewed with absolute disdain," Dr. Schallhorn said. "So where are we going in the future? I guess a better way to put it is, technology only goes in one direction, and I think we've got some fascinating technology available to us for the cataract or clear lens extraction." Tuesday, Oct. 8 Challenges of managing high hyperopia Limits exist in biometry for high hyperopia The main symposium "The Management of High Hyperopia" featured presentations and discussions examining hyperopia from the role of biometry, to phakic IOLs, to the treatment of children with the condition. Wolfgang Haigis, MD, Wurzburg, Germany, gave an overview of "The limits of biometry in higher hyperopia." Paolo Vinciguerra, MD, Milan, Italy, outlined "Hyperopic LASIK and PRK: long-term refractive and clinical results." Béatrice Cochener, MD, Brest, France, discussed "Phakic IOLs in the high hyperope: what is the limit?" Graham Barrett, MD, Perth, Australia, presented on "Refractive lens exchange for high hyperopia: benefits and potential complications." Ken Nischal, MD, Pittsburgh, Pa., discussed "The surgical correction of high hyperopia in childhood," while Allegonda van der Lelij, MD, Utrecht, the Netherlands, discussed "Cataract surgery in patients with nanophthalmos." Refractive outcomes in hyperopic eyes are "more sensitive and less forgiving" than those in normal eyes for measurements errors, IOL manufacturing tolerances, effective lens position determination, and IOL formula choice, Dr. Haigis said in his talk during the "The Management of High Hyperopia" symposium. For axial length measurement, he discussed axial length smaller than 22 mm. He had a note of caution regarding contact lens use in these patients. "In hyperopic eyes where refractive lens exchange might be considered, we will probably have to deal with patients who are wearing contact lenses," Dr. Haigis said. "Be aware of contact lenses wearers. And if they have a hard contact lens, three hours after hard contact lens wearing, the cornea changed by –0.78 D [OD]. … This is a real problem. Please make sure that the hard contact lens has been removed for at least two weeks, and the soft contact lens at least three days before you use your keratometry." He called these eyes "problem eyes" so errors need to be minimized in biometry measurements. A consistent result can be found from optical biometry or immersion ultrasound in these eyes, based on the studies in the literature, Dr. Haigis said. He recommended not using contact ultrasound in these patients. The "holy grail" of IOL calculation is the determination of effective lens position as well, he said. "If we are wrong, then we will have a refractive error," he said. "And unfortunately, this error is dependent on axial length." "Short eyes do not forgive anything," Dr. Haigis said. "Especially not in the effective lens position." Surgery potential for high hyperopia in children While glasses and contact lenses are the conventional therapies for children who are high hyperopes, surgery is a possibility for those patients with multiple neurodevelopmental and behavioral disorders. The parents and guardians of these children should be informed about the possibility of a phakic IOL