Eyeworld

fore," he said. "The cornea is talking to you and saying that it wants to stay in that shape." In that situation, particularly if the patient has a mul- tifocal IOL, Dr. Mackool recom- mends treating the astigmatism using PRK. This is advantageous over LASIK, which can cause more high- order aberrations, he said. Arcuate incisions with the femto laser Laser refractive cataract surgery gives surgeons a tool that can help im- prove outcomes when treating astig- matism, said Eric D. Donnenfeld, M.D., clinical professor of ophthal- mology, New York University Medical School, New York. Dr. Donnenfeld uses the LenSx Laser (Alcon, Fort Worth, Texas) to create arcuate incisions that help correct residual astigmatism. The incisions created by the laser are more predictable than manually created incisions, Dr. Donnenfeld said. First, they do not vary in depth, architecture, or wound length, he said. "The laser creates reliable and reproducible wounds that give surgeons a precise incision that is more self-sealing and reduces the induced cylinder, which is difficult to predict with a manual blade," he said. Additionally, the use of the laser helps to create uniform depth and curvature. Dr. Donnenfeld uses the laser at a 9-mm optical zone, from the center of the cornea, and at 85% of the depth of the cornea based on real-time optical coherence tomogra- phy measurements. He also opens incisions to about 75% of their length, and the following day, he will open and adjust to a greater de- gree depending on the patient's post-op refraction. Dr. Donnenfeld will comfort- ably treat 2 D of astigmatism with arcuate incisions. With the help of arcuate incisions and the ORange intra-operative aberrometer (WaveTec Vision, Aliso Viejo, Calif.), Dr. Donnenfeld routinely gets cylin- der down to 0.25 D or less, which is far better than he regularly achieved with manual incisions. Dr. Donnenfeld uses the DONO nomogram available at www. lricalculator.com. He reduces the calculations from that nomogram by 30% because the incisions made via the laser are more predictable and reliable. Dr. Donnenfeld plans to release a new nomogram soon. EW Editors' note: Dr. Donnenfeld has financial interests with Alcon, Allergan (Irvine, Calif.), and Bausch & Lomb (Rochester, N.Y.). Dr. Mackool has a financial interest with Alcon. Dr. Nichamin has a financial interest with Bausch & Lomb. Contact information Donnenfeld: 516-446-3525, eddoph@aol.com Mackool: phacodr@aol.com Nichamin: 814-849-8344, ldnichamin@aol.com June 2011 Brief Summary of Prescribing Information ATON Pharma, a Division of Valeant Pharmaceuticals North America LLC Madison, NJ 07940 Rx Only LACRISERT ® (hydroxypropyl cellulose) OPHTHALMIC INSERT DESCRIPTION LACRISERT ® Ophthalmic Insert is a sterile, translucent, rod-shaped, water soluble, ophthalmic insert made of hydroxypropyl cellulose, for administration into the inferior cul-de-sac of the eye. Each LACRISERT is 5 mg of hydroxypropyl cellulose. LACRISERT contains no preservatives or other ingredients. It is about 1.27 mm in diameter by about 3.5 mm long. LACRISERT is supplied in packages of 60 units, together with illustrated instructions and a special applicator for removing LACRISERT from the unit dose blister and inserting it into the eye. INDICATIONS AND USAGE LACRISERT is indicated in patients with moderate to severe dry eye syndromes, including keratoconjunctivitis sicca. LACRISERT is indicated especially in patients who remain symptomatic after an adequate trial of therapy with artificial tear solutions. LACRISERT is also indicated for patients with exposure keratitis, decreased corneal sensitivity, and recurrent corneal erosions. CONTRAINDICATIONS LACRISERT is contraindicated in patients who are hypersensitive to hydroxypropyl cellulose. WARNINGS Instructions for inserting and removing LACRISERT should be carefully followed. PRECAUTIONS General If improperly placed, LACRISERT may result in corneal abrasion. Information for Patients Patients should be advised to follow the instructions for using LACRISERT which accompany the package. Because this product may produce transient blurring of vision, patients should be instructed to exercise caution when operating hazardous machinery or driving a motor vehicle. Drug Interactions Application of hydroxypropyl cellulose ophthalmic inserts to the eyes of unanesthetized rabbits immediately prior to or two hours before instilling pilocarpine, proparacaine HCl (0.5%), or phenylephrine (5%) did not markedly alter the magnitude and/or duration of the miotic, local corneal anesthetic, or mydriatic activity, respectively, of these agents. Under various treatment schedules, the anti-inflammatory effect of ocularly instilled dexametha- sone (0 .1%) in unanesthetized rabbits with primary uveitis was not affected by the presence of hydroxypropyl cellulose inserts. Carcinogenesis, Mutagenesis, Impairment of Fertility Feeding of hydroxypropyl cellulose to rats at levels up to 5% of their diet produced no gross or histopathologic changes or other deleterious effects. Pediatric Use Safety and effectiveness in pediatric patients have not been established. Geriatric Use No overall differences in safety or effectiveness have been observed between elderly and younger patients. ADVERSE REACTIONS The following adverse reactions have been reported in patients treated with LACRISERT, but were in most instances mild and transient: transient blurring of vision, ocular discomfort or irritation, matting or stickiness of eyelashes, photophobia, hypersensitivity, edema of the eyelids, and hyperemia. DOSAGE AND ADMINISTRATION One LACRISERT ophthalmic insert in each eye once daily is usually sufficient to relieve the symptoms associated with moderate to severe dry eye syndromes. Individual patients may require more flexibility in the use of LACRISERT; some patients may require twice daily use for optimal results. Clinical experience with LACRISERT indicates that in some patients several weeks may be required before satisfactory improvement of symptoms is achieved. Issued June 2007 Distributed by: Manufactured by: ATON Pharma, MERCK & Co., Inc. a Division of Valeant Pharmaceuticals North America LLC West Point, PA 19486 USA Madison, NJ 07940 © 2011, ATON Pharma All rights reserved. LAC012-0211EWr LAC012-0211EWr_EyeWorld_ThirdVert_PI.indd 1 5/3/11 3:49 PM LRI being performed for with-the-rule astigmatism Source: Louis D. "Skip" Nichamin, M.D. Reducing continued from page 32

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