Eyeworld

EW MEETING REPORTER November 2011 59 Refractive adjustments after oc- ular surgery: To lift or not to lift? Flap lift remains the standard en- hancement after LASIK, as long as the flap is normal and the stromal bed is thick enough, according to a speaker at Monday's main ESCRS symposium, "Refractive Adjustments After Ocular Surgery." "Looking at the literature and talking to my col- leagues, I would say that today, under-the-flap is the preferred tech- nique for enhancements, both for femtosecond LASIK and microker- atome LASIK," said Michael Knorz, M.D., Mannheim, Germany. "The reasons are patient comfort and it is easily repeatable. Always lift the flap rather than recut. The rate of com- plications is much higher if you recut." Surface ablation is preferred if the stromal bed is too thin, if the flap is abnormal, or there has been a previous RK or corneal graft, Dr. Knorz said. Aspheric or custom abla- tion can be used to treat refractive errors, while custom ablation should also be used to treat higher order aberrations. Tuesday, September 20 Decision-making in presbyopia Monovision proponent Graham D. Barrett, F.R.A.N.Z.C.O., Perth, Australia, discussed why he prefers "the classical approach" to multifo- cal or accommodative lenses, or corneal approaches. "With multifo- cal lenses, we can obtain OK near vi- sion, but there's inherent issues of reduced contrast and quality," Prof. Barrett said. "Accommodative lenses provide better optical quality, but the near vision is less predictable. PresbyLASIK is a potential solution for our phakic patients, but one wonders whether corneal remodel- ing will affect the result. With corneal inlays, there's the additional issue of long-term biocompatibility that also needs to be considered." Prof. Barrett said targeting modest monovision means cases of unsatis- fied patients will be extremely rare. He noted that he has had three pa- tients who required further interven- tion during the last 6 years. He pointed to two papers at ESCRS comparing in a prospective fashion multifocal vs. monovision. "They found that the spectacle independ- ence was similar. They found better intermediate acuity, higher overall satisfaction score, and significantly fewer complaints with the monovi- sion patients," he said. The first prospective randomized trial com- paring the two procedures was pre- sented later in the day at ESCRS. "What's of concern in this trial is that six patients required lens ex- change. They're all from the multi- focal cohort," Prof. Barrett said. "I think what happens with our pres- ent solutions for presbyopia is that with multifocal lenses we can get pa- tients with spectacle independence, but they're unhappy. We can get monovision patients who still re- quire spectacles for some activities but are ecstatic." Assessing accommodative IOLs David Spalton, M.D., London, gave the results of a prospective random- ized trial comparing the Crystalens HD (Bausch + Lomb, Rochester, N.Y.) to the Tecnis monofocal (Abbott Medical Optics, AMO, Santa Ana, Calif.). In the study, patients with symptomatic bilateral cataract were randomized to receive the same lens in both eyes during sequential cataract surgery within 6 weeks. Post-op, the patients were reviewed at 1, 3, 6, and 12 months. At each visit 100% and 9% contrast ETDRS logMAR acuity was recorded and digital retroillumination images were taken of the posterior capsule and analyzed using PCO software. The study found that PCO is greater in patients implanted with the Crystalens. "The typical linear fi- brotic pattern of PCO appeared to follow capsule tension lines seen in many patients," Dr. Spalton quoted the study as saying. "The goal of restoring accommodation has yet to be achieved," he said. "Current IOLs work using a mixture of weak accommodation assisted with pseudoaccommodation and depth of focus." "A long way to go" Gunther Grabner, M.D., Salzburg, Austria, reported that 50% or more of patients who undergo presby- LASIK are spectacle free, but that there is up to a 28% retreatment rate with the procedure. "Patients are quite satisfied with the outcome, but over time would like more near vi- sion," he said. "It doesn't treat the cause of presbyopia," he said. "It comes from the hardening of the lens, so why not treat that? It's a brilliant technique, but there's still a long way to go to achieve clinical re- sults," he said. "We need more infor- mation about the long-term effects." Georg Gerten, M.D., Cologne, Germany, examined the femtosecond approach to presby- opia, which could be a successful clinical approach were there not sev- eral factors missing, including long- term effects (dosage, opacification) of the treatment, he said. EW I n a standing-room only symposium sponsored by Abbott Medical Optics (AMO, Santa Ana, Calif.), Oliver Findl, M.D., Vienna, Austria, suggested that before toric lens surgery, clini- cians should mark the axis of treatment or cardinal meridian in the sitting position to avoid cyclotorsion. "You want to have a good marking method at hand," he said. "You need to have rota- tional stability." Dr. Findl said that AMO's Tecnis one-piece lens is very stable when it comes to centration and tilt, especially when compared to multifocal lenses. Katrin Petermeier, M.D., Tuebingen, Germany, reported on the results of a multicenter, prospective, comparative study of 49 patients that showed the advantages of the Tecnis multifocal, including its hydrophobic material and 360-degree barrier edge. She said she was pleased to see that 70% of the patients were comfortable with their intermediate visual acuity. Eduardo Marques, M.D., Lisbon, Portu- gal, said long-term experience with the AMO Synchrony Dual Optic Accommodating IOL proves that the lens provides high levels of quality vision and a significantly lower incidence of posterior capsule opacification. "We believe this is not only due to the care we take in polishing the capsules, but also to the fact that the lens keeps the bag open," he said. At a second AMO symposium on Sunday, Gunther Grabner, M.D., Salzburg, Austria, discussed new applications for the femtosec- ond laser including algorithms for performing penetrating and lamel- lar keratoplasty and for creating channels for intrastromal ring segments and intrastromal pockets for corneal inlays. W. Bruce Jackson, M.D., Ottawa, introduced interim data from the myopic co- hort of the study of a new aberrometry system called the iDesign Ad- vanced WaveScan Studio. The prospective, multicenter, open-label, non-randomized clinical trial, which is ongoing at four sites in Canada, enrolled 101 eyes, 85 of which were available for examina- tion at month 3. "The iDesign measurements were used to generate the treatment profiles, and there was no physician or nomogram ad- justment," Dr. Jackson said. At 3 months, 77% of eyes had an uncor- rected distance visual acuity of 20/16 or better, and 94% had 20/20 or better; 78% were within 0.5 D of their target manifest refractive spherical equivalent, and 98% were within 1.0 D. AMO highlights technologies in two lunchtime symposia

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