EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/422211
EW MEETING REPORTER 72 December 2014 Reporting from the 2014 Asia-Pacific Association of Cataract & Refractive Surgeons annual meeting, Jaipur, India circle scan plus 3 line scans. Finally, Dr. Sachdev said that LenSx has had 3 hardware and 6 software upgrades in 3 years. Chee Soon Phaik, MD, Singapore, discussed the VICTUS laser (Bausch + Lomb, Bridgewater, N.J.). She cited the ease of docking, ease of planning, the effectiveness of CCC, and the effectiveness of nu- cleus fragmentation as major reasons why she prefers the VICTUS. This la- ser is easy to dock, especially in eyes with small palpebral apertures, Dr. Chee said, which is important in the population of patients that she treats with small eyes. The default settings and ability to adjust energy make it easy to use the VICTUS. There is also a short learning curve, and Dr. Chee has found superior visual outcomes with the VICTUS laser. Luis Izquierdo Jr., MD, PhD, Lima, Peru, highlighted why he likes the Ziemer Z8 system (Port, Switzerland). The design of the system is particularly attractive, he said. The imaging aspect offers real time imaging and integrated proprietary state-of-the-art OCT. The femtosecond laser is more powerful, with a laser source with adaptive pulse management (APM). This means that it uses lower energy in the cornea, and it uses higher energy in the lens with less gas formation, for less intraoperative complications. There is also a liquid interface with the system. Finally Suhas Haldipurkar, MD, Panvel, India, discussed why he does not yet have a femtosecond laser system. He said when deciding to invest in this type of technology, a number of questions need to be answered. Am I convinced of the technology? Will it make a signifi- cant difference? Will the cost/benefit ratio tilt in favor of the patient? He concluded that he does not currently see any benefit in this type of machine. Cataract and refractive surgery: Two sides of a coin How would you treat a 54-year-old male Bollywood star who is a slight hyperope with no cataracts and who wants to be spectacle-free? That was the question posed to Sri Ganesh, MD, Bangalore, India, and Cordelia Chan, MD, Singapore, at the "Two Sides of a Coin: Cataract Versus Refractive Surgery Approach" symposium. In this session, several hypothetical scenarios were pre- sented to two surgeons who then debated the best treatment option for the patient from either a cataract or refractive point of view. In this case, Dr. Ganesh took the cataract surgeon's perspective and recommended a refractive lensecto- my with either an extended depth- of-focus (EDF) IOL or a Carl Zeiss Meditec (Jena, Germany) trifocal IOL. In his opinion, lens-based surgery is a permanent solution to the patient's problem that provides better benefits with fewer risks. Dr. Chan took the refractive surgeon's approach, and said that as a Bollywood star, this patient's activ- ities are not highly visually demand- ing—stereopsis is not crucial, the patient only has to drive occasional- ly, and needs reasonably good vision for distance and near. In addition, as a film star, this patient would want a quick fix for his hectic lifestyle and could be a high litigation risk. To Dr. Chan, the best surgical option for this patient would be femto LASIK with monovision. What would happen if a 62- year-old woman with monofocal IOLs implanted in both eyes 3 years prior came into the office wanting to be completely spectacle-free for an expedition to climb Mt. Everest? As this patient sees 20/20 and only needs glasses for reading, the physicians debating this case agreed that the best option would be to do nothing. However, if the patient was insistent upon surgery, Fam Han Bor, MD, Singapore, took the cataract surgeon's approach and recommended either a piggyback IOL or refractive IOL exchange with monovision. From the refractive side, Robert Ang, MD, Makati City, Philippines, said that he would discuss other aspects of the patient's life outside of this expedition to guide his decision. If the patient wanted surgery, Dr. Ang would recommend a KAMRA corneal inlay because it improves intermediate and near vision with- out sacrificing distance vision due to the pinhole effect. What about a myopic and astig- matic 59-year-old ophthalmologist undergoing cataract surgery who flies planes for recreation? In this scenario, Mohan Rajan, MD, Chennai, India, took the cataract perspective, and said his first choice would be to implant a monofocal toric IOL. He believes that this procedure is the best option because it is easy, cheap, has few complica- tions, and will allow the patient to retain the contrast sensitivity needed for flying. View it now: APACRS 2014 ... EWrePlay.org Gerd Auffarth, MD, Heidelberg, Germany, discusses designs and employment of trifocal IOLs. Supported by