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EW MEETING REPORTER 120 February 2015 Reporting from Hawaiian Eye 2015, Maui, Hawaii January 17–23 astigmatism. You cannot just use K readings and put those into the IOL formulas and get an accurate result, Dr. Klyce said, because average Ks can be off by as much as a diopter for refractive surgery patients. He stressed the importance of calcula- tors and how they take into account some of these changes. Regular corneal astigmatism is not a chal- lenge at all, as long as astigmatism is symmetrical, Dr. Klyce said. But one of the problems with understand- ing higher order aberrations is that wavefront devices may provide accu- rate measurements but give you no clue as to what is above normal and what can cause a problem, he said. Consider cylinder of both corne- al surfaces for torics, he concluded. Use corneal topography to assess candidacy for multifocals, and if needed, Dr. Klyce said the norma- tive database could be used to gauge suitability. Editors' note: Dr. Klyce has financial interests with Nidek (Fremont, Calif.) and Oculus. Manual phaco, FLACS should be taught in residency programs, physician says James McCulley, MD, Dallas, spoke about early experience using femto- second laser-assisted cataract surgery (FLACS) in residency training. His study was a retrospective analysis of refractive outcomes of post-myopic LASIK patients who underwent cata- ract surgery. The IOL powers in these cases were derived using intraoper- ative aberrometry. The cases were performed from July 2013 through December 2013. The refractive outcomes were analyzed by calcu- lating prediction error and reported as the mean absolute value of the prediction error. The ORA (Alcon) results were compared to the results that would have been obtained if the IOL power had been calcu- lated preoperatively. Finally, the results were compared to Haigis and Shammas formula results. The study looked at 402 cases with a minimum of 1-month follow up. There were multiple centers and surgeons, with a wide variety of IOL types. The study found that ORA provided more accurate results than were achieved previously from other formulas or physician choice. The use of intraoperative aberrometry to guide IOL power selection reduces the prediction error and provides an improvement in refractive outcomes of cataract surgery in challenging post-LASIK eyes, Dr. Brint conclud- ed. Editors' note: Dr. Brint has financial interests with Alcon. High and low level corneal aberrations overview Stephen Klyce, PhD, Port Washing- ton, N.Y., discussed cornea aberra- tions, highlighting both high and low level aberrations. He mentioned contraindications for multifocal IOLs, including corneal dystrophies, severe ocular surface disease, macu- lar degeneration, and uncompromis- ing personality of the patient, but his presentation mainly highlighted the first 2 issues. The corneal surface is the major contributor to the cause of ocular aberrations, he said. "We've come to learn that we need to look at the corneal endothe- lial surface as well," he said. These aberrations can be low order, either spherical (Ks) or regular astigma- tism, or high order, from irregular residency program at UT South- western is the largest in the United States, with 9 residents per year. It also has one of the largest fellowship programs in the country. Residents typically perform between 250 and 280 cataract operations as the prima- ry surgeon. They begin surgery at the end of their first year or begin- ning of their second year. Dr. McCulley addressed why it might be useful to introduce FLACS into the residency program sooner rather than later. Unique precision, smaller incisions, and effective lens positions are just a few advantages. FLACS will hopefully be a predict- able, safer procedure that will pro- vide better visual acuity for patients, Dr. McCulley said. FLACS has been shown to lead to reduced phaco power and time. However, residents should be comfortable with manual phacoemulsification before initiat- ing FLACS, Dr. McCulley said. Chal- lenges going forward with FLACS for residents include the economic factor, staffing qualified faculty and technicians, and the risk of dilution of manual phaco skills if there is insufficient volume of surgeries in a low volume program. Although Dr. McCulley said he initially thought that FLACS should be introduced earlier in the residency program, with experience, View it now: Hawaiian Eye 2015 ... EWrePlay.org Francis Mah, MD, discusses pearls for HSV and HZV management, especially in the context of cataract surgery.

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