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71 EW FEATURE February 2015 IOL calculations 3. Bring a tonometer to the operat- ing room to check for consistent IOP, Dr. Bafna said. This is espe- cially important if you are new to intraoperative aberrometry. "In a normal physiologic state, the eye is under a certain pressure. You want to make sure the IOP at the time of measurement is similar to that," Dr. Solomon said. Pearls after lens placement Once the lens is placed in the eye and is well centrated, inflating the eye with BSS can help provide a good pressure measurement, he added. 4. Make sure the patient is not overly sedated, which could make fixation more difficult, Dr. Solomon said. 5. When taking measurements, check that there is no pressure from the lid speculum that could induce astigmatism, Dr. Bafna advised. 6. Ensure that the patient's head has no significant tilt and that the microscope head is perpendicular to the patient's eye, with no cyclo- torsion relative to the patient, Dr. Weinstock said. 7. For pseudophakic readings, remove all viscoelastic material, make sure the eye is well sealed and the pressure is firm and stable, and avoid excessive hydration of the wounds, Dr. Weinstock said. Pre- and intraoperative pearls To get the best outcome with intra- operative aberrometry, remember that these are not plug-and-play devices, Dr. Solomon said. "You have to understand its limitations to appreciate the value of the machine," he said. "There is a little bit of a learning curve, and you have to fall back on some of your training." Here are some clinical pearls to maximize your use of the technology. 1. Always have a backup plan going into surgery, Dr. Weinstock ad- vised. "Don't abandon traditional techniques," he said. Bring your readings from topography and preop biometry into the OR so you can see what is similar or different and validate your aberrometry findings. 2. Keep the eye moist with balanced salt solution (BSS, Alcon), Dr. Weinstock advised. "If you have a dry eye or if a patient has an issue with the cornea, it would be diffi- cult to get a good refraction. The same thing takes place in the OR," Dr. Weinstock said. "The eye can't get dried out, and the tear film has to be stable." "The surface of the cornea has to be pristine," Dr. Bafna said. On the other hand, if there are globs of viscosurgical material on the cornea, that can throw off the data as well, Dr. Weinstock said. EyeWorld Monthly Pulse EyeWorld Monthly Pulse is a reader survey on trends and patterns for the practicing ophthalmologist. Each month we send an online survey covering different topics so our readers can see how they compare to our survey. If you would like to join the hundreds of physicians who take a minute a month to share their views, please send us an email and we will add your name. Email carly@eyeworld.org and put EW Pulse in the subject line. Poll size: 247 Intraop aberrometry equipment Source (all): Sean Ianchulev, MD, MPH "Refractive cataract surgery is an evolving subspecialty, and more and more devices, implants, and diagnostics are under development to integrate and improve refractive outcomes," Dr. Weinstock said. "This is one piece of the puzzle in the evolution of cataract surgery and of the modality of trying to provide precise refractive outcomes at the time of cataract surgery." EW Reference 1. Ianchulev T, Hoffer KJ, Yoo SH, Chang DF, et al. Intraoperative refractive biometry for predicting intraocular lens power calculation after prior myopic refractive surgery. Ophthalmology. 2014;121:56–60. Editors' note: Dr. Bafna has financial interests with Abbott Medical Optics (Abbott Park, Ill.). Dr. Ianchulev holds 4 patents for intraoperative aber- rometry and is a consultant for other ophthalmic companies. Dr. Weinstock has financial interests with Alcon and Bausch + Lomb (Bridgewater, N.J.). Dr. Solomon has financial interests with Bausch + Lomb. Contact information Bafna: drbafna@clevelandeyeclinic.com Ianchulev: tianchul@privatemedicalequity.com Solomon: jdsolomon@hotmail.com Weinstock: rjweinstock@yahoo.comw

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