Eyeworld

EW MEETING REPORTER 164 Ideal patients for toric IOLs have regular corneal astigmatism; astigmatism greater than or equal to 0.75 D (don't forget to include SIA in your assessment); and the desire to have crisp, clear distance vision with reduced dependency on glasses. A good toric IOL candidate will have regular symmetrical astigmatism, appearing as a "bowtie" or "figure eight" pattern on the topography. Talking to patients about toric IOLs Dr. Tipperman highlighted import- ant aspects of patients' decision- making process. It is important to give a very clear message, he said. "We don't sell patients, we educate them," Dr. Tipperman said, offering 3 steps to education: a brief letter, brochures and technicians, and videos and counseling. Oftentimes when cost becomes a factor, it is not necessarily that the patient doesn't physically have the money for the lens, but money exists in an emotional bucket, and they don't think they have it for an elective lens. In cataract surgery, it's hard to make sense of the prices. Dr. Tipperman suggested having a menu in the office with prices on it for different procedures. Dr. Lane emphasized tips for talking to patients. He stressed 4 ma- jor points: explaining astigmatism, informing patients of their visual opportunity, balancing expectations, and making a recommendation. One area where physicians fall short is making the recommendation, he said. It's the confident surgeon who does this. You need to know a little about the patient and the eye before mak- ing a recommendation, according to Dr. Cionni. It is also important to make a recommendation without being pushy. Dr. Tipperman tries taking the cost out of the decision- making process. The person has to see value in better uncorrected vision, he said. When explaining astigmatism, having a visual for the patient is very important, Dr. Lane said. Discuss visual opportunity with patients by informing them that there is an IOL option for correcting corneal astigmatism at the time of cataract surgery. Also let them know of the opportunity for excellent distance vision with less dependence on spectacles. Editors' note: Dr. Henderson has financial interests with Abbott Medical Optics, Alcon, and Bausch + Lomb. Dr. Lane has financial interests with Alcon, Bausch + Lomb, ClarVista, Kala Phar- maceuticals, Mati Pharmaceuticals, Ocular Therapeutix, Omeros, Physician Recommended Nutriceuticals, Rapid Pathogen Screening, TearScience, and VisionCare. Dr. Cionni has financial interests with Alcon and Glaukos. Dr. Tipperman has financial interests with Alcon. Measurements, the procedure, and postop assessment Biometry, marking, and positioning are all factors that come into play in regard to toric IOLs. Dr. Henderson highlighted these topics. Up until recently, markings on the eye for toric lenses were done manually, she said. But decreasing the human error portion of marking and aligning properly can be very valuable. Dr. Henderson uses multiple measure- ments to determine the markings, including manual Ks, auto Ks, IOLMaster (Carl Zeiss Meditec, Jena, Germany) or Lenstar (Haag-Streit, Koniz, Switzerland) Ks, and topogra- phy Ks. She also said to remove the contact lenses 2 to 3 weeks prior to measurements. If the measurements do not correlate, she recommended repeat- ing them all, ensuring that the tear film and lids are optimized, and remembering to remove contact lenses and not using drops before measurements except those that are preservative free. Dr. Henderson also added to be on the lookout for an- terior basement membrane dystro- phy (ABMD) because this can cause measurements to be off. She said it is important to mark the eye while the patient is sitting upright. Editors' note: Dr. Henderson has financial interests with Abbott Medical Optics, Alcon, and Bausch + Lomb. 'Glaucoma Therapy in 2015: MIGS, Meds, & Beyond' The glaucoma session was moderat- ed by Richard Lewis, MD, Sacra- mento, Calif., with faculty Douglas J. Rhee, MD, Cleveland, Thomas W. Samuelson, MD, Minneapolis, and Steven R. Sarkisian Jr., MD, Okla- homa City. Topics included medical management of glaucoma, manag- ing severe glaucoma in the MIGS era, new weapons to fight glaucoma, and benefits of femtosecond laser cataract surgery for patients with glaucoma. Dr. Rhee highlighted some of the evolving concepts in the medical March 2015 Reporting from ASCRS•ASOA SideXSide 2015, Aventura, Fla., February 12–15 View videos from Friday at SideXSide 2015: EWrePlay.org Douglas Rhee, MD, Cleveland, describes the movement from palliative glaucoma therapy to treatments addressing glaucoma pathophysiology.

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