EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/511377
57 EW REFRACTIVE SURGERY May 2015 have engendered the need for highly precise biometry. Is wavefront aber- rometry on its way to becoming a tried and true technique, a new gold standard to guide the surgical refrac- tive plan? The answer is not yet, Dr. Lane said. "I think intraoperative aber- rometry as it continues to evolve will become a standard by which we will get the best results that we can get, whether it is for monofocal lenses, toric or multifocal lenses," he said. "I think that the intraoperative aberrometer is a very valuable tool in helping us hit our target. That is what modern day, current cataract surgery and ongoing cataract surgery is all about to me—hitting the target as accurately as you can." "It is not perfect at this point, but it certainly is a very significant advance that will continue to get better and continue to evolve, as we have seen technology always does. We have these opportunities now to improve our results, and if we can improve results even 5–10% of the time, that is significant to that group of patients," he said. EW Editors' note: Dr. Lane has no financial interests related to his comments. Contact information Lane: sslane@AssociatedEyeCare.com by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer "However, the decision for a toric IOL involves an added cost to the patient, and so certainly for the amount of time that it takes to get it right—and what is important is getting it right—the increase in time is minimal." The difference In his practice, Dr. Lane uses real time aberrometry as a means of more precisely controlling the surgical procedure, compared to IOL positioning based on manual eye markings. Aberrometry allows im- provements in toric IOL placement and IOL power selection, he said. "It really makes a difference—I would say that I am adjusting the power of the lens in my practice about 50–60% of the time, based on intraoperative aberrometry, although it is usually within a half diopter of the spherical power," he said. "I am adjusting about 70% of the time, small amounts of correc- tion in the axis or in the direction of where I place the lens implant. So I am manipulating it maybe 5 or 10 degrees. We don't want it to be any more than about 5 degrees off of our intended." Gold standard Improvements in IOL technology is in the right position at the time of surgery," Dr. Lane said. The systems "help reduce any secondary procedures that might become necessary and ensure a better result for our patients, which is the intended improvement in vision and the independence of spectacles—the primary reason that patients have chosen a toric option," he said. Time in OR Guidance systems do not increase surgery time, but may, in fact, shorten the overall surgery time by eliminating preoperative eye mark- ing. Furthermore, IOL placement is faster, due to the easy and exact alignment provided by the guidance system. Intraoperative aberrometry, on the other hand, does increase surgery time, but is well worth the extra minutes, according to Dr. Lane. The data that these systems provide with regard to IOL position and power are indispensible and give the surgeon added confidence. "For the majority of the aber- rometers that are now used, capture takes 30–40 seconds," he said. "But the procedure does add time, espe- cially if you take multiple readings, potentially adding several minutes to your surgery time. Physician discusses intraoperative systems for increased accuracy in IOL placement T oric IOLs promise to correct astigmatism and render patients spectacle-free for distance vision. To deliver this, refractive surgeons require the utmost in precision and predictability, particularly when treating patients with high expectations. Most would consider surgical outcomes of within 0.5 D of the intended refraction practically hitting the mark. When it comes to correcting astigmatism with toric IOLs, fine-tuning of on-table surgical planning technologies may well be the last step in this evolving area of refractive surgery. What are our choices? Effective tools for aligning toric IOLs are a smart choice, according to Stephen Lane, MD, medical direc- tor, Associated Eye Care, and adjunct clinical professor, University of Minnesota, Minneapolis, who spoke to EyeWorld at the 2014 Side X Side meeting in Aventura, Fla., about the evolving technologies that he thinks are improving clinical outcomes of toric IOL implantations. "Probably the fastest-growing segment in the advanced technol- ogy lens sector is toric lenses," Dr. Lane said in a video interview at the meeting. "We are seeing more and more toric lenses being used, but it seems that most people are still using an ink marker to mark the cor- nea both pre- and intraoperatively to position toric IOLs." The 2014 ASCRS Clinical Survey found that 37% of respondents were using anatomical landmarks or ink marking without the aid of axial instruments. These toric markers can cause imprecision and areas of error, which limits best results in these cases. However, new technology is helping to end the older marking era and should change future survey results, he said. "We are now seeing the next step in this evolution, the placement of toric IOLs using guidance systems that help to position lenses precise- ly, and aberrometry-type systems that act as a double check or even a primary plan to ensure that the lens Narrowing the margin of error with toric IOLs Dr. Lane describes the roles of intraoperative aberrometry and guidance systems for toric IOL implantation at the ASCRS Side X Side meeting in Aventura, Fla. Source: ASCRS