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For those who are using intraop- erative aberrometry in post-RK eyes, Dr. Hoffman warned if the device produces the same lens power the surgeon came up with preoperative- ly, be leery. "Patients will have great vision on postop day 1, but will rapidly regress over the next couple of months and be myopic." He is slightly wary of intraopera- tive aberrometry use with toric lens- es as well—"we hydrate the cornea during phaco, and that hydration can change the curvature of the cor- nea temporarily," he said. While the change is transient and small, basing lens placements and power on just the intraoperative measurement may result "in more errors than if you know what your surgically in- duced astigmatism is and you've got that lens lined up perfectly on the topographic meridian without doing the intraoperative aberrometry." In contrast, Dr. Donaldson thinks that intraoperative aberrome- try has great potential. "But I think incorporating the ORA intraoperative aberrometry and helping that transition from the office into the operating room is key," she said. "The more seamless the integration from preoperative measurement and planning, to intraoperative application and modi- fication, to postoperative feedback of data with nomogram creation can be, the better for us as surgeons." Improvements in wavefront analysis have impressed Dr. Hoffman. "My ability to get a post-LASIK patient close to plano has been enhanced. Five years ago, I couldn't make that same statement," he said. "It's incrementally more reliable now, especially in the post-refractive patient's data. Technology will evolve so that What's new continued from page 28 we're just going to do intraoperative measurements and choose a lens off the shelf based on those mea- surements. We haven't quite gotten there yet." What about femto? Dr. Hoffman has not "jumped on board just yet" with the femtosec- ond laser. "It slows down the procedure, and for the average patient, I think manual techniques work just as well," he said, adding "it does bene- fit a select group of patients, but I'm still on the fence." Dr. Donaldson said incorporat- ing these lasers into a practice "may add a significant amount of time to the procedure and will require careful choreography of the OR day." At Bascom Palmer, the femto lasers are placed directly in the OR suites, which reduces OR efficiency. "However, with more laser experi- ence we have reduced our extra time from 12 minutes during the learning curve to the current additional 6.7 minutes per patient," she said. She mentioned that other groups have increased their efficiency by moving the laser outside the operating room to a separate laser suite or by having a separate surgeon dedicated to performing the femto portion of the case while another surgeon performs the phaco components. In those cases, the time to perform cataract surgery is actually reduced. EW Editors' note: Dr. Donaldson has no financial interests related to her comments. Dr. Hoffman has financial interests with Carl Zeiss Meditec. Contact information Donaldson: KDonaldson@med.miami.edu Hoffman: rshoffman@finemd.com " Combining technology among different companies and getting the companies to work cooperatively is crucial to achieving our best results. " –Kendall E. Donaldson, MD

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