Eyeworld

47 EW FEATURE August 2015 Keratorefractive surgery Although collagen crosslinking in primary laser vision procedures has garnered some interest overseas, U.S. surgeons are still waiting for studies demonstrating promised clinical benefits. "It's compelling that you can in theory not weaken the structur- al integrity, which goes along the same line of thought as the SMILE procedure to make it as strong as a standard natural PRK procedure," Dr. Kraff said. However, prospective clinical trials are needed to evaluate that. A better understanding is also needed regarding the potential impact of crosslinking on the final refractive results, Dr. Koch said. "Patients are not going to be happy if we strengthen their cornea but they end up with a residual refractive error," Dr. Koch said. Reversible treatment As a clinical investigator for the KAMRA (AcuFocus, Irvine, Calif.) clinical trials, Dr. Kraff can see a role for the removable corneal inlays. However, investigators found during the presbyopia trial that very careful patient selection is key. "If you select patients carefully, the data from the AcuFocus trial suggests that we can generate good results and give patients a corneal presbyopic solution using an inlay medical device," Dr. Kraff said. That focus likely means that there aren't as many good candi- dates for the device as one might think—for instance, those who can tolerate having 1 eye treated for presbyopia in some manner. Future applications may include treating patients who have had prior refractive surgery and who are now presbyopic or performing simultane- ous LASIK and inlay application. "As we get more comfortable with this procedure in a commercial environment, we'll learn a lot more about who are the absolute best patients for this and we'll learn who 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: 230 continued on page 48 Preop scan of keratoconus patient Scan at 18 months postop of the same patient following UV crosslinking as well as bilateral topography-guided PRK Source: Ken Dickerson, OD What percentage of your cataract patients do you currently implant with a toric IOL? What is your primary technique to assist in toric IOL alignment? What is the maximum amount of postoperative manifest astigmatism you consider acceptable after a premium IOL? 1 to 5% 6 to 15% 16 to 25% More than 25% I do not implant toric IOLs 0.00 to 0.25 D 0.50 to 0.75 D 1.00 to 1.25 D 1.50 to 2.00 D Limbal marks placed prior to the procedure Identifying scleral vessels Intraoperative aberrometry Head and eye position on the operative table

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