Eyeworld

149 October 2015 EW MEETING REPORTER previous corneal refractive surgery. Using the ORA system, Dr. Cionni consistently achieves refractive accu- racy within a half diopter in 85% of multifocal IOL patients, he said. When calculating the axis and magnitude of astigmatism for toric IOL implantation, older technology is still valuable, but each modality measures different things, and the surgeon needs to understand those differences, said Stephen Lane, MD, Stillwater, Minn. Newer technol- ogies, both for preop and intraop astigmatism measurement, can pro- vide more and better information than some of the "oldie but goodie" tools, Dr. Lane said. With advanced topographers, tomographers, and intraoperative imaging systems, Dr. Lane asked: Is there a gold standard for measuring astigmatism? Can one instrument provide all the informa- tion a surgeon needs? The answer, he said, is no. "The most important factor is the sur- geon's capacity to gather the infor- mation and use his own brain power to determine what the lens power is going to be," he said. "What I do in my practice is take the tools I have and use them together. Some are more dependable in certain circum- stances, and the good news in all of this is that you can make a decision based on a number of different data points." If all the devices you use give you the same results, you know you're going to have a good refrac- tive outcome, Dr. Lane said. If the numbers don't align, he said, share that information with your patients —tell them that they may have residual refractive error and you may need to go back in and do PRK or a lens exchange. A new use for OCT Oliver Findl, MD, Vienna, Austria, closed the CSCRS session by dis- cussing a new use for an old tool: real-time OCT in anterior segment surgery. The largest source of error in IOL power calculations is postop anterior chamber depth (ACD), so Dr. Findl asked: Can we get a better direct measurement of ACD during surgery? Intraoperative aberrometry can double-check preop measure- ments, but it doesn't take into ac- count changes to the corneal shape during surgery and it can't predict IOL position, he said. Intraoperative OCT, on the other hand, could do both of these things. Dr. Findl helped develop a prototype intraoperative OCT sys- tem that provides a live feed of the OCT image to the operating micro- scope. Using this prototype system, Dr. Findl has shown that intraop OCT is clinically feasible for anterior segment surgery. He uses the system to take aphakic measurements of the anterior chamber, and after implant- ing the IOL, he uses the lens haptic plane to determine the position of the anterior capsule and calculate the ACD. In addition to enhancing IOL power calculations, OCT can show the surgeon just how often lens frag- ments touch the corneal endothe- lium during surgery, Dr. Findl said, which could shed light on whether this contributes to endothelial cell loss after surgery. Accommodating IOLs: concept or reality? Will an IOL ever be able to provide true accommodation, or is this just a pipe dream? During the "Treat- ing Presbyopia: From Concept To Evidence" symposium, speakers dis- cussed current presbyopia solutions and whether a truly accommodating IOL is in our future. Roger Steinert, MD, Irvine, Calif., opened the session by de- scribing the ideal design parameters for accommodating IOLs. The ideal device should provide an objective accommodation amplitude of at least 3 diopters, Dr. Steinert said. The device should occupy the entire volume of the capsular bag and use or mimic the natural physiological accommodative mechanism. Finally, the device must have a simple and robust design and an optic power that is less sensitive to lens volume. Surgeons will not be able to offer their patients truly accommodating IOLs anytime in the near future, he said, but lens designers have made Uniform epithelium removal in only 5 - 7 seconds Corneal Xlinking, PRK Advanced Surface Ablation Improved clinical outcomes of CXL and PRK with Amoils Epithelial Scrubber Minimize total procedure time Avoid alcohol damage to surrounding tissue No need for subsequent scraping T. 800.461.1200 www.innovativexcimer.com g e uent scraping er.com order online www.innovativexcimer.com in the S4OPTIK booth #2013 Visit AMOILS at the AAO www.innovativexcimer.com AMOILS continued on page 150

• Cover