Eyeworld

151 October 2015 EW MEETING REPORTER corneal biomechanics. It also offers earlier rehabilitation and stability in correction. The astigmatic correction is excellent, he said, and contrast sensitivity is far better. Dr. Ibrahim is trying SMILE with a combination of other treatments, including corneal crosslinking in some "suspicious" cases, but he warned that only experienced surgeons should be performing this. monofocal and multifocal IOLs after dysfunctional lens replacement. Dysfunctional lens syndrome is defined by lens opacities, presby- opia, and higher order aberrations. In Stage 1 of dysfunctional lens syndrome, the patient becomes pres- byopic and develops higher order aberrations. There may be some ear- ly light scatter that can be measured objectively. Stage 2 involves wors- ening presbyopia and appreciable light scatter, but these don't qualify for insurance-based procedures, Dr. Waring said. In Stage 3, there is subjective and objective data that would qualify for an insurance-based cataract extraction. Dr. Waring was involved in the first study evaluating the role of forward light scatter as an objective measurement of quality of vision in dysfunctional lens replacement. This could potentially improve the quality of vision, offer a permanent refractive solution without altering the cornea, provide a technique that does not hinder future options for advanced IOLs, and uses the femto- second laser. The study looked at 25 consecutive eyes in 2 groups. This is for patients who would routinely be coming in and asking for LASIK to help reduce their dependence on bifocals, reading glasses, or contact lenses, Dr. Waring said. It can offer a laser-based solution to help meet their goals and also help improve BCVA. ISRS session and refractive topics During the International Society of Refractive Surgery (ISRS) session, Osama Ibrahim, MD, Alexandria, Egypt, presented the keynote talked, titled "Refractive surgery today – moving the limits ahead for better outcomes." Dr. Ibrahim has been involved in refractive surgery since its infancy. There have been a num- ber of innovations over the years, he said, from incisional surgery, to lamellar corneal surgery, to the exci- mer laser, to the femtosecond laser. The lecture focused on the small incision lenticule extraction (SMILE) procedure, which Dr. Ibrahim said is tissue removal instead of ablation. "The femtosecond laser does it all," he said. Using SMILE, a surgeon can make a small incision and dissect the lenticule. Of course, there is a learning curve, he said. Potential difficulties include decentration, suction loss, difficult dissection, stuck lenticules, radial tears, and uneven lenticules. When looking at LASIK com- pared to SMILE, Dr. Ibrahim said that SMILE helps preserve the Surgeons inject the crosslinking riboflavin in the pocket, he said. In a prospective case series of 34 eyes of 18 patients, Dr. Ibrahim explored this option. These patients had high myopia and astigmatism. They also had suspicious topography and thin corneas, or a diagnosis of forme fruste keratoconus. EW

• Cover