Eyeworld

EW CATARACT 36 November 2015 comfort after surgery and it's easy to see. Marking pens can bleed and are rather blunt, as much as 5 degrees. My own method of marking patients currently involves the slit lamp. A slit lamp is kept at the ASC, and the patient sits on a stool next to the OR bed in the preop area. Ori- enting the slit horizontally, I make a mark at the limbus at 3:00 and 9:00 with a fine point marking pen. This has the advantage of being inexpen- sive, rapid, and extremely precise. It does require having a slit lamp at the surgery center, but they can be handy for other uses. I asked Warren Hill, MD, Mesa, Ariz., what his method is, given his keen interest in precise refractive outcomes, and he uses a "belt and suspenders" method: He marks the cornea at 3:00 and 9:00 with the naked eye and marking pen, and brings to the operating room a photo from the LENSTAR (Haag-Streit, Koniz, Switzerland) and an overlay of the toriCAM app to further fine-tune the orientation. He is particularly enthusiastic about the future of precision toric IOL surgery, as real-time intraoperative aberrom- etry carries the potential to precisely orient the IOL without regard to any preoperative marking and estimates of postoperative astigmatism. In the future this could perhaps even help select the IOL power and astigma- tism magnitude. As you can see, there is "more than one way to skin a cat." I think Dr. Hill's idea of having a precision preoperative photo in addition to your normal method is a good one, especially if your markings compare exactly to the photo and there is a handy landmark present at your desired IOL orientation. EW Editors' note: Dr. Gossman is in private clinical practice at Eye Surgeons & Physicians, St. Cloud, Minn. The physicians have no financial interests related to this article. Contact information Gossman: n1149x@gmail.com Hill: k7wx@earthlink.net Nichamin: ldnichamin@gmail.com 4. Comparison to office photo- graph: I've found comparison to photographs while in the OR to be tedious, even when attached to the microscope for example. I have taken preoperative photos with the slit lamp with the iPhone app "toriCAM" (from Graham Barrett, MD), and it can be ef- fective but in my hands no more accurate than other methods. I have found it useful to measure the actual toric position in the office after surgery. The second question was, "How do you make the mark?" One issue is the expense of the use of the Nd:YAG laser and the office visit time both in terms of office overhead and patient incon- venience. The method of scratching the cornea is very attractive because of its precision, and adherents state that there is no meaningful effect on CORNEAL HYSTERESIS. You shouldn't have to be a fortune teller to predict glaucoma progression. Only Ocular Response Analyzer ® measures Corneal Hysteresis, a superior predictor of glaucoma progression, providing you with a more confident glaucoma risk assessment. Introducing the all-new Ocular Response Analyzer ® G3, an essential part of your glaucoma workup. Learn more at www.reichert.com/ora © 2015 AMETEK, Inc. & Reichert, Inc. (10-2015) · www.reichert.com Advancing Eye Care. American Innovation. Ocular Response Analyzer ® is made in the USA • CPT is registered trademark of the American Medical Association. How are continued from page 35 YAG laser 4% Cautery 0% Needle scratch on cornea 7% Marking pen 64% Metal instrument with ink applied to tip 20% Other 5%

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