Eyeworld

Reporting from the 2015 AAO annual meeting, November 14–17, Las Vegas EW MEETING REPORTER 70 Current and new applications for monofocal and toric IOLs There's a lot of talk nowadays about the potential for multifocal IOLs— but monofocal IOLs continue to play an important role in ophthal- mic surgery, said Alan Carlson, MD, Durham, N.C. "Let's face it, these lenses work, and they've just gotten better with time," he said. Mono- focal IOLs meet the expectations of many patients, are good for patients with a history of monovision, are covered usually by insurance, and are better for patients with mac- ular degeneration, severe dry eye, advanced glaucoma, and diabetic retinopathy, Dr. Carlson said. Dr. Carlson also addressed the increasing use of toric IOLs, al- though he said these may not be the best choice for patients with insufficient astigmatism, economic concerns, irregular astigmatism, and other factors. To ensure patient suc- cess with toric IOLs, surgeons need to consider factors such as incorrect IOL placement, surgically induced astigmatism, and posterior corneal astigmatism, Dr. Carlson said. Editors' note: Dr. Carlson has financial interests with TearScience (Morrisville, N.C.). or isn't a good candidate for refrac- tive surgery because of their ocular surface health, said Michael B. Raizman, MD, Boston. "We need a combination of tests for our screen- ing," he said. When assessing a patient's risk for dry eye associated with refrac- tive surgery, Dr. Raizman consid- ers classic factors such as age and menopause status for women, but he also considers if the patient has a neurologic condition or is using antidepressant medications, as these can exacerbate dry eye. Patients with conditions such as lupus and rheumatoid arthritis can also be prone to dry eye, but he does not eliminate them altogether from having refractive surgery. The slit lamp exam is where Dr. Raizman finds the most important information regarding dry eye risk. Other tests that he prefers include tear osmolarity, MMP-9 level in tears, aberrometry, and corneal topography. If Dr. Raizman finds dry eye preoperatively, he will treat it and then reassess how the ocular surface has improved. Editors' note: Dr. Raizman has finan- cial interests with Alcon, Allergan, and Bausch + Lomb. which was also the annual meeting of the International Society of Re- fractive Surgery. Clinicians and researchers have found increasing use for corneal biomechanics to help improve outcomes in the past decade, Dr. Dupps said. However, he thinks the potential of corneal biomechanics will improve in the future to become more prospective, deterministic, and personalized. Editors' note: Dr. Dupps has finan- cial interests with Avedro (Waltham, Mass.), Carl Zeiss Meditec (Jena, Ger- many), and Ziemer (Port, Switzerland). Assessing long-term changes with corneal crosslinking is difficult Although corneal collagen crosslink- ing (CXL) has been approved by all EU nations since 2006 and many surgeons report success with it, questions still remain about the best way to track its efficacy. "It's stan- dard of care, yet it's hardly standard- ized," said Parag A. Majmudar, MD, Chicago. The ongoing epithelium (epi)- on versus epi-off debate and a lack of standardization in how the procedure is performed have made it hard for researchers to perform a meta-analysis of CXL, he said. Dr. Majmudar is hopeful that CXL will be approved eventually by the U.S. Food and Drug Administra- tion, as it would reduce the econom- ic burden of keratoconus treatment and decrease the physical burden of surgery, he thinks. In the future, Dr. Majmudar thinks epi-on will prevail and that pharmacologic CXL as well as refrac- tive CXL will be performed. Editors' note: Dr. Majmudar has finan- cial interests with Alcon, Allergan, and Bausch + Lomb. Dry eye diagnostic tests provide clues, but no clear answers Diagnostic tests for dry eye have proliferated within ophthalmology in recent years, but there's no clear- cut test to reveal that a patient is continued on page 72 View videos from AAO 2015: EWrePlay.org Elizabeth Yeu, MD, discusses indications and contraindications for multifocal IOLs. December 2015 Sponsored by

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