JAN 2016

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/618732

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Page 39 of 78

37 EW FEATURE January 2016 • Management of the irregular cornea candidates for this procedure, and if these patients don't get good results, the procedure could get a bad repu- tation. Topographic ablation could work for patients who have had previous surgery, but it's important to remember that there is currently no U.S. data on this. Dr. Barsam currently only uses topographic ablations on diseased corneas that also have an irregular corneal shape and poor quality of vi- sion as a result of this. He uses wave- front-optimized ablations in routine cases. "I find wavefront scanning to be somewhat unpredictable on diseased corneas and therefore do not do wavefront-guided treatments on diseased corneas," he said. "It goes without saying that either with Contoura [Alcon, Fort Worth, Texas] treatments or wave- front-guided treatments, you must first be able to capture an accurate, reproducible, and complete diagnos- tic measurement," Dr. Stonecipher said. Otherwise, the outcomes could suffer. He suggested using wave- front-guided treatments for patients who have higher-order aberrations of 0.4 microns RMSH or higher and no lenticular issues. As for Contoura, he follows the guidelines and treats over 18 years of age and up to –9 D of myopic astigmatism and up to 3 D of astigmatism. Pearls for assuring a good topography to treat As physicians are beginning to use topographic ablation more frequent- ly, Dr. Durrie said it's important to understand a few major points. First, he said that it's possible for patients' noses to get in the way, so the surgeon simply has to know to tilt the head. Some patients don't open their eye wide enough, so you need to help them but without putting pressure on the eye and distorting it. "You need to make sure the tear film is really good," he added. Also, surgeons need to be able to look at the Placido disc rings on the topog- raphy device and be able to see the raw data. "This treatment is all about the measurement," Dr. Stonecipher said. "If you don't have a good picture, you can't get a good outcome." He finds that in some patients, be- cause of their anatomy, he ends up reverting back to a wavefront-op- timized treatment. "Don't let the computer interpolate the data," he said. "That is very important." Taking multiple pictures will help to ensure reproducibility and eliminate noise. "Make sure the ocular surface is healthy, and definitely treat any ocular surface disease prior to mea- suring and treating patients," Dr. Stonecipher said. Leonard B. Nelson, MD Director, Wills Eye Strabismus Center It's a progressive surgical procedure called a Horizontal Four-Muscle Tenotomy that increases visual acuity and improves target acquisition in adult nystagmus patients. The Wills Eye Strabismus Center, under the direction of Dr. Leonard Nelson, is leading the way in developing this innovative technique. Some patients have even been able to get a driver's license for the first time. We're improving lives at Wills Eye Hospital. 840 Walnut Street Philadelphia, PA 19107 www.willseye.org 1-877-AT-WILLS BREAK NYSTAGMUS BREAKTHROUGH FOR ADULTS Additionally, positioning the patient in the device is extremely important. "In some cases it will continued on page 38

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