EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/618732
EW FEATURE 36 Management of the irregular cornea • January 2016 AT A GLANCE • Currently in the U.S., the indications for topographic ablation are only for treating virgin eyes with asymmetric topography. • It's important for surgeons to be able to capture a high quality image and realize that this is different from using topography as a diagnostic tool. • Optimizing the ocular surface prior to treatment is key. by Ellen Stodola EyeWorld Staff Writer touch-ups. "It's approved for treat- ing virgin eyes who have asymmet- ric topography," he said. One worry, he said, is that some patients may not be the best ablation pattern, he said. However, Dr. Durrie said it's important to note that all of the patients in the U.S. clinical trial had virgin eyes, so there were no enhancements or a high quality topography before using the data. Patients who have asymmetric topography do well because the to- pography will drive the asymmetric Tips for using topographic ablation Physicians discuss which patients are strong candidates for topographic ablation A s topographic ablation becomes more popular worldwide, it's important for physicians to know which patients may be the best candidates, which patients are not the best candidates, and when it will benefit them most to use this technology. Karl Stonecipher, MD, Greensboro LASIK, Greensboro, N.C.; Allon Barsam, MD, AB Vision, London; and Daniel Durrie, MD, Durrie Vi- sion, Overland Park, Kan., discussed when they would use topographic ablation, pearls to ensure a good topography, and when topographic ablation may be used with certain conditions. When to choose a topographic over a wavefront or optimized ablation Dr. Durrie was a clinical investigator for the topography-guided study in the U.S. "One of the most important things about this new system is for surgeons to understand that this is different from doing diagnostic topography," he said. Topogra- phy helps in diagnostics to make decisions, he said, but if there's a bad test, it won't hurt anyone as a diagnostic tool. However, using it now as a therapeutic tool, Dr. Durrie's worry is that physicians will think they already know how to use it, even though there are different considerations. You need to pay a lot more attention to the quality of the image, he said. Be sure that it's Topographies of one of Dr. Barsam's patients pre and post topography-guided PRK. Prior to the procedure, the patient had moderately severe keratoconus with 5 D of irregular astigmatism. After topography-guided PRK with the WaveLight system (Alcon), the astigmatism was halved and is more regular. The patient had improvement in both unaided and best spectacle- corrected visual acuity. Source: Allon Barsam, MD