Eyeworld

Reporting from Hawaiian Eye 2016, January 16–22, Wailea, Hawaii EW MEETING REPORTER 100 Sponsored by planning, ensuring accurate place- ment of the lens using things like corneal marking and intraoperative aberrometry, and tracking outcomes. However, there's still significant variability in how surgeons get the measurements that they're going to use, Dr. Rajpal said. In all of our practices, he said, we have patients who have other preexisting conditions. Try to avoid a multifocal or presbyopic lens in these cases, and if one of these lenses is used, it's important to be extremely careful. From the perspective of the corneal specialist, Dr. Rajpal said, in patients with corneal disease, you may want to avoid multifocal IOLs, arcuate incisions, and LASIK/ PRK. The goal with these patients, he said, is to minimize contact lens use. The patient may need to accept the need for glasses to correct high residual astigmatism. "I think we have to be careful of choosing a toric lens in these corneal types of situations," Dr. Rajpal concluded. It's important to be diligent both preoperatively and intraoperatively. Be aware of specific patient expectations, he said. EW Editors' note: Dr. Rajpal has financial interests with Abbott Medical Optics, Alcon, Allergan, Avedro, Bausch + Lomb, Nicox, and Shire. used is that it will be able to keep the integrity of the upper corneal layers intact. Preservation of corne- al biomechanical stability and less corneal nerves severed, especially to the anterior surface, are also poten- tial benefits. However, there are still some concerns about the procedure, including whether it will induce higher order aberrations and how centration and future enhancements may be impacted. Editors' note: Dr. Berdahl has no related financial interests. Toric IOLs in special situations Choosing the right IOL for your patient is critical. Rajesh Rajpal, MD, McLean, Va., spoke about con- siderations for toric IOLs in special situations, particularly discussing corneal issues. There has been a better un- derstanding over the last couple of years of what parameters are most important when selecting toric lenses, he said. There are a number of important factors at play when se- lecting the best IOL for a patient in order to achieve the best outcome. Some of these parameters include multiple K/topography measure- ments, ensuring there is a healthy ocular surface, measuring surgically induced astigmatism, factoring the posterior cornea into the surgical accommodation and depth of focus testing, listing variables for consid- eration by device manufacturers to aid in more efficient trial designs, and working with patient reported outcome (PRO) experts to develop appropriate questionnaires. It's particularly timely to discuss accommodative and extended depth of focus lenses, as these are in the process of coming to market. Endpoints and guidelines have been developed, and they have been put up for review by industry, he said. So far, Dr. Holladay said, the task force has made progress relating to extended depth of focus IOLs by recommending the use of comput- erized vision charts with random- ized letters to minimize bias due to memorization, doing non-clinical laboratory testing, and drafting for dissemination to the industry. Ad- dressing these endpoints for extend- ed depth of focus lenses is important because usually every single sponsor has to go through the process of reinventing the wheel for each prod- uct seeking approval, he said. The result of such a task force could help shorten the time and lower the cost for these FDA approv- als, Dr. Holladay said. This would benefit both patients and surgeons. Editors' note: Dr. Holladay has no related financial interests. SMILE The small incision lenticule ex- traction (SMILE) procedure (Carl Zeiss Meditec, Jena, Germany) is a new technique using a femtosecond laser to cut a small corneal lenticule. John Berdahl, MD, Sioux Falls, S.D., presented on the topic on behalf of Vance Thompson, MD, Sioux Falls, S.D. With SMILE, Dr. Berdahl said, the femtosecond laser creates an anterior lamellar flap and a posterior lamellar flap. The posterior flap is dissected, and so is the anterior flap, creating a lenticule, like a contact lens, that you would pull out of the eye. The anterior cornea then col- lapses down into a new shape. The procedure is still in the early stages, but the potential ben- efit when it becomes more widely February 2016 View videos from Hawaiian Eye 2016: EWrePlay.org David Chang, MD, discusses a technique for providing reverse optic capture with single-piece acrylic IOLs in scenarios of posterior capsular rupture.

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