Eyeworld

EW MEETING REPORTER 162 April 2016 Reporting from ASCRS YES ACT March 5–6, New York Reporting from ASCRS YES ACT Transitioning to refractive cataract surgery A major theme of the first session of the ASCRS Young Eye Surgeons (YES) Advanced Cataract Training (ACT) meeting was how the subspe- cialty has gone from cataract surgery to refractive cataract surgery. One consideration in achieving a success- ful refractive outcome in cataract surgery is correction of astigmatism. "If you're not doing astigmatic incisions, you can't be a refractive cataract surgeon," said Eric Donnenfeld, MD, Rockville Centre, New York. Kerry Solomon, MD, Mount Pleasant, South Carolina, said that based on newer standards of accept- able residual astigmatism, almost three-quarters of patients with 0.5 D of astigmatism or more would benefit from correction in refrac- tive cataract surgery. He called the opportunity for astigmatism correc- tion in these patients "low-hanging fruit." The first step to managing astigmatism is understanding how to read corneal topography. Dr. Solomon also noted the importance of emerging technology to measure posterior corneal astigmatism to confirm that patients are good can- didates for corneal procedures and for accurate toric IOL calculations. "Corneal topography is manda- tory for refractive corneal screening. When I say refractive surgery, I'm not just talking about LASIK—this is for cataract surgery as well," Dr. Solomon said. Options for correction of astigmatism include limbal relaxing incisions (LRIs), arcuate incisions, and toric IOLs. Elizabeth Yeu, MD, Norfolk, Virginia, offered several pearls for how LRIs could be used to correct up to 1.0 D of astigmatism, including the importance of careful slit lamp examination and anterior topogra- phy. Dr. Yeu noted the importance of precise corneal keratometry mea- surements, using a minimum of 2 reliable devices, and accounting for the role of posterior corneal astigma- tism, which she said can act like a negative lens. Dr. Donnenfeld said LRIs creat- ed with a femtosecond laser are pref- erable to manual LRIs because they are adjustable, customizable, more precise, and safer. What's more, he said intrastromal lasers, which don't break through the corneal surface and thus cause no pain and require no antibiotics, will likely be "the fu- ture for small amounts of cylinder." As for where to place LRIs, Dr. Donnenfeld said physicians must use vector analysis and factor in surgically induced astigmatism. He recommended www.LRIcalculator. com as well. While LRIs might be adequate to correct astigmatism requiring a small amount of cylinder, Dr. Donnenfeld said toric IOLs in

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