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EW NEWS & OPINION 18 May 2016 by Liz Hillman EyeWorld Staff Writer YES Connect topographer (i-Optics, The Hague, the Netherlands). "I'm sure that one could use many devices, but I do like to have 2 different readings for topography," he said. "What I think is very im- portant is that 1 of the devices has Placido rings or mires to evaluate the quality of the data that you're getting of the cornea." The third point Dr. Koch takes into account is the patient's refrac- tion, as he said it can give a clue about a patient's astigmatism, but the crystalline lens could be contrib- uting to it. Berdine Burger, MD, Carolina Eyecare Physicians, Charleston, South Carolina, also emphasized the importance of taking multiple mea- surements and making sure they're in agreement. "One should use as many meth- ods as needed to obtain accurate numbers and treat consistently," she said. "Every surgeon's personal no- mogram will be different. Remem- ber, these keratometry values should make sense and agree. We are not treating arbitrary numbers. When treating astigmatism, you must have a clear understanding of the corneal thus refractive outcomes if a proce- dure were to move forward. Dr. Garg also makes it clear that a 20/20 refractive outcome is not guaranteed, emphasizing instead that treatment of astigmatism will at least "minimize" a patient's depen- dence on corrective lenses. Provided the ocular surface is healthy, then it's time to conduct biometry. "I think it's important to have at least 2, maybe 3, ways to evaluate astigmatism," said Doug Koch, MD, professor and Allen, Mosbacher, and Law chair, Cullen Eye Institute, Bay- lor College of Medicine, Houston. Dr. Koch uses the IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany), the LENSTAR LS 900 (Haag-Streit, Koniz, Switzerland), or both for op- tical biometry. He uses these devices to select a magnitude of correction, coupling them with the Baylor nomogram, the Barrett formula, and the Abulafia-Koch formula, to take into account the posterior cornea. From there Dr. Koch said he conducts topography using the Galilei Dual Scheimpflug Analyzer (Ziemer Ophthalmic Systems, Port, Switzerland) or the Cassini corneal What methods to use, what to do if measurements disagree, and treatment of choice P atients no longer just want to be cataract-free after surgery. They often hope to be glasses-free as well. As more and more patients are interested in the refractive surgi- cal options available at the time of cataract surgery, the physician often has to address astigmatism. But before the surgeon can even decide whether to do limbal relax- ing incisions or select a toric IOL, a sound evaluation of the degree of astigmatism at the preoperative stage is critical. Sumit "Sam" Garg, MD, Gavin Herbert Eye Institute, University of California, Irvine, said the first thing he does is make sure the ocular surface as a whole is healthy, post- poning surgery until any issues are improved. If such a condition on the ocular surface is found, Dr. Garg said he's upfront about how this con- dition on the ocular surface could affect the corneal measurements and Preoperative assessment for astigmatism correction at the time of cataract surgery A technician at Carolina Eyecare Physicians demonstrates how to take measurements to assess astigmatism preoperatively. Source: Berdine Burger, MD W e are excited to introduce YES Connect, a monthly column for EyeWorld readers in training or the first 5 years of their careers. We begin with a 3-part series on the management of astigmatism during cataract surgery because this is now a fundamental part of being an anterior segment surgeon. This month, our focus will be on pre- operative evaluation and preparation: What do you need to consider when you examine patients in clinic? How do you counsel patients? How do you plan for success? In the next 2 parts of the series, we'll discuss intraoperative pearls and postoperative management. One of our goals for YES Connect is to incorporate expertise from young eye surgeons, and we are fortunate to have 2 participating in this column: Sam Garg, MD, and Berdine Burger, MD. In addition, Doug Koch, MD, explains how he chooses the magnitude and axis of cylinder to correct. Our experts also discuss dealing with incon- sistent measurements and their recommen- dations for surgeons who are getting started with astigmatism correction. Thanks for joining us, and we look forward to seeing you again next month. Bryan Lee, MD YES Connect co-editor

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