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May 2016
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another, it comes in handy for glau-
coma patients who have astigma-
tism. If the astigmatism needs to be
addressed after cataract surgery with
glasses, this again can be an issue. If
the glasses are off center, there are
going to be a lot of aberrations as a
result, he said, adding that in such
a case the glaucoma patient will
become even more visually handi-
capped as a result.
"Again, you're really trying to
land that refractive outcome," Dr.
Teymoorian said. The intraoperative
aberrometer will help the surgeon
to pick a better toric lens power and
orient this in the correct way. "Just
because you picked the right lens
doesn't mean that it's well posi-
tioned," he said, adding that the
intraoperative aberrometer will alert
practitioners if this is an issue.
He views those with significant
astigmatism as perhaps the most
important glaucoma patients to get
top-notch refractive outcomes in,
and those who need only spherical
correction as relatively less critical.
With the intraoperative aber-
rometer, Dr. Teymoorian stressed
how important it is to use good
technique. "Be especially mindful of
understanding how it's used, when
you can get good results and when
you may not because there are fac-
tors that can cause the aberrometer
not to read as well." For example,
if the speculum is pushing down
on the eye, increasing astigmatism,
that is going to throw things off, Dr.
Teymoorian noted, adding that prac-
titioners need to know how to use
the system well so that they don't
end up with false astigmatism due to
a technical error.
Overall, Dr. Teymoorian hopes
that practitioners come to realize
how critical good refractive out-
comes are in the glaucoma patient
population. "More and more we're
going to be talking about good
refractive outcomes in glaucoma pa-
tients because you want to improve
their quality of life," he said. "It's
worth taking the extra step to get
it spot-on because at first we think,
'They're not going to do well with
a premium lens,' and we shove it
off as not being important, but it's
actually quite critical." EW
Editors' note: Dr. Teymoorian has
no financial interests related to his
comments.
Contact information
Teymoorian: steymoorian@harvardeye.com
Visual field of a patient with superior arc losses, which would
make using bifocals difficult.
Source: Savak Teymoorian, MD
