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EW RESIDENTS 72 May 2016 unclear to what degree this would influence our phaco setting choices. This study demonstrated increased efficiency at higher IOP settings, but in our experience, we adjust the IOP more due to intraoperative safety and comfort issues rather than efficiency issues. Most of our cases, as with the rest of the community, are done under topical anesthesia, and many of our patients would feel some discomfort at IOPs of 80–110 mm Hg. Operating at our affiliate facilities where many of our patients have poor access to care and as a result present with very advanced diseases, we are often operating on advanced glaucoma patients where such high IOPs can be dangerous. Finally, this setting was introduced to "maintain the anterior chamber," and as such, we are often adjusting the IOP in coordination with the size of our anterior chamber—for example, lowering it for highly my- opic patients. From our experience, the IOP is likely the last setting to be changed to achieve efficiency or decrease chatter. On the other hand, it is possible that in a patient with no history of glaucoma and relatively uncompli- cated cataracts, increasing the IOP could improve clinical outcomes. If this laboratory finding did in fact translate clinically, increasing the IOP could potentially reduce the amount of phaco energy needed in a case, and thus decrease the likelihood and amount of postoper- ative corneal edema and endothelial compromise. Additionally, reducing chatter by increasing the IOP could help the surgeon maintain control, which may be important for nov- ice resident surgeons and also be beneficial for patient safety. Thus, in patients who have otherwise normal baseline IOPs and no other con- cerning comorbidities, increasing the IOP may have some potential clinical benefits. While Active Fluidics was introduced with the Centurion as a means to further minimize post-oc- clusion surge, this study suggests that by increasing the IOP, efficien- cy can also be enhanced. Rotating from 1 hospital to the next, we as residents often use the settings of our attendings or residents that precede us. With the number of phacoemulsification systems and their respective increase in options in controlling fluidic parameters, it becomes more difficult to learn how to personalize our settings. Objective studies such as this one are important and helpful for a novice surgeon to understand the newest technology that contributes to fluidics in order to better optimize our settings. EW References 1. Sharif-Kashani P, et al. Comparison of occlusion break responses and vacuum rise times of phacoemulsification systems. BMC Ophthalmol. 2014;14:96. 2. Gupta I, et al. Effect of increased vacuum and aspiration rates on phacoemulsifica- tion efficiency. J Cataract Refract Surg. 2015;41:836–841. 3. Oakey ZB, et al. Porcine lens nuclei as a model for comparison of 3 ultrasound modalities regarding efficiency and chatter. J Cataract Refract Surg. 2013;39:1248–1253. Contact information Devgan: devgan@ucla.edu UCLA continued from page 70 UCLA residents, from left: Wonchon Lin, MD, Mitra Nejad, MD, and Jenny Chen, MD Source: UCLA View the EyeWorld CME and non-CME supplements at: cmesupplements. eyeworld.org supplements. eyeworld.org

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