Eyeworld

EW CATARACT 33 July 2016 After insertion, he'll leave the IOL 10 degrees shy of its intended axis, remove all of the viscoelastic, and rotate the lens into its final position. Dr. Berdahl had similar advice, noting that using stable IOLs in the first place can help prevent rotation. In addition to making sure you remove all the viscoelastic and give the lens adequate time to unfold completely, he suggested surgeons tamp on the lens, making sure it comes into solid contact with the posterior capsule. Dr. Hardten said 1 of the most common preoperative pitfalls is using a toric IOL in a patient with irregular astigmatism. "Toric IOLs are designed to treat regular astigmatism, so if the patient has irregular astigmatism from keratoconus, significant basement membrane dystrophy, prior corneal refractive surgery, or traumatic cor- neal scarring, beware of the use of toric IOLs in this situation. Corneal topography is an important tool to analyze the regularity of the astig- matism," he said. Dr. Hardten said that while most of the time physicians will be on target with their initial astigma- tism corrections, they should have a plan for patients with residual astigmatism who have a strong desire to achieve good uncorrected visual acuity. "It is difficult for patients to be told that there is still residual refractive error and that they need to wear glasses for their vision after you have done the initial procedure. Develop the skills and the knowl- edge to take these patients all the way to spectacle independence for their distance uncorrected vision," he said. In the end, Dr. Kieval said while toric IOLs can be wonderful, residual astigmatism postop is not uncommon. Fortunately, there are strategies to successfully treat these surprises. "Be sure to communicate with the patient throughout this pro- cess," Dr. Kieval added. EW Editors' note: Dr. Berdahl has finan- cial interests with Alcon (Fort Worth, Texas), Abbott Medical Optics (Abbott Park, Illinois), ClarVista Medical (Aliso Viejo, California), and Calhoun Vision (Pasadena, California). Dr. Hardten has financial interests with Abbott Medical Optics and Oculus (Arlington, Washington). Dr. Kieval has financial interests with Abbott Medical Optics, Alcon, and Shire Pharmaceuticals (Lexington, Massachusetts). Contact information Berdahl: john.berdahl@vancethompsonvision.com Hardten: drhardten@mneye.com Kieval: jkieval@lexeye.com Only the HOLOS IntraOp ™ Wavefront Aberrometer continuously streams patient refractive data. Meaning you'll get a non-stop look at your procedure as it changes. And see cataract surgery in a whole new light. With HOLOS, precision doesn't pause —and neither will you. Really real time. ©2016 Clarity Medical Systems Inc. PN 100331 Rev A 04/16 HOLOS.com IOL Predictor Coming Summer 2016

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