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EW SECONDARY FEATURE
September 2016
characterize the condition and come
up with the best way to address the
patients' visual needs. For some, that
means going right back to a contact
lens, Dr. Harvey said. EW
said. The SRK-II or SRK-T formulas
may work.
Dr. Barsam said that he will use
both a topography device, either
the Pentacam (Oculus, Arlington,
Washington) or Galilei (Ziemer Oph-
thalmic Systems, Port, Switzerland),
and a biometry device, either the
IOLMaster 700 (Carl Zeiss Med-
itec, Jena, Germany) or LENSTAR
(Haag-Streit, Koniz, Switzerland). He
said it's important to obtain multi-
ple keratometry readings from these
devices.
How to handle less-than-
optimal outcomes
If the toric lens implant is out of
alignment, the best option is to
fix the main problem, Dr. Lee said,
which is either rotating the IOL
or changing the IOL power if it is
inaccurate. Several free websites that
can help with the decision-making
process exist, such as astigmatismfix.
com or assort.com, he added.
Dr. Lee said he has had situa-
tions where the patient thinks the
results are suboptimal. "To this
point, I have been able to apply
these cases to the formulas on sites
such as astigmatismfix.com and
provide improved outcomes for the
patients in almost all situations,"
he said. "In rare cases, I have simply
performed an IOL exchange for
a monofocal lens, and this has
restored vision in the rare case that
the patient remained unhappy."
There is always a chance
that a surgeon will end up with
a less-than-optimal outcome. All
options are on the table for most
eyes that are crosslinked, Dr. Harvey
said. Patients could have PRK with
topography guidance if they are not
too severely affected by ectasia. Also,
an IOL exchange could be used, or
small limbal relaxing incisions in
mild keratoconus. Dr. Harvey noted
that he would not do LASIK because
it weakens the cornea more by cut-
ting more stromal fibers.
"The first thing is to recognize
that these are abnormal eyes, and
they can certainly cause trouble
even in the most experienced
hands," Dr. Harvey said.
Identifying the abnormal cor-
neas is the first thing you need to
do, he said. The second thing is to
Editors' note: The physicians have
no financial interests related to their
comments.
Contact information
Barsam: www.allonbarsam.com
Harvey: tm.harvey@sbcglobal.net
Lee: wblee@icloud.com
