Eyeworld

155 October 2016 EW MEETING REPORTER What is a revolution? Dr. Krueger said that its definition is a forcible overthrow of social order in favor of a new system, or in this case, new technology. Dr. Krueger highlighted predictability, imaging, lasers, and lenses as the aspects of the coming cataract and refractive revolution. In terms of predictability, he highlighted simulations, alignment, and customization. In imaging, intraoperative aberrometry and intraoperative image overlay are two aspects that could improve and help customize procedures. There is also a revolution with lasers, with minimally invasive elasto-modulation, a new genera- tion of femto-lasers, and new femto procedures, Dr. Krueger said. Current femtosecond lasers give us nice separation with laser ablation and cleaving, he said. New generation lasers may go into the ultraviolet, which could create even more re- fined pulses, he added. In terms of new procedures, Dr. Krueger said that SMILE is taking off around the world. "I think in the future, we'll see more SMILE-like procedures being done," he said, suggesting that perhaps procedures could be done using the lenticules and possibly reinserting them in eyes. New femto procedures may allow us to treat the lens itself and perhaps alter biomechanics and the rigidity of the lens, Dr. Krueger added. New lens updates include the possibility for intraoperative IOL adjustment and next generation presbyopic lenses. "Technology has been increas- ing [at] an exponential rate," Dr. Krueger said. The upcoming techno- logical revolution has already had a profound effect on cataract and refractive surgery and will continue to do so in the future, he added. It's important to be prepared, informed, and ready to adapt and integrate technology to your practice, Dr. Krueger said, adding it's important to be a part of the revolution and not a casualty of it. EW calculation formulae used in pedi- atric cataract surgery in a free paper session. He started by discussing the economic and social burden of childhood cataracts, adding that there is a higher prevalence in de- veloping countries. There have been microsurgical advances, he said, but IOL power calculation accuracy has not improved as much as the operative techniques. IOL calcula- tion formulae derived for adults are used in children, he said, but these are inaccurate. Dr. Deshpande added that accurate estimation of the IOL power is important in children to prevent amblyopia. His study aimed to evaluate the predictive value and accuracy of various formulae used for IOL power calculation in pedi- atric patients undergoing cataract surgery. The study also assessed the influence of a number of variables like age, axial length, keratometry values, anterior chamber depth, and lens thickness on the accuracy of several formulae. The study found there is still a question of which formula is best to use in children. Dr. Deshpande said that it's suggested that the SRK-T formula could be best for pediatric cataract surgery. He added that new- er variables need to be explored to improve the ability to achieve more accurate prediction of postoperative refractive errors. He suggested the development of an IOL calculation formula specifically designed for the pediatric population. Marie-Jose Tassignon, MD, Antwerp, Belgium, the chair of the session, stressed the importance of keeping all parameters in mind when choosing a formula. Don't just follow one formula blindly, she said. Additionally, Dr. Tassignon suggest- ed using a lens that can be explant- ed easily. International Society of Refractive Surgery (ISRS) symposium During the ISRS symposium, Ronald Krueger, MD, Cleveland, gave the keynote lecture on "Upcoming tech- nological revolution in cataract and refractive surgery." being the best in terms of patient satisfaction) was also reported. Overall, the mean pupil diam- eter decreased over time in patients with asymmetrical multifocal IOLs, and a correlation was observed between quality of vision and pupil diameter each year of the study period, showing that the photopic pupil diameter does in fact impact visual quality. Patient satisfaction was very good in those who had a pupil diameter of at least 3.2 mm, while those with a diameter less than that appeared to have significantly reduced quality of vision. "To be 95% confident of attain- ing a pupil size postoperatively of 3.2 mm or above at 1 year postop, the mean drop in pupil size after surgery at 1 year is 0.2 mm plus two [standard deviations of error] of 0.07 mm, equaling a required preop pupil size of 3.54 mm," Mr. McNeely said. Mr. McNeely said that assess- ing pupil diameter preoperatively could help predict quality of vision in patients considering asymmetri- cal multifocal IOLs, but he said the methodology still has to be validat- ed further to see if it could be used to improve screening strategies. Pediatric cataract surgery Rahul Deshpande, MD, Pune, India, presented on a study of pre- dictive value of various IOL power If the patient is still experienc- ing pain, it could be a combination of ocular surface disease and neuro- pathic pain or just neuropathic pain. In addition to many of the pre- viously discussed ocular surface and lid treatments for dry eye, Dr. Asbell said post-LASIK patients might be candidates for peripheral nerve regenerative therapies, therapeutic scleral lenses, or systemic pharmaco- therapy. Effect of postop pupil diameter on quality of vision with multifocal IOLs Studies have shown that pupil diameter affects visual performance of asymmetric multifocal IOLs, and it's well known that pupil diameter decreases with age. As such, Richard McNeely, a PhD student, Belfast, Northern Ireland, presented research during a session that sought to assess the re- lationship between postop pupil size and quality of vision up to a 3-year period, specifically following those with asymmetrical multifocal IOLs. The study included 150 patients with the LENTIS Mplus MF30 IOL (Oculentis, Berlin). Pupil diameters were measured preop and postop at 1, 2, and 3 years. A quality of vision questionnaire was taken postop each year during the study period and a 0 to 10 score (0 being the worst, 10 View videos from ESCRS 2016: EWrePlay.org Boris Malyugin, MD, discusses surgical approaches for treating various stages of traumatic aniridia.

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