DEC 2016

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/753216

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Page 129 of 130

7 Supported by an unrestricted educational grant from Abbott Medical Optics cases at a single center. J Cataract Refract Surg. 2015;41:47–52. 2. Gavris M, et al. Fuchs endothelial corne- al dystrophy: is femtosecond laser-assisted cataract surgery the right approach? Rom J Ophthalmol. 2015;59:159–163. 3. 2015 ASCRS Clinical Survey 4. Yoo A, et al. Femtosecond laser-assist- ed arcuate keratotomy versus toric IOL implantation for correcting astigmatism. J Refract Surg. 2015;31:574–578. Dr. Yeu is assistant professor, East- ern Virginia Medical School, and in private practice, Virginia Eye Con- sultants, Norfolk, Virginia. She can be contacted at eyeu@vec2020.com. is an excellent way to perform limbal relaxing incisions for pa- tients with low levels of astigma- tism (less than 1.0 D), for whom a toric IOL is not available, and for patients with mixed astigmatism after surgery. 4 Patients are ex- tremely pleased if we can correct their suboptimal outcomes. Being familiar with technol- ogy that provides that extra level of precision and can help our patients achieve their refractive goals is a worthwhile and worthy pursuit. References 1. Abell RG, et al. Femtosecond laser-as- sisted cataract surgery versus standard phacoemulsification cataract surgery: outcomes and safety in more than 4000 in healing response and other considerations may necessitate a touch-up. I also explain that there is a very small chance that a lens exchange may be neces- sary. In this case, I will optimize vision for distance or near with a monofocal IOL, depending on the patient's preference. Patients with a very short eye (less than 22.0 mm), longer axial length (greater than 26.0 mm), or who are post-LASIK/ PRK/RK have a higher chance of a missed refractive target, and I stress that to these patients. If an enhancement is necessary, I emphasize that it is part of the package. It may take a little extra time to fine-tune their outcomes, but I promise to help them achieve their goal and have them use light spectacles or a contact lens in the interim. Contagious enthusiasm The enthusiasm for advanced technology IOLs and LACS is contagious. Patients and staff will be excited about this technology if surgeons are passionate about it. Having almost 4 years of expe- rience with LACS and seeing the reliable, reproducible outcomes and the high patient satisfaction continue to feed into the entire process. In addition, from the prac- tice's perspective, being well-in- formed, up-to-date, and educated on our own results helps main- tain the integrity of what we offer our patients. Increased opportunities Half of cataract surgeons do not perform relaxing incisions, based on results from the 2015 ASCRS Clinical Survey. 3 However, LACS greater level of safety for condi- tions such as Fuchs' dystrophy or zonular weakness. 1,2 The most important part of the discussion is identifying pa- tients' refractive goals in relation to their desired level of spectacle independence, profession, hob- bies, and needs; this guides me in making a recommendation. I en- courage them to ask questions to help them make a decision. In my practice, 55% of patients desire greater spectacle independence for distance, near, or both. I explain that refractive options with LACS help provide a level of spectacle independence that they would not have if they had blade-assisted surgery. To minimize the need for glasses at a specific focal point, in my expe- rience LACS has produced more reliable results. We review our cases routinely, and with LACS vs. manual cataract surgery with a monofocal IOL, my spherical equivalent outcomes are within 92% of the predicted target vs. 76% to 78% with manual cataract surgery, respectively. In addition, I can use LACS to reproducibly treat 1.0 D of astigmatism or less; if astigmatism exceeds 1.0 D, however, I recom- mend a toric monofocal or toric presbyopia-correcting IOL option. I routinely add LACS for ad- vanced technology IOLs because my personal results demonstrate that LACS adds greater refractive predictability. Before I conclude the con- versation, patients understand that there is a 92% chance that we will be able to achieve their goal of spectacle independence if I use LACS. In the remaining 8%, human factors such as variations " In our practice, we have "Cat Chats" with staff about three times per year in order to familiarize the clinicians and the cataract team of counselors, surgical schedulers, and technicians with the evolving technology and techniques. " –Elizabeth Yeu, MD

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