Eyeworld

EW FEATURE 52 All about IOL calculations • January 2017 AT A GLANCE • Advanced refractive technology for astigmatic patients can help improve outcomes, make surgery more efficient, and guide surgical decisions. • Cutting-edge technology is not necessarily needed to start using toric IOLs and better address astigmatic concerns. • Provide solid training to staff on advanced technology for astigmatism, and have backup plans in place when technology does not work. • Incorporate posterior cornea measurements into your data for astigmatic patients. by Vanessa Caceres EyeWorld Contributing Writer Dr. Lane gave the analogy of prescribing glasses for a patient and always making sure to address a patient's astigmatism—it makes sense that a cataract surgeon would give the same consideration when implanting IOLs in patients by ad- dressing astigmatism. It's important to look beyond outcomes when you select technol- ogy for astigmatic correction, Dr. Findl said. In fact, having advanced technology to help treat astigmatic patients has not really changed his outcomes. He was involved with a trial that compared manual mark- ings with the Callisto; although the Callisto did show more precision, it was not a significant difference. "At the end of the day, if you do manual markings with a focus on precision, it works well," he said. Consider other ways that technology may help you, such as by making surgery more efficient or eliminating some human errors. As you start to incorporate advanced refractive technology into your cataract surgery, keep these pearls in mind for achieving better astigmatic outcomes. 5 tips to maximize technology use T he advanced technology that refractive cataract sur- geons have at their disposal can help sharpen outcomes for astigmatic patients, according to physicians well versed in the technology. From intraoperative aberrome- try to femtosecond lasers to guid- ance systems to toric IOLs, patients experience better outcomes—and surgeons find that the various tech- nologies work synergistically. "The technology has made ev- erything more accurate," said Robert Weinstock, MD, Eye Institute of West Florida, Largo, Florida. Refrac- tive enhancements for Dr. Weinstock now occur in fewer than 4% of patients. "I attribute a lot of that to great biometry but also to the utiliza- tion of these devices and software to make sure astigmatism management is as accurate as possible." Advanced refractive technology also eliminates some of the preoper- ative steps once needed, said Oliver Findl, MD, Department of Ophthal- mology, Hanusch Hospital, Vienna, Austria. For instance, preop marking of the eye was once crucial—and oc- casionally forgotten. Now with the Callisto system (Carl Zeiss Meditec, Jena, Germany), it isn't necessary, he said. Various technology he has available now can transfer data among his systems without the risk of human transcription errors that were sometimes made before. Technology such as intraopera- tive aberrometry can be a "tiebreak- er" in driving final surgical decisions, Dr. Weinstock said. He has an ORA System (Alcon, Fort Worth, Texas) and uses it to help assess his laser-cre- ated arcuate incisions and whether or not to modify them. He also uses ORA to guide toric IOL placement. Published reports have shown that the use of intraoperative aberrometry can improve results by 5% to 10%, said Stephen Lane, MD, medical director, Associated Eye Care, and adjunct clinical professor, University of Minnesota, Minneapolis. That said, Dr. Lane encourages cataract surgeons to make the leap to using toric IOLs in astigmatic patients even if they don't have all of the cutting-edge technology now available. "While we have incredible tools to help us, we don't need all of those tools for excellent results. You can improve good results to become excellent, but you shouldn't sit on the sidelines waiting to use toric IOLs because you don't feel the technology is good enough yet or is too expensive. … The first step is being involved in implanting toric IOLs," he said. Advanced technology sharpens astigmatic outcomes after cataract surgery Tip 1: Get tech-savvy—and have your best technicians get savvy as well Use of advanced refractive technol- ogy requires a solid working knowl- edge of things like femtosecond lasers and the interaction between preoperative and intraoperative systems. Get the proper training for everyone involved. Tip 2: Have backup plans in place Even the best technology can fail, and that's why Dr. Weinstock has patients marked ahead of time with the RoboMarker (Surgilum, Wilmington, North Carolina), in case laser technology does not work or does not give a good reading. "Sometimes, the corneal marking is your fallback," he said. Tip 3: Consider the role of the posterior cornea Cataract surgery leaders have re- cently reported on the importance of posterior cornea measurements, which can be done in several differ- ent ways. Dr. Findl and staff always perform corneal topography and tomography and use the latter to assess the posterior cornea versus The Callisto as seen by the surgeon during the procedure Source: Oliver Findl, MD continued on page 54

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