Eyeworld

9 EW NEWS & OPINION January 2017 World view Better outcomes through better calculations T he birth of refractive cataract sur- gery occurred shortly after World War II when Sir Harold Ridley boldly implanted the first IOL. For several decades all IOLs were of the same power until the first IOL formu- las gave us the opportunity to implant IOLs specifically indicated for individual patients. These early formulas like the Binkhorst and Hoffer gave us the tools to give patients thinner glasses and occasion- ally spectacle independence at distance. However, we continued to deal with high astigmatism associated with large incision intracapsular and extracapsular cataract extraction. Charles Kelman revolutionized all surgery—not just cataract surgery—with small incision phacoemulsification. Mean postoperative astigmatism was suddenly dra- matically reduced and refractive outcomes improved. When the A-scan was superseded by optical biometry, the accuracy of refractive cataract surgery took another leap forward. Today, new IOL formulas evaluating multiple parameters and using regression analysis and learning technol- ogy have improved outcomes even more. Keratometry devices that eval- uate both the anterior and posterior cornea give us better evaluation of corneal curvature, and intraoperative aberrometry has further improved IOL selection and astigmatism management. There are ophthalmologists who are mathematical geniuses that we regularly welcome into our offices. We know their names because their formulas help us improve our surgical outcomes—names like Barrett, Haigis, Hill, Hoffer, Holladay, Koch, Masket, and Olson. They have done more to improve our patients' lives than we may realize. In this issue of EyeWorld several of them share their experiences and pearls on improv- ing refractive outcomes. Jack Holladay, MD, and Kenneth Hoffer, MD, provide insights into perfecting IOL power predictions. They share their secrets using their own formulas as well as their colleagues'. Arguably the most challenging IOL calculations are in eyes with previous refractive surgery. Thanks to modern refractive corneal surgery's accuracy, these patients have enjoyed spectacle independence and are overwhelmingly looking for the same results following their cataract surgery. Doug Koch, MD, Sam Masket, MD, and Daniel Chang, MD, share their expertise in managing these patients. Today's number one step in providing the best uncorrected visual acuity following cataract surgery is treating residual astigmatism. Robert Weinstock, MD, Oliver Findl, MD, and Stephen Lane, MD, take on the challenge of combining modern technology with surgical expertise in treating astigmatism and improving outcomes. Finally, to treat astigmatism you must be able to measure it accurately. Jonathan Rubenstein, MD, Richard Tipperman, MD, Stephen Klyce, PhD, and Jack Holladay, MD, provide the pearls needed to measure cor- neal curvature and translate these measurements into reduced residual postoperative astigmatism. This is a must-read issue that will make all of us better cataract surgeons with happier patients. I would also like to acknowledge that EyeWorld recently marked its 20th birthday of publishing the most important stories in ophthalmolo- gy. EyeWorld has been guided by extraordinary leadership from its previ- ous medical editors, Marguerite McDonald, MD, Stephen Obstbaum, MD, Edward Holland, MD, Stephen Lane, MD, and David Chang, MD. David Karcher has been the guiding force at ASCRS for these 20 years, and it is an understatement to say we would not be where we are today without his leadership. However, the man behind EyeWorld is our publisher, Don Long. Don founded EyeWorld 20 years ago, and we continue to celebrate two decades with him working tirelessly behind the scenes. EW Eric Donnenfeld, MD, chief medical editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S January 2017 Volume 22 • No. 1 Publisher Donald R. Long don@eyeworld.org Editorial Editor Amy Goldenberg amy@eyeworld.org Managing Editor Stacy Jablonski stacy@eyeworld.org Senior Staff Writer/Digital Editor Ellen Stodola ellen@eyeworld.org Staff Writer Liz Hillman liz@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Stefanie Petrou Binder, MD Berlin, Germany Vanessa Caceres Bradenton, Florida Michelle Dalton Reading, Pennsylvania Rich Daly Arlington, Virginia Lauren Lipuma Washington, D.C. 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