Eyeworld

EW MEETING REPORTER 106 Editors' note: Dr. Holladay has no financial interests related to his com- ments. Dr. Miller has financial interests with Abbott Medical Optics (Abbott Park, Illinois) and Alcon (Fort Worth, Texas). Pharmacology and new intraocular lenses Sessions on pharmacology and new intraocular lenses covered sublingual sedation, optimizing clear corneal incision construction, alternatives to drops and intravenous therapy for the cataract patient, intracameral antibiotics and hemorrhagic occlu- sive retinal vasculitis, presbyopic in- traocular lenses, and next generation accommodating intraocular lenses. Eric Donnenfeld, MD, Rock- ville Centre, New York, gave an update on presbyopia IOLs. Right now, Dr. Donnenfeld said, multifocal and extended depth of fo- cus lenses are his current best option for spectacle independence follow- ing cataract surgery. In the past, there was high spectacle indepen- dence but complaints of halos. New IOLs give dramatically better quality of vision, he said. There are now many options for different powers of these lenses and performance differs. This helps to meet the demands of patients with near and intermedi- ate vision needs. "It's all about the capsules are smoother than those created by any femtosecond laser; greater than 99.5% of FLACS cap- sules are completely free of tags or adhesions to the remaining capsule when performed by experienced surgeons; posterior corneal folds, interface bubbles, corneal opacities, intumescent white cataracts, and loss of suction are the most com- mon causes of incomplete capsulo- tomies; capsulotomies created with low pulse energies are more resistant to tears than those created with high pulse energies; and increasing nucle- ar density increases the likelihood of an incomplete capsulotomy. The femtosecond laser creates a perfectly round capsulorhexis that can be centered with respect to the pupil or cornea, Dr. Miller said, and this is probably the biggest advantage. It may also be stronger when created by a femtosecond laser, he said. A femtosecond laser capsulorhexis does not require the use of OVDs or capsule stains, and it can be fashioned in small pupil cases after the insertion of a pupil expansion device. However, he did note that radial tears in the anterior capsule still occur. "We're at the beginning of this technology," Dr. Miller said, comparing it to the early days of phacoemulsification. This measures a ring of the cornea, not a zone. With keratometry, the actual power of posterior cornea is unknown, but that's OK about 90% of the time, he said. Remember that keratometry measures from four to 24 points on a ring, whereas zonal Ks measure thousands of points, Dr. Holladay said. If the ring is not regular, you should move to topography, he said. Kevin Miller, MD, Los Angeles, spoke about femto capsulotomy, sharing clinical and lab results. He first discussed the capsulorhexis, which he said ensures in-the-bag containment of the IOL for the life of the patient. It is the most difficult part of cataract surgery for begin- ners, he said. Meanwhile, femto laser capsulotomy allows a beginner surgeon to achieve the same results as an expert, much like OVDs did when they were introduced. How- ever, beginner surgeons must learn to dock a patient interface to the eye and navigate the instrument's software. The very first part of the procedure is going to be the capsu- lorhexis, Dr. Miller said. Advantages of femto capsulot- omy include perfect sizing; perfect positioning with respect to the pupil or limbus; possible improvement in the ELP calculation; it reduces the risk of radialization, vitreous loss, and dropped lens fragments; and it facilitates the development of IOL designs that require a perfectly sized and positioned capsulorhexis. There are not many disadvan- tage of femto capsulotomy, Dr. Miller said, but there are some, including the major point that femtosecond lasers are expensive and the capsulotomy is not sepa- rately covered by insurance. Other potential disadvantages are a longer time to perform the femto capsulo- tomy than a manual capsulorhexis and a possible reduction in tensile strength of the capsulotomy. He added that the femtosecond laser cannot be used in every case. Hundreds of studies have been published on femto capsulotomies. The take-home messages from these studies, Dr. Miller said, are that the capsulotomy edges of manually torn February 2017 continued on page 108 View videos from Hawaiian Eye 2017: EWrePlay.org Eric Donnenfeld, MD, discusses the new technology of current presbyopic IOLs. Reporting from Hawaiian Eye 2017, January 14–20, Kauai, Hawaii Sponsored by

• Cover