Eyeworld

MAR 2012

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

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March 2012 EW MEETING REPORTER 121 have a perfect system," said Jonathan B. Rubenstein, M.D., vice chairman and Deutsch Family Professor of Ophthalmology, Rush University Medical Center, Chicago. PCRIs may be used to manage astig- matism when implanting a multifo- cal lens in a patient or in cases of high astigmatism where a patient's astigmatism exceeds the power of the toric lens. In those cases, a sur- geon may opt to combine the toric lens implantation with the PCRI, according to Dr. Rubenstein and panelist Brock K. Bakewell, M.D., clinical assistant professor of oph- thalmology, University of Utah, Salt Lake City. Contraindications for PCRIs include limbal peripheral corneal pathology, extreme dry eye (often associated with rheumatoid disease), and previous radial kerato- tomy and astigmatic keratotomy, as well as possible asymmetric astigma- tism. Saturday, February 18 Pre-op screening for HOAs A device to quantify patients' qual- ity of vision will help surgeons bet- ter understand why some patients are unhappy after multifocal IOL implants, even when they are seeing 20/20, said one surgeon speaking during a new technology sympo- sium Saturday at the 2012 ASCRS Winter Update in Riviera Maya, Mexico. The iTrace (Tracey Tech- nologies, Houston, distributed by Hoya Surgical Optics, Chino Hills, Calif.) offers traditional topography, but also allows clinicians to evaluate higher order aberrations (HOAs) from the entire eye. "It allows you to separate from the internal optics, which would typically be the lens or the cornea," said David F. Chang, M.D., clinical professor of ophthal- mology, University of California, San Francisco. The technology, which provides auto-refraction, corneal topography, ray tracing aberrometry, pupillometry, and auto-keratometry, gives surgeons an objective guide to help supplement the patient's subjective history and assessment of an IOL, Dr. Chang said. "There are a lot of people out there with multifocals who are com- plaining about the quality of their vision, yet Snellen acuity is very good," he said. "We reassure them that everything is normal and then we think to ourselves, 'This is a fussy person. I hate these type A people.'" Instead, he said, surgeons need to screen for corneal HOA to under- stand where a patient is coming from. Dr. Chang showed five exam- ples and pointed out how the iTrace can give clinicians an idea of what the patient is experiencing visually by providing an eye chart "E" at the image quality the person is seeing. For example, the more HOAs, the blurrier the "E" will appear on the readout. This year, Dr. Chang added, Hoya has included a new package based on toric IOLs, including a toric planner. "This is a Sim K, a 3- mm reading just like a keratometer," Dr. Chang said. "The other function, where they measure the refraction and all the points within this 3-mm zone and they use a best fit for the refraction now using wavefront for the toricity—if you think about it, that's what we do with glasses." "A renaissance" in glaucoma surgery Minimally invasive glaucoma surgery (MIGS) offers glaucoma surgeons much lower risk and earlier surgical intervention for the disease, according to Richard A. Lewis, M.D., cataract surgeon and glaucoma specialist, Sacramento, Calif. Drainage stents are the latest and greatest part of a glaucoma sur- geon's armamentarium, he said. "We have a true renaissance happening in glaucoma right now," Dr. Lewis said. The iStent Trabecular Micro-By- pass (Glaukos, Laguna Hills, Calif.), which is expected to be FDA ap- proved in the U.S. in the coming weeks, is a quick procedure that places a stent in the canal. It often will be used in conjunction with cataract surgery. "The iStent utilizes the primary physiological outflow pathway for aqueous humor, which is the trabecular meshwork, whereas a shunt like a trabeculectomy or a tube creates an artificial pathway by bypassing the natural, physiological outflow system," he said. Dr. Lewis said the MIGS procedures offer no risk of hypotony. Surgeons don't have to worry about blebs or bleb-re- lated complications. "There's very little impact on visual acuity," he said. MIGS procedures are for mild to moderate disease in patients with continued on page 122

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