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August 2012 EW CORNEA 51 Dr. Werner said clinically speak- ing, ophthalmologists can use these systems to "confirm a diagnosis of different conditions leading to opacification of IOLs, which include calcification of hydrophilic acrylic lenses, snowflake degeneration of PMMA lenses, among others." Advantages of anterior segment OCT Both physicians agreed, however, that a major benefit of anterior segment OCT is to confirm what the slit lamp cannot. "The slit lamp is still an incredi- bly important piece of equipment," Dr. Safran said. "But when you see something that needs clarification, OCT can provide very detailed infor- mation about things that can't be vi- sualized optically. The OCT images are guided, however, by slit lamp examination and then can be used to bring out details about specific things seen on exam. When looking at the posterior segment we know where the macula and optic nerve are, so we can automatically go there to scan. But with anterior seg- ment OCT, the pathology that needs examination is almost completely guided by the slit lamp evaluation." For instance, if a patient's corneal transplant graft is failing and the endothelium doesn't look healthy, "I can look at the posterior surface of the cornea to the host- graft junction," Dr. Safran said. "If the junction is small, you can plan on a DSAEK instead of a repeat graft." And because the diagnostic tool is helping plan a (potentially) safer surgery, using anterior segment OCT is reimbursable, he said. For more common pathologies, this type of OCT can help clinicians differentiate between posterior or anterior astigmatism, he added. Dr. Werner said while IOL opaci- fication and glistenings can gener- ally be confirmed under the slit lamp, "some ophthalmologists not familiar with these conditions may be in doubt," she said. Since IOL cal- cification or snowflake degeneration can only be treated by explantation, an OCT scan can help confirm the location of the opacification—IOL, posterior capsule, vitreous, etc. "If unnecessary procedures such as Nd:YAG laser posterior capsulo- tomy or vitrectomy are avoided in these cases, the surgeon explant- 973-989-1600 r 800-225-1195 r www.katena.com ™ IntraLase® Flap Lifter Combines a 1mm long Sinskey Hook for finding the flap edge and a long, blunt, 11mm long hook to undermine the flap perpendicular to the hinge. ing/exchanging the opacified IOL will have the best conditions and will be able to place the new lens within the capsular bag," she said. Anterior segment OCT is being used to measure corneal flaps, ante- rior chamber diameter, and crys- talline lens thickness, and can be used to evaluate phakic IOL vault- ing, epithelial ingrowth in post- LASIK eyes, or residual stromal bed thickness, or even help determine where to place sutures in a corneal transplant, the surgeons said. "If my OCT could do what the IOLMaster [CZM] can do, I'd have to continued on page 52 Fe Femtos cond INSTRUMENTS Thorlakson Eye Speculum Adjustable mechanism 10mm rounded wire blades designed to accommodate the suction ring of the FEMTO LDVTM laser. emtoseconde Thorlakson Z-LASIKTM Flap Lifter Combines a 1mm long, extra fine modified Sinskey Hook and a 12mm long bi-convex spatula with beveled notches. To lift LASIK flaps created with a femtosecond laser.