Eyeworld

9 June 2017 EW ASCRS NEWS Dr. Donnenfeld noted that Dr. Steinert is a family man, with six children, six grandchildren, and a loving wife, April. Dr. Donnenfeld also hailed Dr. Steinert's humanity and sense of humor. "He is a friend to me. And he is a friend to all of us," Dr. Donnenfeld said. EW References 1. Dubbelman M, et al. Radius and asphericity of the posterior corneal surface determined by corrected Scheimpflug photography. Acta Ophthalmol Scand. 2002;80:379–383. 2. Koch DD. The enigmatic cornea and intra- ocular lens calculations: The LXXIII Edward Jackson Memorial Lecture. Am J Ophthalmol. 2016;171:xv–xxx. 3. Wang L, et al. Comparison of newer intraoc- ular lens power calculation methods for eyes after corneal refractive surgery. Ophthalmolo- gy. 2015;122:2443–2449. Editors' note: Dr. Koch has financial interests with Alcon (Fort Worth, Texas), Carl Zeiss Meditec, and Johnson & Johnson Vision (Santa Ana, California). Dr. Donnenfeld has financial interests with Johnson & Johnson Vision and other companies. Contact information Koch: dkoch@bcm.edu Donnenfeld: ericdonnenfeld@gmail.com challenge is the lack of a gold stan- dard to validate measurements. Some research, however, has indicated better results when using various lens power calculation formulas. For instance, Graham Barrett, FRANZCO, found that with the Barrett Universal II formula total corneal power from the IOLMas- ter 700 (Carl Zeiss Meditec, Jena, Germany), he was able to get 91% of eyes within 0.5 D. "That's promising in terms of our ability to crack this nut, to actu- ally measure the posterior cornea," Dr. Koch said. Surgeons have relied on what Dr. Koch calls regression solutions to measure posterior corneas among post-LASIK eyes. The approach is based on an average from a prior series of patients—as opposed to simply measurement of the patient. However, among such patients with no prior data, surgeons are only getting 60% within 0.5 D. "Regression approaches have maxed out in my view," Dr. Koch said. New approaches that measure posterior corneal curvature using either Scheimpflug or OCT technol- ogy still have not taken physicians to more than 70% within 0.5 D, his group reported. 3 Corneal disease Dr. Koch noted that keratoconus has a lot in common with LASIK in that the anterior cornea and poste- rior cornea need to be measured to get an accurate reading of corneal power. "We have found that the steeper the cornea, the greater the hyper- opic error in these keratoconus eyes," Dr. Koch said. Similar issues arise in corneal transplantation. For instance, it's known that the posterior cornea after DSEK steepens unpredictably. Astigmatism correction The research of Dr. Koch and others has shown that the posterior cornea is steep vertically in more than 85% of corneas. "If we calculate the corneal astigmatism from the anterior sur- face only, we're going to overcorrect with-the-rule patients and undercor- rect against-the-rule patients," Dr. Koch said. One way to account for that in calculations is to use regression for theoretical-based formulas that are based on averages. But using the five available formulas has only achieved about 80% within 0.5 D. "Again, just as for spherical corneal power, we need accurate measurements of posterior corneal astigmatism. Then we can get be- yond our current regression formu- las, which I consider to be place- holders awaiting the capability of measuring posterior corneal power in all of our patients, whatever their corneal condition," Dr. Koch said. Honoring Dr. Steinert Dr. Koch hailed Roger Steinert, MD, chair of the department of ophthal- mology, and Irving H. Leopold pro- fessor, University of California, who asked Dr. Koch to deliver the first Steinert Refractive Lecture during Refractive Day at the ASCRS•ASOA Symposium & Congress. "I've had some nice opportu- nities in my career but none mean more to me than giving this lec- ture," Dr. Koch said. In introducing Dr. Koch, Eric Donnenfeld, MD, clinical professor of ophthalmology, New York Uni- versity, hailed Dr. Steinert as "clearly the most beloved person in all of ophthalmology." "It is with great pride that ASCRS decided to honor Roger for our respect and admiration for the man and for overwhelming ap- preciation for his accomplishments and his impact on ASCRS, ophthal- mology, our patients, and all of refractive surgery," Dr. Don- nenfeld said. Dr. Steinert's leadership in ophthalmology has included serving as president of the medical staff and director of the corneal service at Massachusetts Eye and Ear Infirma- ry. He then moved to California and became professor, chairman, and interim dean at University of Cali- fornia Irvine. "Having accomplished this on both coasts, he said, 'What more could I do?' He said 'Let's build an eye center,' and he built the Gavin Herbert Eye Institute in Irvine," Dr. Donnenfeld said. A former president of ASCRS, Dr. Steinert held 18 visiting fellow- ships, presented 21 named lectures, owns 15 patents, and has published eight books, 116 book chapters, and many journal articles. "More impressive to me is that he was program director of ASCRS' annual meeting for 10 years," Dr. Donnenfeld said. "It is a task I'd wish on no one and Roger did it with panache, he did it with extraor- dinary dignity." Dr. Steinert's leadership ex- tends all the way back to his role as principle investigator and medical monitor for the first excimer laser, and he's served as medical monitor for many subsequent medical trials on inlays, femtosecond lasers, and other technology. HEALTHCARE PROFESSIONAL INDICATION AND IMPORTANT SAFETY INFORMATION The STAR S4 IR® Excimer Laser and iDESIGN® Advanced WaveScan Studio System for wavefront-guided LASIK in patients with myopia. CAUTION: U.S. Federal Law restricts this device to sale, distribution, and use by or on the order of a physician or other licensed eye care practitioner. ATTENTION: Reference the Operator's Manual for a complete listing of Indications and Important Safety Information. INDICATIONS: The STAR S4 IR® Excimer Laser and iDESIGN® Advanced WaveScan Studio System is indicated for wavefrontguided LASIK in patients with myopia as measured by iDESIGN® System up to -11.00 D SE, with up to -5.00 D cylinder; with agreement between manifest refraction (adjusted for optical infinity) and iDESIGN® System refraction of 1) SE: magnitude of the difference is ˂ 0.625 D, and 2) cylinder: magnitude of the difference is ≤ 0.5 D; with patients 18 years of age and older, and with refractive stability (a change of ≤ 1.0 D in sphere or cylinder for a minimum of 12 months prior to surgery). CONTRAINDICATIONS: Laser refractive surgery is contraindicated in patients with: collagen vascular, autoimmune, or immunodeficiency diseases, pregnant or nursing women, keratoconus, abnormal corneal topography, epithelial basement membrane disease (EBMD) and degenerations of the structure of the cornea, symptoms of significant dry eyes, corneal thickness would cause anticipated treatment would violate the posterior 250 microns (μm) of corneal stroma, advanced glaucoma, and uncontrolled diabetes. If the patients have severely dry eyes, LASIK may increase the dryness; this may or may not go away. Severe eye dryness may delay healing of the flap or interfere with the surface of the eye after surgery; it may result in poor vision after LASIK. WARNINGS AND PRECAUTIONS: LASIK is not recommended in patients who: have a history of Herpes simplex or Herpes zoster keratitis, have severe allergies or tendency rub their eyes often, are taking the medication Isotretinoin (Accutane®), are taking antimetabolites for any medical conditions. The safety and effectiveness of this laser for LASIK correction have NOT been established in patients: with progressive refractive errors; previous corneal or intraocular surgery; or trauma in the ablation zone, who are taking the medication Sumatriptan (Imitrex®), or Amiodarone hydrochloride (Cordarone®), with corneal neovascularization within 1.0 mm of the ablation zone, over the long term (more than 1 year after surgery), for patients who engage in activities that could endanger or damage the LASIK flap, for patients who have a family history of degenerative corneal disease, history of inflammation of the eye, for patients who have a history of crossed eyes (strabismus) or who have undergone strabismus surgery, prior LASIK or Refractive Surgery, with history of any eye diseases or abnormalities such as corneal scars or active disease, and whose BSCVA is worse than 20/20. To reduce the risk of corneal ectasia, the posterior 250 microns (μm) of corneal stroma should not be violated. The treatment of highly myopic eyes necessitates the removal of significant amounts of corneal tissue. The iDESIGN® System calculates the estimated residual bed depth using the pachymetry and intended flap thickness entered by the user. Actual flap thicknesses may vary. If the estimated residual stromal bed is ≤ 320 microns, an in-the-bed pachymetric measurement should be performed. ADVERSE EVENTS: Possible adverse events include loss of best spectacle corrected visual acuity (BSCVA), serious Transient Light Sensitivity Syndrome, serious primary open angle glaucoma, miscreated flap, melting of the flap, severe glare, and severe dry eyes. Complications can include corneal edema, epithelial ingrowth, diffuse lamellar keratitis, foreign body sensation, and pain. ©2016 Abbott Medical Optics Inc. iLASIK, iDESIGN, iDESIGN Advanced WaveScan Studio, WaveScan, and STAR S4 IR are trademarks owned by or licensed to Abbott Laboratories, its subsidiaries or affiliates. All other trademarks are the intellectual property of their respective owners. PP2016RF0055

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