Eyeworld

139 February 2018 EW MEETING REPORTER tunnels at a 400-micron depth. The inserts are tangentially oriented and at a 4-mm distance relative to the limbus. Dr. Beckman described a study looking at postoperative near visual acuity outcomes of eyes with laser vision correction (LVC) to neutral- ize unwanted refractive error in an effort to achieve better uncorrected near visual acuity in patients who previously received the VisAbility micro inserts for presbyopia correc- tion. The patient cohort included 31 patients with prior VisAbility inserts bilaterally implanted. The patients elected laser vision correction upon completion of their VisAbility follow up, Dr. Beckman said, and 38 eyes have been followed to 6 months post-LVC. Dr. Beckman noted the im- provement in lines of vision for these patients, and he said there was almost three lines of near improve- ment following LVC. At baseline, 3% of patients had J1 or better, 8% had J2 or better, and 26% had J3 or better. At 3 months, this improved to 58% with J1 or better, 85% with J2 or better, and 94% with J3 or better. At 6 months, 55% had J1 or better, 76% had J2 or better, and 92% had J3 or better. In summary, Dr. Beckman said there was a mean line improvement at 3 months of +2.9 lines and +2.8 lines incidence of cataract surgery in this population. The patients understand the importance of quality uncorrect- ed visual acuity and overwhelmingly are interested in a presbyopia IOL solution, he said. Dr. Donnenfeld noted that there is not a lot of literature on this topic, but he did reference a few studies where surgeons have found success using these lenses in post-refractive surgery patients. What do you need to consider? Dr. Donnenfeld said IOL calculation, the ablation, and patient expecta- tions. For IOL calculations, you have to be using an advanced IOL for- mula, and there are many that give good results. He highlighted the ASCRS calculator, and he also likes to use intraoperative aberrometry to help give him better accuracy. With the ablation, Dr. Donnen- feld said you need to consider cen- tration, the preoperative refractive error, and ablation technology. Finally, with patient expec- tations, he noted that the patient must be informed about the risk of glare and halos and about the possibility of having to do an IOL exchange. In conclusion, Dr. Donnenfeld said that with preoperative patient selection and additional informed consent, multifocal and extended depth of focus IOLs can provide excellent results following previous refractive corneal surgery. Editors' note: Dr. Donnenfeld has financial interests with a number of ophthalmic companies. Scleral micro inserts for presbyopia with laser vision correction Kenneth Beckman, MD, Colum- bus, Ohio, presented "Follow-up of patients with scleral micro inserts for the treatment of presbyopia who elect to undergo laser vision correc- tion enhancement." He first described the VisAbility procedure (Refocus Group, Dallas), during which four PMMA micro inserts are placed into the scleral John Vukich, MD, Madison, Wis- consin, Helen Wu, MD, Boston, and Vance Thompson, MD, Sioux Falls, South Dakota. Dr. Vukich presented a case of a traumatic perforation of the corneal bed post-LASIK that he handled for a 34-year-old construction worker who was 5 years post-LASIK, which had been performed in Mexico City. He was struck with the edge of alu- minum siding and had flap disloca- tion with full thickness perforation of the corneal bed in the visual axis. Dr. Vukich asked what potential treatment options would be, suggest- ing the possibility of using sutures, cyanoacrylate glue, a primary graft, or viscoelastic to form the AC. Dr. Yeu said her choice would depend on how extensive the problem is and how the pieces fit together. Dr. Farid added that it also depends on how quickly you have access to tissue. Ultimately, Dr. Vukich used fi- brin glue to the edge of the flap and interrupted sutures, with the repair being done under topical anesthet- ic. His treatment decision was also impacted by the fact that the patient was only going to be able to follow up for a limited amount of time before returning to Mexico. Editors' note: The speakers on the panels have financial interests with a number of ophthalmic companies. Multifocal and extended depth of focus lenses in the post- refractive surgery patient Eric Donnenfeld, MD, Rockville Centre, New York, discussed "Mul- tifocal and extended depth of focus lenses in the post-refractive surgery patient: What to consider." He highlighted important factors that surgeons must think about for these patients. Even if you don't do LASIK, you'll be dealing with these patients frequently, he noted. More than 16 million refractive procedures have been performed in the U.S. over the last 2 decades, Dr. Donnenfeld said. As these post-refractive patients have aged, there has been an increased View videos from Hawaiian Eye 2018: EWrePlay.org Terry Kim, MD, discusses how to work with intraoperative aberrometry in atypical cataracts. continued on page 140 at 6 months. Dr. Beckman said that line im- provement in uncorrected near visu- al acuity was around three lines on average in this study. Patients who previously had the VisAbility micro insert procedure and later elect to undergo LVC to correct unwanted residual refractive error present a significant improvement in optimal UCNVA, he said. The most likely explanation is that any effect caused by the Vis- Ability scleral inserts is first applied to improving the latent hyperopia before you get improvement in near. He said that neutralizing residual refractive error significantly aids in improving patients' UCNVA. Editors' note: Dr. Beckman has finan- cial interests with Refocus Group. Refractive cataract panel A panel highlighted several refrac- tive cataract cases. Sonia Yoo, MD, Miami, moderated the panel, with panelists Richard Lindstrom, MD, Minneapolis, Vance Thompson, MD, Sioux Falls, South Dakota, Audrey Talley Rostov, MD, Seattle, Zaina Al-Mohtaseb, MD, Houston, and Parag Majmudar, MD, High- land Park, Illinois. One case discussed was that of a 62-year-old male who had a history of radial keratotomy and significant

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