Eyeworld

EW REFRACTIVE 58 April 2018 by Michelle Stephenson EyeWorld Contributing Writer Device focus should not be managing astigma- tism without topography or tomog- raphy. This would prevent you from participating in presbyopia-correct- ing IOLs. Additionally, you would not be able to do toric IOLs because you can't properly measure the magnitude or orientation of your astigmatism, and you can't ade- quately screen for risk factors for the development of ectasia in laser vision correction unless you use topography. Lastly, you're going to miss pathology that can affect your outcomes, such as keratoconus and/ or epithelial basement membrane dystrophy, or even dry eye, in many cases," he said. Dr. Carlson said it has been especially helpful in ruling out patients for certain procedures, like LASIK. "We have much better technology to pick up early kerato- conus, as well as the patients at risk for post-LASIK ectasia. It also gives us a better handle on stability of the refraction after contact lens wear. We see a lot of patients with hard lens wear, toric contact lens wear, and even soft lens wear in whom we want to make sure that they've been adequately out of their contact lenses. Topography and tomography together have been huge advances over the past 3 decades, but partic- ularly over the past 10 years when it comes to refractive surgery and refractive cataract surgery," he said. Wavefront analysis Dr. Hovanesian uses the Wave- Light Contoura system (Alcon, Fort Worth, Texas), which is topography- guided treatment that evaluates the whole eye. "It's important because there's clearly a demonstrable dif- ference in refractive outcome when you treat higher order aberrations as opposed to just lower order aberra- tions," he said. Dr. Waring uses high defini- tion wavefront on all laser vision correction patients. "Now, we have extraordinarily powerful high defini- tion aberrometers with the iDesign suite [Johnson & Johnson Vision] that measure more than 1,000 points of refractive data per eye that also account for chromatic aberra- tion. We have seen a boost in our patients who are 20/15 and 20/10 with the advent of this advanced technology," he said. PRK for a high correction that will have a much slower and unpredict- able recovery," he said. Daniel Durrie, MD, Overland Park, Kansas, uses the TearLab test in select cases, and he uses LipiScan or LipiView on every patient. "As a screening on all of our refractive surgery patients, we want to make sure that their meibomian glands are functioning well," he said. "In short, LipiFlow works," Dr. Hovanesian said. "It treats the most common type of dry eye that we see in young and old patients. When we see an abnormal tear film, we need to treat it. It's a valid and valuable tool." Dr. Durrie agreed. He uses Lipi- Flow in patients who do not respond to lid hygiene. Topography for corneal analysis Topography provides thousands of points of data, in terms of curvature. "Not only does it help us identify the degree of corneal astigmatism, but it also provides a sense of surface irregularity, so it's a poor man's dry eye test as well," Dr. Hovanesian said. "It's standard of care to do some type of topography imaging." Dr. Waring agreed. "Topogra- phy and tomography are requisites for any form of refractive surgery. It's the hallmark and foundation of refractive surgery, both cornea and lens-based refractive surgery. All patients should have topography and/or tomography. You cannot and in those who have symptoms only. George Waring, MD, Charleston, South Carolina, uses this technolo- gy on every lens refractive surgery patient and selectively for laser vi- sion correction patients. "We take a holistic approach to eye care, and we have found that objectively, dry eye can result in fluctuation of vision as a result of increased light scatter. If we are going through the efforts of helping a patient relieve his or her dependence on glasses and contact lenses and improve overall vision, we think that we may be able to improve it even further if we address any underlying ocular surface issues and the overall health and wellness of the ocular surface," he said. He has found that even young patients can have meibomian gland dysfunction and blepharitis that may be due to computer vision syndrome. Alan Carlson, MD, Durham, North Carolina, said that LipiScan, LipiView, and LipiFlow (Johnson & Johnson Vision) have been a huge asset in managing dryness. "These have also given us a lot more com- fort performing LASIK procedures. Previously, we have been so worried that we would make dry patients even drier that our options were lim- ited. Now, diagnostically evaluating these patients and therapeutically treating them has allowed us to take a lot of patients who are better suit- ed for LASIK or SMILE and proceed with that rather than giving them Surgeons share what's helped them improve refractive outcomes S everal technologies have revolutionized refractive surgery and improved pa- tient outcomes. They allow surgeons to prepare the oc- ular surface for surgery and achieve results that are better than 20/20. Tear film analysis Both the TearLab Osmolarity Test (TearLab, San Diego) and LipiScan (Johnson & Johnson Vision, Santa Ana, California) are used for tear film analysis. According to John Hovanesian, MD, Laguna Hills, California, today's refractive surgery patients are baby boomers, who are older. "Dry eye, and addressing it before surgery, can mean everything to their outcome. Many of these eyes are in a marginally compensat- ed state. In other words, they aren't symptomatic, but their eyes are somewhat dry. If a doctor doesn't educate a patient about his or her dry eye before surgery, then the doctor owns that problem after sur- gery. It's important that the patient understands that he or she has two problems: one that requires correct- ing refraction and one that requires correcting and treating dry eye," he said. Dr. Hovanesian uses this technology in older patients and Technologies that improve refractive surgery continued on page 60 LipiView II, LipiScan, and LipiFlow Source: Johnson & Johnson Vision

• Cover
• Blank Page
• Blank Page (1)