Eyeworld

69 May 2018 EW MEETING REPORTER refractive outcome after surgery be- cause postoperative refraction is of- ten a source of error. He added that there is variability when looking at different machines. One main issue is trying to predict IOL position. If it's possible to figure out where it will be sitting in the patient's eye, this could be the holy grail of IOL power calcu- lation, he said. It's possible that it could change position after surgery, and capsule shrinkage can alter the IOL position. Other factors that can change IOL position after surgery are fibrosis (which may depend on the material and patient) and haptic design. A past study compared sin- gle-piece haptics to three-piece hap- tics. The three-piece haptics tended to have more anterior movement/ shift, but these are rarely used in the bag today. Dr. Findl shared a study looking at intraoperative aberrometry-based aphakia refraction in patients with cataract. The study concluded that reproducibility of aphakic measure- ments was not good enough for IOL power calculation. You also have to take into account that you have corneal changes during surgery. He stressed the importance of double checking preoperative biometry and said that intraoperative aberrome- try is useful in eyes after refractive surgery. However, he noted that the "missing link" is postoperative IOL position, as there is no prediction for this. He again stressed that intraop- erative OCT helps with better IOL prediction. He also addressed the clinical workflow, suggesting that surgeons should first do biome- try and power calculations, then pre-select the IOL. At that point, intraoperative OCT can be used to verify or adapt the IOL choice. This is especially useful for short or odd eyes. Editors' note: Dr. Findl has financial interests with Carl Zeiss Meditec (Jena, Germany) and Johnson & Johnson Vision (Santa Ana, California). Karcher, outgoing executive director of ASCRS. The role of executive director is an essential part of the or- ganization's team, Dr. Holland said, and ASCRS has had the fortune of exceptional leadership in the execu- tive director position for 37 years. Mr. Karcher began his career in the hotel business, and it was during his time working at the Century Pla- za Hotel that he met his wife, Anne, and connected with the American Intra-Ocular Implant Society, which would later become ASCRS. Mr. Karcher's family was in attendance during the session. Mrs. Karcher received 37 roses and had the Anne Karcher Friends of ASCRS Breakfast named after her for future meetings. Additionally, the Honored Guest Award was renamed the David A. Karcher Honored Guest Award. Mr. Karcher was presented with a trophy, which identified him as the "MVED," the "Most Valuable Execu- tive Director." Binkhorst Lecture discusses choosing the right IOL power Oliver Findl, MD, Vienna, Austria, gave this year's Binkhorst Lecture, titled "The Challenge of Choosing the Right IOL Power." There is a growing demand from patients, Dr. Findl said, and postoperative refraction is the main factor for patient satisfaction. Patients have high demands for multifocal IOLs, toric IOLs, and clear lens exchanges. There are a variety of sources of error, including pupil size, axial length, and postoperative refraction. Dr. Findl discussed optical bi- ometry, which he said has enhanced measurement for axial length. He noted that it was developed in his hometown of Vienna, Austria. Dr. Findl spoke about the value of swept-source OCT and the interest in screening for macular disease with it. Macular screening with OCT biometry provides good detection for cystoid macular edema (CME), macular holes, and epiretinal membrane. However, it could be challenging to use with geographic atrophy and dry AMD. Refraction measurement is one problem in aiming for a specific continued on page 70

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