Eyeworld

75 May 2018 EW MEETING REPORTER included Vance Thompson, MD, Sioux Falls, South Dakota, Edward Holland, MD, Cincinnati, Reay Brown, MD, Atlanta, Graham Barrett, MD, Perth, Australia, and David Chang, MD, Los Altos, Cali- fornia. Richard Tipperman, MD, Bala Cynwyd, Pennsylvania, presented the best cataract papers. The first paper he selected was "Prevalence of Macular Abnormalities Identi- fied Only by OCT in Patients with Cataract." The research sought to evaluate the prevalence of macular abnormalities not suspected by the biomicroscopic fundus exam and identified only by macular OCT in the preoperative evaluation for cataract surgery. In the results of the study, in eyes without previous diagnosis of macular disease and a normal biomicroscopic fundus exam, 905 (95.1%) eyes had normal OCT, while 47 (4.9%) eyes had an abnormal OCT. Following Dr. Tipperman, Oli- ver Findl, MD, Vienna, Austria, pre- sented several of his selected cataract papers. The first paper he discussed was "Implantation of Scharioth Macular Lens in AMD: Results of a European Multicenter Clinical Trial." The idea here, he said, is the new technology would have sufficient magnification, is an easy and safe also said it's important to have a strategy for enhancement postop and talk to the patient about that strategy in the preop visits. When it comes to IOL exchange, Dr. Slade said the history is important to consider when addressing multifocal IOL complaints, and your decision to exchange should be made earlier with a plan no later than 3 months. Dr. Hovanesian presented research that supported the mixing of low- and medium-add multifocal IOLs. Compared to those who had the same multifocal IOL in both eyes, the mixed patients had less of a need for glasses at computer dis- tance and had significantly less glare and halos. Compared to the binoc- ularly implanted group, the mixed group showed similar satisfaction, overall spectacle independence, best corrected visual acuity, and refrac- tive accuracy. Editors' note: The physicians have fi- nancial interests with various ophthal- mic companies. The Best of ASCRS 2018 The ASCRS•ASOA Annual Meeting concluded with "The Best of ASCRS 2018" General Session. Presenters shared some of the "Best papers of session" from the meeting. The moderator of the session was Eric Donnenfeld, MD, Rock- ville Centre, New York. Panelists therapy. Dr. Chang said the perfect presbyopia correction would work for both phakic and pseudophakic eyes; would have guaranteed centra- tion on the visual axis; no unwanted images or halos; would be reversible; have a zero-complication rate; and be inexpensive and permanent. The perfect device, Dr. Chang said, is actually our iris. He said Liquid Vision makes use of the iris to drive near vision with a weak mydriatic aceclidine and tropicamide drop. Dr. Chang noted that it complements spectacles, con- tact lenses, and IOLs; it's fast-acting with a 30-minute onset, allowing for office trials; lasts about 4 hours with the potential for a second drop, if needed; and it's binocular. Phase 2b trials are underway with this drop. In the "Best tip for improving practice efficiency and patient ex- perience" category, Dr. Hovanesian won by describing how to make the 43 steps that generally are required for cataract surgery patients simpler with MDbackline (Orange County, California). This software explains various aspects of the surgery and technologies in simple language, provides alerts for when patients need to remove their contact lenses or start drops, and it even drives premium lens conversions. In the "Best tip for improving the ocular surface" category, the audience agreed most with Dr. Yeu about the value of an amniotic cytokine extract (Genesis, Ocular Science, Manhattan Beach, Califor- nia) and its applicability for a variety of ocular surface issues. The best pearl for presbyopic IOL patient satisfaction went to Dr. Yeu who recommended making patient-centered considerations (work/hobbies, motor eye domi- nance, height, prior multifocal or monovision contact lens usage, prior refractive surgery, and ocular comorbidities) when deciding on using mini-monovision or mix and match IOLs. Dr. Chang emphasized the im- portance of using a digital alignment system with toric IOLs. Dr. Solomon spoke on hitting the refractive target by avoiding errors and optimizing surgeon factors and alignment. He developed diamond-coated forceps. In that instrument, however, dia- monds recessed from the tip, which led someone else to develop an instrument with fine end grasping. That instrument had a squared-off 20-gauge tip that could actually damage the retina; this led Dr. Charles to develop conformal for- ceps, followed by Alcon/Grieshaber developing 23-, 25-, and 27-gauge DSP IML forceps. Editors' note: Dr. Charles has finan- cial interests with Alcon. Dr. Rhee has no financial interests related to his comments. Rapid-fire 'X-Rounds' gives audience quick tips and pearls In "X-Rounds: Refractive Cataract Surgery to the Max," five leading ophthalmologists gave rapid-fire presentations on a variety of topics. The audience then voted for the tip or idea that they found the most interesting or useful. Kerry Solomon, MD, Mount Pleasant, South Carolina, garnered the most votes in the "What am I doing differently this year?" catego- ry for sharing his thoughts on the flanged double-needle intrascleral haptic fixation technique by Shin Yamane, MD, PhD. "This technique is phenomenal. … It's easy to use, easy to learn, and actually minimally invasive," Dr. Solomon said. Elizabeth Yeu, MD, Norfolk, Virginia, and David Chang, MD, Los Altos, California, both spoke about using Zepto (Mynosys, Fre- mont, California) for automated capsulotomy creation. Stephen Slade, MD, Houston, discussed putting extended depth of focus and multifocal lenses in previous refractive surgery patients, and John Hovanesian, MD, Laguna Hills, California, spoke about microbleph- aroexfoliation (BlephEx, Franklin, Tennessee) before taking biometry for cataract surgery. In terms of new technology on the horizon, Dr. Chang was voted the winner for his presentation on Liquid Vision (Presbyopia Therapies, Coronado, California) eye drops as a topical presbyopia-correcting continued on page 78 View videos from ASCRS•ASOA 2018: EWrePlay.org Neel Desai, MD, shares pearls for PRK.

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