DEC 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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December 2012 In the journal ��� December 2012 Comparison of spherical aberration and small pupil profiles in improving depth of focus for presbyopic corrections Adam Hickenbotham, O.D., Pavan Tiruveedhula, M.S., Austin Roorda, Ph.D. In this comparative case series, investigators honed in on two different methods for correcting presbyopia, resulting from expanding depth of focus. The idea was to compare how use of induction of spherical aberration worked for presbyopia correction versus use of small pupil apertures. For the study, 13 subjects were enrolled. The CDVA for patients with a 5mm pupil profile was ���0.218 logMAR. Meanwhile, with the 2-mm pupil profile, a less optimal CDVA of ���.012 logMAR was attained. However, in this case, mean visual acuity improved to 0.061 logMAR. When it came to use of induction of spherical aberration, with ���0.274 micrometers here, investigators found that CDVA was ���0.082 logMAR. Investigators concluded that across a 3 D range of defocus, mean visual acuity was improved by spherical aberration and small pupil profiles. The tradeoff was a decrease in CDVA at the plane of best focus. They determined that when it came to patient satisfaction, predictability, and expected accuracy, small pupil profiles were preferable for correcting presbyopia compared to spherical aberration profiles. Evaluation of four corneal astigmatic marking methods Nina Popp, M.D., Nino Hirnschall, M.D., Sophie Maedel, M.D., Oliver Findl, M.D. Just how do different corneal marking techniques used before astigmatism-reducing surgery compare? Investigators in this randomized, examiner-masked clinical trial, involving 60 patients, compared four unique devices. Methods applied included using an insulin needle to mark the cornea at the slit lamp, as well as use of a pendular marker, a bubble marker, and a tonometer. The least rotational deviation compared to the reference meridian was found with the use of the pendular marking device, which was measured at a mean of 1.8 degrees. Meanwhile, it was the slit lamp marking device that had the least vertical misalignment, with a mean of 0.28 mm. Significant differences were found between the pendular marker and both the bubble marker and the tonometer. However, when it came to the slit lamp and pendular marking, there was no significant difference found. Also, in terms of vertical misalignment, there was no statistically significant difference between the four groups. A slight deviation to the horizontal reference meridian was found in all marking devices. The conclusion reached here was that when it comes to the astigmatic-reducing effect of toric IOLs, even small deviations of the meridian can affect outcomes. Keeping variable cyclotorsion caused by shifting from the upright to the supine position in mind, investigators stressed that accurate marking of the cornea prior to surgery is critical. Characterization of corneal structure in keratoconus David P. Pi��ero, Ph.D., Juan C. Nieto, M.Sc., Alberto Lopez-Miguel, M.Sc. A new focus on treatment options for corneal disorders has been generated by increasing numbers of patients interested in refractive surgery. Practitioners today are able to provide patients with better counseling on eligibility for refractive surgery thanks in particular to anterior and posterior corneal elevation diagrams, corneal power, pachymetry maps, and corneal coma-like aberrometry data. In general, the corneal analysis field has taken off in the past 10 years, investigators pointed out, thanks to instrumentation such as the Placido disk corneal topography, as well as scanning slit topography, Scheimpflug photography, and optical coherence tomography. This technology enables practitioners to better elucidate the geometry of the anterior corneal surface, as well as the details of the posterior surface, corneal volume, and pachymetry. Thanks to state-of-the-art instrumentation, practitioners are better able to avoid saddling patients with a misleading diagnosis. EW NEWS & OPINION 9 2013 recipient of the prestigious ASCRS Binkhorst Medal announced by Cindy Sebrell ASCRS���ASOA Director of Public Affairs Nick Mamalis, M.D., chosen to receive medal and present prestigious Binkhorst Lecture at the ASCRS���ASOA Symposium & Congress in San Francisco N ick Mamalis, M.D., will be awarded the Binkhorst Medal and will present the prestigious Binkhorst Lecture during the Open General Session of the ASCRS���ASOA Symposium & Congress in San Francisco on April 20. His lecture, titled ���Intraocular Lens Evolution: What a Long Strange Trip It���s Been,��� will explore the history and future of intraocular lens implantation and trace the surgical techniques from the beginning to the next technological frontier in providing clear, uncorrected distance, intermediate, and near vision following cataract surgery. Since 1975, the Binkhorst Medal has been awarded to the world���s most prominent ophthalmologists whose careers have made significant contributions to the science and practice of ophthalmology. During his distinguished career, Dr. Mamalis���s work has established him as a foremost leader in the field of ophthalmology and a primary force in the study and understanding of toxic anterior segment syndrome. (TASS) He earned his undergraduate degree in biochemistry from Harvard University and attended the University of Utah School of Medicine. He completed a residency in ophthalmology at Loyola University Medical Center and a fellowship in ophthalmic pathology at the University of Utah School of Medicine. In 1987, Dr. Mamalis joined the faculty at the University of Utah, where he is currently a professor of ophthalmology. Dr. Mamalis is also director of the ophthalmic pathology labora- tory, John A. Moran Eye Center, University of Utah; co-director of the Intermountain Ocular Research Center; and an editor of the Journal of Cataract & Refractive Surgery. He established a center at the University of Utah to evaluate unexplained post-op anterior segment inflammation and is chairman of the ASCRS TASS Task Force. Dr. Mamalis has an active clinical practice where he is an anterior segment ophthalmic surgeon. As director of the ophthalmic pathology/research fellowship, he is involved in training residents, fellows, and students, including working with residents directly in the clinic and in the operative suite and directing trainees in the gross and microscopic analysis of ophthalmic pathology specimens. Dr. Mamalis���s research is in the area of intraocular lenses and their complications, and includes evaluation of intraocular lens materials, designs, and compatibility to evaluate new intraocular lens designs, including accommodating and injectable lenses, and biocompatibility of intraocular lens materials. He has published more than 200 peer-review publications, 18 review papers, 33 text book chapters, 40 editorials, and more than 40 videos, many of which have won awards at meetings worldwide including ASCRS���ASOA, the European Society of Cataract & Refractive Surgeons (ESCRS), and the American Academy of Ophthalmology (AAO). He has given numerous presentations including invited or keynote/plenary lectures locally, nationally and internationally over the past 30 years. continued on page 10

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