Eyeworld Daily News

EW SHOW DAILY 2 Wednesday, May 10, 2017 (MMC)," that looked at the Rain- drop corneal inlay (ReVision Optics, Lake Forest, California). It demon- strated a decrease in corneal haze. The other inlay paper she presented was "Effect of Pupil Size on Visual Performance with Small-Aperture Corneal Inlay." The study found that pupil size had minimal impact, and it looked specifically at the KAMRA inlay (AcuFocus, Irvine, California). Dr. Hofmeister then shared three SMILE papers: "Lenticule Thickness Precision in SMILE – a Target-Actual Comparison Using Spectral Domain OCT," "SMILE for Hyperopia: Visual and Refractive Outcomes, Optical Zone Centration, Diameter, and Aberration Induction," and "Com- paring Visual Outcomes of SMILE vs. Topo-Guided LASIK." EW Editors' notes: The physicians have no financial interests related to their comments. were followed 3 weeks to 1 year after surgery. The study found that ISBCS and DSBCS seem to be similar. The first cataract paper Dr. Knorz presented was "Prospective Randomized Study Comparing Visual Outcomes of an Accommo- dating and 2 Multifocal IOLs: 5-Year Follow-up." The second paper he shared was "Ocular Scatter Index of EDOF IOLs," which used the HD Analyzer (Visiometrics, Costa Mesa, California) and concluded that the difference of ocular scatter index between monofocal and extended depth of focus IOLs was not signifi- cant. The final paper he shared was "Visual Performance and Perceived Photopic Phenomena with a New Extended Depth of Focus IOL." Nathan Radcliffe, MD, New York, presented the glaucoma papers. The first paper he shared was "Excimer Laser Trabeculostomy Alone and Combined with Phaco + IOL 8 Year Post-Op Observations." Excimer laser trabeculostomy (ELT) is when the excimer laser is used to open the trabecular meshwork from an ab interno approach, Dr. Radcliffe explained. He added that there was a 30% pressure reduction with ELT, and when combined with phaco, there was a 45% pressure reduction. The next paper he presented was "Multicenter, Open-Label Study of the Performance of a Novel Gela- tin Stent in Refractory Glaucoma in the United Sates." This, he said, was about the XEN Gel Stent (Allergan, Dublin, Ireland). The final paper Dr. Radcliffe chose was "Efficacy of Two Target- ed Versus Non-Targeted Trabecular Micro-Bypass Stents: A Preliminary Investigation." John Hovanesian, MD, Laguna Hills, California, presented the best cornea papers. His first selection was "High-Resolution OCT Imaging of Bowman Layer in Asymmetric Keratoconus." His second paper selection was "Prevalence of Meibo- mian Gland Atrophy in a Pediatric Population." We know that dry eye affects almost 30 million Americans, he said. Meibomian gland disease (MGD) dominates in these patients, and meibomian glands are critical to ocular surface health. The study featured 49 participants (23 female) and found that 55% had evidence of meibomian gland atrophy in a normal population. The last paper he highlighted was on "CAIRS," corneal allogenic intrastromal ring segments. Elizabeth Hofmeister, MD, San Diego, shared some of the best refractive papers, choosing papers focused on corneal inlays as well as SMILE. She presented a paper, "LASIK and a Transparent Shape-Changing Corneal Inlay with Mitomycin-C In this category, Dr. Henderson spoke about a technique to prevent negative dysphotopsias; Dr. Hova- nesian offered "bite-size" cataract surgery pearls; Dr. Lane discussed the Transformer I/A handpiece (Alcon, Fort Worth, Texas); and Dr. Slade shared how he talks with pa- tients about the relatively new small incision lenticule extraction (SMILE) refractive procedure. Dr. Chang was voted as offer- ing the best new technology on the horizon. He spoke about the MILOOP (IanTECH, Reno, Nevada), which is a nitinol loop that circles cataracts for manual chopping. Dr. Chang said this disposable, FDA-approved device can be used on both soft and dense lenses, but it's the dense lenses where he said the device will provide a "wonderful adjunct." Dr. Henderson teased a portable OCT for self-monitoring. Dr. Hova- nesian spoke about using software to help better patient care and expe- rience, while Dr. Lane talked about the Harmony modular IOL (ClarVis- ta Medical, Aliso Viejo, California). For the best tip in getting started in refractive surgery, Dr. Henderson was voted by the audi- ence as the winning instructor for offering tips on helping physicians feel more comfortable with multi- focal IOLs. Dr. Henderson advised having a game plan; performing a thorough preoperative exam to rule out coexisting eye diseases and con- traindications; performing compre- hensive counseling; and managing the patient's expectations. Dr. Chang offered pearls for avoiding rotation; Dr. Hovanesian suggested performing limbal relax- ing incisions without charge to get comfortable correcting astigmatism surgically; and Dr. Slade advised to avoid vitreous loss at all costs because expectations are so high in this group and you don't want to have to explain why you couldn't put in a toric or multifocal IOL. The best tip for managing ocular surface disease went to Dr. Hovane- sian for his presentation on mi- croblepharoexfoliation with BlephEx (Rysurg, Palm Beach, Florida), which he demonstrated cleans off even stubborn biofilms and crust. He cit- ed data that showed increased tear breakup time, improved symptom scores, and increased OSDI scores with this technique. Dr. Lane said using technolo- gy to assess the tear film to test for quality can give you images to show patients, helping them understand their condition visually and perhaps encouraging compliance with ther- apy. Dr. Slade discussed amniotic membrane, which can be used preop or postop to heal the ocular surface. Though Dr. Henderson was jok- ingly voted the winner in the pearls for management of astigmatism category, despite not presenting, Dr. Donnenfeld called it a draw between Drs. Chang and Lane, who discussed tips for the malpositioned IOL and figuring out the axis of alignment of an existing IOL with the app Axis Assistant, respectively. Dr. Slade won the category for complication management, offering a decision tree to help physicians decide on whether a multifocal IOL should be exchanged if the patient is unhappy or if another intervention could save the case. In one case, Dr. Slade simply had to vacuum the capsule of cells under the IOL, which allowed him to better identify whether the issue was with the capsule or the IOL itself. In this case, just removing the cells improved the patient's vision. Dr. Chang offered the tip of not rotating the lens in cases of weak zonules when there is a radial tear in the capsule to avoid wraparound. Dr. Henderson presented photodynamic therapy (crosslinking with riboflavin or using rose bengal and green light) to treat infections that have persist- ed despite other interventions. Dr. Hovanesian's case highlighted why physicians should beware of mak- ing decisions based on pachymetry when there are visual issues in the presence of an intracorneal inlay. Dr. Lane showed a case of pseudoexfoli- ation where the lens was looser than expected during cataract surgery; capsular tension hooks provided stability, viscoelastic helped stabilize the bag, and a CTR was placed due to the possibility of late lens disloca- tion in this patient. EW Editors' note: Dr. Lane has financial interests with Alcon and ClarVista. Dr. Slade has financial interests with Carl Zeiss Meditec (Jena, Germany). Dr. Chang has financial interests with Carl Zeiss Meditec and Johnson & Johnson Vision (Santa Ana, California). Dr. Hovanesian has financial interests with AcuFocus (Irvine, California). Dr. Henderson has no financial interests related to her comments. Pearls continued from page 1 Best continued from page 1

• Cover