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ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Vanessa Caceres EyeWorld Contributing Writer Also looking forward, Doug- las Koch, MD, Houston—who is well known for his work on pos- terior cornea astigmatism—would like surgeons to have the ability to measure crystalline lens tilt to help with astigmatism management. The session was sponsored by the ASCRS Refractive Surgery Clinical Committee. Editors' note: Dr. Donaldson has financial interests with Alcon, Allergan, Bausch + Lomb, and other ophthalmic companies. Dr. Koch has financial in- terests with Alcon, Carl Zeiss Meditec, Johnson & Johnson Vision, and other ophthalmic companies. Dr. Krueger has financial interests with Alcon, Calhoun Vision, and Johnson & Johnson Vision. Dr. Schallhorn has no related financial interests. Dr. Weikert has financial interests with Alcon and Ziemer. of cylinder and OK for 0.75 D of cylin- der," he said, adding that an "OK" option is not ideal. For low to moderate astigmatism management, a variety of incision choices, including arcuate, intrastromal, femtosecond arcuate, adjustable femtosecond laser, and slit lamp LRIs are a better choice, he explained. Topography-guided correction is yet another astigmatism cor- rection option, and it's favored by Ron Krueger, MD, Omaha, Ne- braska. With Contoura topograph- ic-guided technology (Alcon), there are more patients who were 20/15, Dr. Krueger said. "Wave- front-guided has been around longer, but topography-guided is growing and supported by the market leader," he said. Kendall Donaldson, MD, Plantation, Florida, shared infor- mation on Phorcides, a new pro- gram based on vector analysis that she anticipates will be used more often in the future for astigmatism management. • If the astigmatism is 0.5 D or lower, higher-order aberrations negate image quality improve- ment with astigmatism correc- tion. Minimizing residual cylinder will lead to happier patients, said Julie Schallhorn, MD, San Fran- cisco, who shared a few details on correction options such as wavefront-guided and topograph- ic-guided astigmatism correction. When using refractive surgery for astigmatism correction, PRK and LASIK are shown to have sim- ilar results, Dr. Schallhorn said. Although small incision lenticule extraction (SMILE, Carl Zeiss Meditec) is associated with a slower visual recovery it also has excellent results, she said. In the U.S., patients who are –3 to –20 D have the Visian Toric ICL (STAAR Surgical) available for treatment, but there are still no good options for high hyper- opes, Dr. Schallhorn said. "The toric ICL is excellent for myopes who aren't laser vision correction candidates," she said. If you plan to use limbal relaxing incisions (LRIs), they are best for 0.75 D of astigmatism, said Eric Donnenfeld, MD, Rockville Centre, New York. "To- ric IOLs are best for higher levels A stigmatism manage- ment involves careful consideration of tech- niques, formulas, and technology. Fortunately, ophthalmologists have more tools at their disposal than ever before for crisp vision. During Sunday's session "The Complete Guide to Manage- ment of Astigmatism: Everything You Need to Know to Optimize Cornea and Lens-based Options," presenters shared a variety of pearls to improve astigmatism management. When using multifocal IOLs, keep in mind that they work best with 0.5 D or less of astigmatism, advised Mitchell Weikert, MD, Houston. However, "try to get it below 0.3 diopters if you real- ly want to go for it," he said. A few other astigmatism pearls Dr. Weikert shared were: • Distance visual acuity decreases with increased astigmatism. • Near visual acuity decreases with increased hyperopic astigmatism but increases with increased myopic astigmatism. Becoming a pro at astigmatism management Dr. Krueger shares pearls for astigmatism management. 34 | EYEWORLD DAILY NEWS | MAY 7, 2019

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