Eyeworld Daily News

40 | EYEWORLD DAILY NEWS | MAY 7, 2019 ASCRS SYMPOSIA ASCRS ASOA ANNUAL MEETING by Vanessa Caceres EyeWorld Contributing Writer to Samuel Masket, MD, Los Angeles, and Dr. Fram for their published article from last year, "Surgical management of negative dysphotopsia." Editors' note: The physicians have fi- nancial interests with various ophthalmic companies. anterior vitrectomy, addressed by Abhay Vasavada, MD, Ahmed- abad, India, versus a traditional anterior vitrectomy, addressed by Kevin Miller, MD, Los Angeles. Nick Mamalis, MD, Salt Lake City, and Sathish Sri- nivasan, MD, Ayr, Scotland, moderated the symposium. The session also included the presen- tation of the JCRS editorial award formulas are as good if not better than the technology. Additionally, a just-published study in JCRS by Kerry Solomon, MD, found no difference between surgeries that used aberrometry and those that did not, with a trend toward favor- ing standard surgery. Looking at 129 myopic LASIK and PRK eyes, Dr. Koch found that use of ORA intraoper- ative aberrometry (Alcon) would have hurt his overall results. The numbers he presented showed that using the IOL chosen by ORA was a better option in only a little over 50% of eyes. Another consideration is the state of the eye when intraopera- tive aberrometry is used, Dr. Koch said. It's under a lot of drops, has had two to three incisions, and has sustained trauma. Another debate in the session focused on the use of the fem- tosecond laser versus a manual approach for a white cataract. Richard Davidson, MD, Aurora Colorado, spoke in favor of the laser for better results. "Even pa- tients with white cataracts expect refractive surgery outcomes," Dr. Davidson said. With a laser, surgeons can have a more effective lens posi- tion, less endothelial cell loss, and capsulotomies that are precisely centered. Additionally, there is the ability to perform reverse optic capture, if needed. Any small risks from use of a femtosecond laser are better than the risks that accompany a more traditional approach, Dr. Davidson said. Soon Phaik Chee, MD, Sin- gapore, shared several tools that are available to assist with white cataracts without a femtosecond laser and detailed how to safely ap- proach these difficult cataracts via manual phaco, allowing surgeons to get good patient outcomes without added cost. The third topic in the session focused on the use of a pars plana F rom intraoperative aber- rometry to handling white cataracts to cataract sur- geons performing anterior vitrectomies, participants in "Controversies in Ante- rior Segment Surgery" on Monday afternoon had no trou- ble shying away from debatable topics. Sponsored by the Journal of Cataract & Refractive Surgery (JCRS), the symposium pitted surgeons against each other to argue for or against decisions cataract surgeons must routinely make. Intraoperative aberrometry is used by some surgeons in an ef- fort to improve surgical outcomes. However, only 80% of surgeries get within 0.50 D of the target, said Nicole Fram, MD, Los An- geles. "We're not doing as well as we thought we would," she said. For this reason, intraopera- tive aberrometry confers several advantages, including real-time information, consideration of the posterior cornea, and big data op- timization. Use of intraoperative aberrometry allows surgeons to "look in a mirror" to analyze their data, said Dr. Fram, who found that 86% of her surgeries last year were within 0.50 D of target compared with 92% more recent- ly with the use of intraoperative aberrometry. When using intraoperative ab- errometry, Dr. Fram recommends double checking the numbers you input, avoiding over-hydration of the incision, and taking two to three readings. "Once you're savvy on how to use it, it takes minimal time and will pay off," Dr. Fram said. However, debating against the use of aberrometry, Douglas Koch, MD, Houston, said that the Barrett Universal II and Hill-RBF JCRS hosts point/counterpoint on key surgical issue Dr. Fram presents on intraoperative aberrometry during the JCRS symposium.

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