Eyeworld Daily News

MAY 7, 2019 | EYEWORLD DAILY NEWS | 51 ONSITE by Vanessa Caceres EyeWorld Contributing Writer it. Also, let the patient know it may take 3 months for their vision to stabilize. Editors' note: This session was support- ed by educational grants from Johnson & Johnson Vision and Carl Zeiss Meditec. is happy. "I wouldn't do anything. It's about the patient, not the numbers," Dr. Trattler said, adding that rotating the IOL is not with- out risk. If a patient had MGD after surgery and was unhappy, Dr. Fram said it's yet again important to acknowledge what patients are experiencing and let them know that you are helping them to treat they were asymptomatic. For this reason, surgeons can't only rely on patient-reported history to decide if ocular surface disease treatment is needed. Use tear film breakup time, cornea staining, and topog- raphy for further assessment. By treating meibomian gland dysfunc- tion (MGD) and optimizing the ocular surface, it becomes more likely that you will reach your refractive targets, Dr. Trattler said. Daniel Chang, MD, Bakersfield, California, ad- dressed the range of tools and formulas that surgeons can use to assist with toric IOLs. "You don't need many devices, but you need ones that give you good information," Dr. Chang said. The Barrett Universal II and Barrett Toric Calcula- tor are consistently good, Dr. Chang said. Some additional pearls shared by Dr. Chang: Mark the cornea, perform careful wound construction, do a final check of your lens position, and don't burp the wound when you take the speculum out. One pearl shared by Nicole Fram, MD, Los Angeles, is letting patients know you'll try to correct appropriately but that they may need some residual correction. By setting these expectations in advance, patients are usually more open to further correction, she explained. There is now various marking technology available, but manual marking is always a good idea in case technology fails you, Dr. Fram said. The use of intraop ab- errometry also can help surgeons improve outcomes, she said. The panelists discussed a few cases, including a patient who was –0.75 +1.25 x 160 and 15 degrees off target. However, the patient S easoned surgeons shared tips for success with toric IOLs at Monday morning's "Lens-Based Astigmatism Correction: Pearls for Success with Toric IOLs," an Eye- World CME Education event. Sharing results from the ASCRS Clinical Survey, Douglas Koch, MD, Houston, said that 20% of their cataract patients get a toric IOL. However, if cost were not an issue, the same surgeons would like 75% of patients with 1.25 D or more of astigmatism to receive a toric IOL. Twenty-sev- en percent of respondents used topography to help with astigmatic axis decisions, while 47% used more than one device. Dr. Koch, who is well-known for his research on the posterior cornea, shared that 51% of ante- rior corneas are steep vertically, and 87% of posterior corneas are steep vertically. Astigmatism correction should take place if there is at least 0.75 D of astigma- tism correction needed in a patient receiving a monofocal IOL; for multifocal IOLs, aim to correct at 0.50 D, Dr. Koch advised. In the future, Dr. Koch would like surgeons to have the ability to measure lens tilt to assist with astigmatism management. If patients have residual error, there could be several reasons, including an axis that is off-tar- get, wrong astigmatism power, or ocular surface disease that may affect measurements, said William Trattler, MD, Miami. In previous research, Dr. Trattler and colleagues found that 87% of cataract patients had clinical signs of dry eye even though Getting toric IOLs right Dr. Koch discusses how to improve outcomes with toric IOLs.

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