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Issue link: https://daily.eyeworld.org/i/124055
February 2013 ASCRS•ASOA SYMPOSIUM & CONGRESS, SAN FRANCISCO2011 EW SHOW DAILY 7 Trends in cataract, refractive, and smartphones by Michelle Dalton EyeWorld Contributing Writer T he Leaming-Duffey survey on cataract and refractive trends—now in its 28th year—found toric IOL implantations increasing while laser refractive surgery numbers continue to fall, said David V. Leaming, MD, Palm Springs, Calif. Among this year's findings: 58% of the 452 respondents use electronic medical records, up 15% from 2011, optical coherence tomography (OCT) or high-definition OCT is the most common device used to image the optic nerve, and 37% prefer prescribing generic latanoprost for glaucoma. "Presbyopic IOLs are 12% of the total IOL market," Dr. Leaming said, adding that 76% of surgeons use these lenses, "but that's down from 81% in 2010." Over the same time frame, toric lenses increased use by 5%. For patients with 1.5 D of astigmatism, the toric lens is clearly the leading treatment. "In 2012, 61% are now calculating their own surgically induced astigmatism, up from 58% in 2011," he said. When it comes to the femtosecond laser for cataract surgery, the percent of people with no plans to purchase a system fell from 66% in 2011 to 49% in 2012. "Additionally, the percentage of physicians who now have access to these lasers doubled from 2011 to 2012," he said. The primary reason against the femtosecond lasers are: not cost effective (76%), takes too long (33%), and no good data proving better safety or efficacy (48%). The most common cataract incision was 2.4-2.6 mm; 68% now use intracameral lidocaine in their cataract surgery, and 30% now move to the steepest K when significant cataract is present. Richard J. Duffey, MD, Mobile, Ala., discussed the refractive details in the survey, including that laser vision correction fell 14% from 2011, and "it's down 44% over the past seven years," he said. "The percentage drop in laser vision correction may be due to other surgical techniques taking market share, but it's more of a consumer confidence index correlation." Surgeons explant IOLs for multiple reasons, but by far the most common reason is decentration and dislocation, said Nick Mamalis, MD, Salt Lake City. While many different types of lenses have been explanted, "there has been an increasing number of multifocal IOL explantations, but there are also more being implanted," he said. Dislocation/decentration was the leading cause of explantation for one-piece and three-piece with haptic, acrylic, hydrophobic lenses, and calcification and dislocation was the leading cause for three-piece hydrogels. Glistenings were not cited as a reason for explantation, Dr. Mamalis said. Using a smartphone for medical applications is gaining momentum, too. In one example, the idea is to adapt the iPhone by using an electri- cal conduit clamp to allow the iPhone to be used in anterior segment, said George N. Magrath III, MD, Charleston, S.C. "It cost me about $9 or $10 to do this," Dr. Magrath said. While there are iPhone adapters currently available, Dr. Magrath said "they're not ideal because of the slit lamp orientation." The devices are currently being used in telemedicine by having lower level residents send images to upper level colleagues. The iPod 5th generation is also a reliable method for documenting dry eye findings, said Christian Hester, MD, Houston. "We've used Facetime for a bit in telemedicine, but it's good enough to evaluate dry eye in the clinic," he said. EW move at all, and a completely quiet anterior chamber [with no pseudophakodonesis]. I was very impressed with the results of this and that's why I continue—maybe not in-the-bag lens dislocation, but in other types of capsule support to promote the concept of glued IOLs," she said. Following her video, moderator Rosa M. Braga-Mele, MD, Toronto, asked the audience their preferred modality of IOL fixation in the absence of capsular support, with five options including sutured scleral fixation of the IOL, iris claw lens, anterior chamber (AC) IOL, and glued/intrascleral fixation of the IOL. The majority of the audience voted for AC lenses in those cases. "Lisa [Arbisser] is one of the top surgeons in the world, and just to watch the maneuvers, I think you can tell that this is a complicated technique," Dr. Chang said. "I would certainly say … this is something to consider, but the literature would support that an AC IOL is every bit as good as a PC sutured IOL in terms of visual outcomes. I think you just have to weigh individually, what are the risks if it doesn't get centered well or is tilted or things like that. I think it's helpful to see all the different options." EW Editors' note: Dr. Leaming noted Abbott Medical Optics (Santa Ana, Calif.) and Alcon (Fort Worth, Texas) are corporate supporters of the survey. None of the other physicians has any related financial interests. continued from page 6 eyes," she said. "The bag lens still moves, you liberate some of the material from the bag. These glaucomas tend to get worse and not better after these surgeries, so I decided to try this technique." She outlined the steep learning curve of the procedure, and showed in her video the complications that she encountered and then the ultimate results: "[The patient] was on three glaucoma meds and ended up well pressure controlled, off meds entirely with a lens that did not Editors' note: Drs. Arbisser, Braga-Mele, and Chang have no relevant financial interests. 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