Eyeworld Daily News

12 | EYEWORLD DAILY NEWS | APRIL 23, 2022 ASCRS ANNUAL MEETING DAILY NEWS Blake Williamson, MD, addressed the need for post-LASIK enhancements. He shared that he realized that en- hancements are a big deal that should be embraced after he underwent his own. After primary LASIK, he was pla- no in one eye and –0.75 D in the other. "It's like having one boot in the end zone and the other boot at the 10-yard line," he said, noting that after 3 months, he chose to get an enhance- ment and the experience changed his approach to these patients. Dr. William- son discussed the different modalities for enhancement and when to enhance under certain conditions. Kerry Solomon, MD, presented on the role of digital apps, specifically Veracity (Carl Zeiss Meditec), to refine the surgical strategy. Editors' note: The speakers have finan- cial interests with various ophthalmic companies. Ashley Brissette, MD, shared the surgical considerations involved in making a surgical plan with IQ in mind. Communication with patients is key, she said, even more so if their case is complex. She said to explain that while they might be at higher risk, you're on a team. In the preop exam, identify bleph- aritis and ocular surface issues and handle them preoperatively. Look for corneal guttata, pseudoexfoliation, pupil dilation issues, cataract density, glaucoma, and macular pathology that could affect what you have available in the OR, Dr. Brissette explained. Biome- try determines anterior chamber depth, astigmatism, and macular pathology. Once you have a plan, she said to also make plan B and C. "The last thing you want to do is have a compromised capsule and you're waiting for extra viscoelastic," she said about having the right things "on standby." Finally, she said to consult with colleagues, asking for assistance when needed. "Control what you can. Trust your skills will carry you through for things you can't control. Communicate with your patients, and communicate with each other," Dr. Brissette said. Roger Zaldivar, MD, shared more information about making a plan based on the evaluation of the eye, includ- ing importance of assessing, treating (when relevant), and discussing the tear film, retina, aberrations, pupil dynamics, and lifestyle. He said when choosing an IOL, it's important to un- derstand the optical principles of each. When the patient has a healthy pupil, retina, tear film, and a lifestyle to support it, his favored lens is a trifocal. But if the patient has a disturbed tear film, retinal issues, or is post-LASIK, he'll turn to an EDOF. If the patient has higher order aberrations or some- thing disturbing the quality of vision, he'll advise a small-aperture IOL, Dr. Zaldivar said. T he second session of Refrac- tive Day focused on "Making a Surgical Plan to Boost Your Pa- tient's IQ," maximizing it based on preop assessments and advances in technology. Douglas Koch, MD, led the session with the topic of IOL calculations un- der different eye conditions. Most cases (80%) are within 0.5 D of target (some studies show as high as 92%), Dr. Koch said, then asking, "Can we do better, or is 90% within a half diopter really our ceiling?" The possible sources of error include ELP, the cornea (anterior or posterior), and refraction. With ELP, Dr. Koch said there have been studies using OCT preop and intraoperatively to improve ELP, but no published stud- ies show an increase in IOL calculation accuracy as a result. Also, ELP shifts can occur postop, he said. Even still, Dr. Koch doesn't think we're stalemated with it. In short eyes, there is a big oppor- tunity to improve accuracy. Dr. Koch said that with higher power IOLs, even a small shift can be a huge refractive change. Long eyes, however, don't necessarily have this problem. Dr. Koch said that with the Wang-Koch modifica- tion for long eyes and other formulas, a good percentage are within 0.5 D. The cornea is the largest source of error over which the surgeon has some control, Dr. Koch continued. He said he has patients use preservative-free artificial tears, warm compresses, and lid scrubs before taking measurements for IOL calculations and found that it improved calculation accuracy. Dr. Koch also discussed how post- LASIK eyes and eyes with keratoconus are often less accurate in lens power calculations and are an area for im- provement. "We're getting near a ceiling for our lens calculations. I think the ability to adjust postoperatively will grow. We need to educate our patients that this is an imperfect science whether it's a nor- mal or abnormal eye," Dr. Koch said. How to create a surgical plan that boosts IQ Dr. Brissette shares the surgical considerations for making a plan with image quality in mind.

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