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14 | EYEWORLD DAILY NEWS | APRIL 7, 2024 ASCRS ANNUAL MEETING DAILY NEWS Prior treatment options for floaters, Dr. Chu said, were noth- ing—telling the patient to get used to them or ignore them—or vitrectomy, which he was reserved for extreme cases and had a high success rate. The option of laser floater removal with YAG vitreolysis is non- invasive, well-tolerated, repeatable, and safe. Some people, he said, may be skeptical of this option, but it's not the same procedure as in the past. Previous attempts had a lack of visu- alization, energy settings that were too long, a number of shots weren't enough, and the energy beam was not as efficient. Conventional YAG lasers are de- signed for posterior capsulotomy and iridotomy treatments. These have a limited view of the vitreous, which can make it difficult to identify the floaters and membranes to target. There is also a risk of damage to surrounding ocular tissue in inexperi- enced hands. Dr. Chu noted that Ellex has designed the first new-generation YAG laser specifically to perform vitreolysis, as well as more standard procedures. This new technology has Ultra Q Reflex lenses with a different technique and settings. O n Saturday, ASCRS pro- gramming featured a variety of symposia that covered many clinical topics, includ- ing glaucoma and retina. Laser vision correction in glaucoma patients During a glaucoma symposium, John Berdahl, MD, discussed laser vision correction in glaucoma patients. If you're a refractive surgeon, you should think about glaucoma, he said. In the literature, there are few data articles on this topic, he said, admitting that he's a little embar- rassed by the lack of data on this topic. However, there are many opinion articles. Factors that may lead a physician to be suspicious of glaucoma are elevated IOP, suspicious optic nerve, family history of glaucoma, age, African American or Hispanic race, corneal thickness, or myopia. Preoperative considerations include accounting for risk factors, education about lifelong risk of glaucoma, consider a baseline (OCT, visual field, photos), gonioscopy, and IOP with alternative devices. We need to make sure these patients get their eye exams, he said. Postoperatively, Dr. Berdahl is worried about dry eye, steroid use, pressure-induced stromal keratitis, and education about lifelong risk of glaucoma. The biggest one is prob- ably steroid use, Dr. Berdahl said. "Steroid use can cause pressure-in- duced stromal keratitis, and that is an easy thing to miss, especially if you're a refractive surgeon," he said. The pressure inside the eye gets high after LASIK, in response to the ste- roid, and it hydrates the cornea and creates a fluid cushion that's hard to measure. When thinking about IOP after refractive surgery, Dr. Berdahl said it's possible for patients to forget that they had LASIK. GAT underestimates IOP after refractive surgery, so it's important to use a variety of mea- surements. In his clinic, Dr. Berdahl said he measures IOP after LASIK with the CATS Tonometer and corneal hyster- esis. In terms of how to measure IOP after LASIK, Dr. Berdahl said there is a mean reduction in measured IOP by GAT, but the data is very scattered, making it dubious to use a correction factor based on amount of correction. Correcting IOP based on corneal thickness is unadvisable in a normal population and is even more uncertain in a post-LASIK population, he said. Editors' note: Dr. Berdahl has financial interests with a variety of ophthalmic companies. Retina debates In a debate during the retina sym- posium, Ralph Chu, MD, argued for using YAG vitreolysis for laser floater removal. Floaters can negatively affect quality of life, and seven in 10 people will suffer from floaters. He presented his main point showing objective analysis on a patient where before vitreolysis, they had a high dysfunctional lens index, and after vitreolysis, the patient saw great. The iTrace Wavefront Aberrome- ter and Corneal Topographer (Tracey Technologies) provides a breakdown of contribution between corneal and internal aberrations, Dr. Chu said. Internal aberrations include the lens, the posterior cornea, macula, and vit- reous. It objectively measures quality of vision, which matches the patient's subjective response. ASCRS symposia cover topics in retina, glaucoma, and more Dr. Berdahl speaks about laser vision correction in glaucoma patients. Source: ASCRS continued on page 17

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