Eyeworld Daily News

EW SHOW DAILY 20 Sunday, April 27, 2014 ASCRS Symposia Symposium zeroes in on astigmatism concerns by Vanessa Caceres EyeWorld Contributing Writer M aximize your use of toric IOLs by treating ocular surface disease pre- and postopera- tively, keeping pa- tients out of their contact lenses before surgery until their refraction stabilizes, measuring for surgically induced astigmatism, and optimiz- ing the incision location for the lowest residual manifest cylinder, said Jay Pepose, MD, St. Louis, who shared this advice during Saturday's "Management of Astigmatism" symposium. Other pearls that Dr. Pepose suggested included: • Know how each device you use measures corneal astigmatism. • Consider the patient's posterior corneal astigmatism. • Minimize alignment errors. • Take advantage of intraoperative aberrometry if available. • Make use of new ray-tracing formulas. Clinical survey Also at the symposium, John Vukich, MD, Madison Wis., shared results from the 2013 ASCRS Clinical Survey. The survey found that 57% of respondents see benefits with the use of femtosecond arcuate incisions, but he noted that the U.S.-based respondents were more likely to favor them. The most ac- ceptable degree of postop cylinder before it affects visual quality is 0.71 D, according to the survey. When asked what they would do if a multifocal IOL patient has significant residual cylinder, nearly 52% said they would use laser vision correction, said Dr. Vukich. Among respondents, 19% of cataract procedures involved a toric IOL, with a slightly higher percent- age among non-U.S. based surgeons. ASCRS is now collecting results for its 2014 Clinical Survey. You can participate by going to www.eyeworld.org/survey. Steve Schallhorn, MD, San Diego, shared results from a survey involving more than 47,000 eyes and 23,000 patients, and reported that the average age for laser vision correction has gone down from 39.2 years old about 5 years ago to 34 years old in 2013. The survey found that patients were more likely to be happy if they did not have any postop astigma- tism. "Even 0.5 D of postop astigmatism can lessen the chance of attaining 20/20 uncorrected distance visual acuity and can reduce patient satisfaction," he said. The survey found that among patients who had refractive lens exchange and cataract surgery, 41% had 1 D or less of significant corneal cylinder. Today's stronger clinical outcomes, devices, and IOLs are opportunities to "raise the bar" to reduce postop residual astigmatism, Dr. Schallhorn said. That theme was echoed by Karl Stonecipher, MD, Greensboro, N.C., who spoke about refractive enhance- ments. "If we're even just a little off, our patients are unhappy," he said. He pointed out that many patients perceive enhancements as a failure to get the surgery right the first time—even if that's not an accurate portrayal. Some ways to help prevent postop enhancements before surgery include aggressively managing ocu- lar surface disease and performing measurements twice. "Dry eye is the number one reason for unhappy pa- tients," he said. He also noted that a number of patients who require enhancements have undiagnosed epiretinal membranes. When enhancing, Dr. Stonecipher will usually wait at least 3 months after the initial procedure. He will also perform a capsulotomy. Another astigmatism concern that surgeons should consider more is the possibility of posterior cornea astigmatism, said Doug Koch, MD, Houston. Dr. Koch and Li Wang, MD, Houston, have developed the Baylor nomogram to measure the mean posterior astigmatism in eyes that have with-the-rule or against- the-rule astigmatism. Other topics covered at the sym- posium included optical quality and astigmatism, astigmatism correction with laser vision correction or limbal relaxing incisions, and key calcula- tions to manage astigmatism. The symposium was sponsored by the ASCRS Refractive Surgery Clinical Committee. EW Editors' note: Dr. Koch has financial interests with Alcon, Abbott Medical Optics, and other ophthalmic compa- nies. Dr. Pepose has financial interests with AMO, AcuFocus, TearLab, and other ophthalmic companies. Dr. Schallhorn has financial interests with AMO and Allergan. Dr. Stonecipher has financial interests with Alcon, Bausch + Lomb, Nidek, and other ophthalmic companies. Dr. Vukich has financial interests with AcuFocus, AMO, and Carl Zeiss Meditec. ASCRS to offer joint meeting with Latin American Society of Cataract and Refractive Surgeons in 2015 A SCRS•ASOA announced that the 2015 ASCRS•ASOA Symposium & Congress will be held jointly with the Latin American Society of Cataract and Refractive Surgeons (LASCRS/ALACCSA-R). The joint meeting will be held April 17–21, 2015, in San Diego. "ASCRS is a truly international organization. As many as 40% of our membership comes from countries around the world," said ASCRS president Richard A. Lewis, MD. "I am pleased to announce that the 2015 ASCRS•ASOA Symposium and Congress in San Diego will be a joint meeting with the Latin American Society of Cataract and Refractive Surgeons. This is an exciting and powerful partnership that will be sure to help advance our profession. ASCRS continues to build international alliances as part of our effort to deliver quality eyecare around the world and here in the U.S." "LASCRS/ALACCSA-R is honored to be joining ASCRS in this joint program," said William De La Peña, MD, chairman of the LASCRS/ ALACCSA-R Board of Directors. "This is a true sign of the strong and lasting relationship between our two societies who have worked together for many years. We will do our best to bring the best of Latin American ophthalmology, which has been characterized by innovative techniques and procedures." EW Dr. Stonecipher spoke about refractive enhancements.

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