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EW SHOW DAILY 34 ASCRS Symposia Sunday, May 8, 2016 it seems to behave similar to other toric IOLs, but is "from a surgical point of view, very stable for the surgeon." "With this lens, we have very friendly relation-power calculation for 'blended micromonovision,'" Dr. Güell said, but perhaps more important it seems to have "low refractive impact in front of minor rotations." "It's a significant, at least in my hands, advantage because in spite of using the latest technology … in spite of trying to do the best in aligning properly, it's not strange to have this minimum deviation between 2 to 3 degrees up to 10 degrees," he continued. "If we have the option of a lens that tolerates these slight rotations … I feel much safer." While corneal crosslinking (CXL) was recently approved by the Food and Drug Administration for use in the United States as a treat- ment for keratoconus, photorefrac- tive intrastromal crosslinking (PiXL, Avedro, Waltham, Massachusetts) could offer significant refractive ad- vantages over conventional CXL for keratoconus patients, said Anders Behndig, MD, Umeå, Sweden. When it comes to refractive re- sults after crosslinking, Dr. Behndig said some cases have resulted in pos- itive refractive results while others have not had any effect at all. "PiXL is based on topography at the individualized level," Dr. Behndig said, noting that its ultimate aim is to control and enhance refractive improvement in crosslinking. Dr. Behndig presented on 12-month PiXL results, calling them the "first attempt to control and im- prove the refractive outcomes after crosslinking." While PiXL showed some advantages in uncorrected vi- sual acuity and best corrected visual acuity 3 months postop, Dr. Behndig said the difference was not huge. Still, he thinks PiXL has the "potential to become valuable in the treatment of keratoconus." EW Editors' note: Dr. Lisa did not disclose any financial interests. Dr. Güell has financial interests with Ophtec and Visiometrics (Barcelona, Spain). Dr. Holland, Lane, and Behndig do not have any financial interests related to their comments. by Liz Hillman EyeWorld Staff Writer Stephen Lane, MD, Stillwater, Minnesota, a panelist at the sym- posium, called intraoperative OCT "very exciting technology" and said he envisioned it being used beyond corneal surgery in cataract surgery and lens implantation as well. Fel- low panelist Edward Holland, MD, Cincinnati, asked Dr. Lisa if he thought it was worth the money and effort to bring OCT from the clinic into the operating room. "How often has it made you change your surgery?" he asked. Dr. Lisa said he considers the technology very helpful, and when he sees his cannula, for example, at a depth he doesn't like, he will reposition it. José Güell, MD, Barcelona, Spain, presented on the Precizon toric IOL (Ophtec, Groningen, the Netherlands), which is theoretically supposed to tolerate more rotation or decentration. Dr. Güell also said the hydrophilic acrylate lens is the- oretically pupil independent as well. Precizon has a dioptric range from +1 to +34 and cylinder range from +1 to +10. A relatively new lens with only a few clinical studies, Dr. Güell said already been found useful in the anterior segment, he thinks using it intraoperatively could lead to safer surgeries. Dr. Lisa compared fully inte- grated OCT to that conducted with handheld devices. Fully integrated systems provide real-time visual- ization that does not interrupt the procedure but disadvantages include its lack of caliper and a large finan- cial investment. Handheld devices, on the other hand, present disad- vantages such as a higher chance of contamination with the devices needing to be placed closer to the eye and not providing real-time data. Advantages, on the other hand, include their portability and presence of caliper. These devices could be bene- ficial in procedures such as DALK, allowing the physician to assess the depth of the cannula and detect an uneven residual stroma, for example. In DMEK, Dr. Lisa said intraoperative OCT can help assess the location of the endothelial side of the graft, identify remnants of Descemet's membrane, and reveal posterior stroma irregularities. Intraoperative OCT, transitional conic toric IOLs, and crosslinking among the topics T he "Old World," or "across the pond" as some would say, brought information about some new technol- ogies to the "New World," and experts from the United States were given their chance to ask questions during the Saturday sym- posium sponsored by ASCRS and the European Society for Cataract & Refractive Surgeons. "New technology from the Old World, assessment by the New World" included presentations about the use of iris clips IOLs in aphakic eyes, intraoperative OCT, transition- al conic toric IOLs, the use of capsu- lar tension rings to help prevent pos- terior capsular opacification (PCO), topography-guided crosslinking, and topography-guided custom ablation for irregular astigmatism. Carlos Lisa, MD, Madrid, Spain, presented on intraoperative OCT, saying while the technology has "Old World" presents "New World" with some new technology From left: Moderator Rudy Nuijts, MD, Stephen Lane, MD, and Kerry Solomon, MD, watch 1 of the new technology presentations from the "Old World" during a Saturday afternoon symposium.

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