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EW SHOW DAILY 20 Sunday, May 8, 2016 ASCRS News Today by Liz Hillman EyeWorld staff writer 3. Complete the ASCRS Clinical Survey (physicians only) either at the Clinical Survey booth #3001 in the front of Hall D or in the Tesla booth. Important things to know Perhaps 1 of the most important things for participants to know is that they must be present at the Tesla booth in the Exhibit Hall at the time of each drawing in order to win the item at play. As for the Tesla, the winner is also responsible for transporting the car—either driving or shipping it— to his or her final destination. Last year, Thomas Carter, MD, won the Tesla and drove it from San Diego to his home state of Oklahoma. As the winner, you also agree to pay the applicable taxes under U.S. and Louisiana State law. Best of luck to all registered attendees who enter to win. EW 3 ways to enter drawings for premium items B ack by popular demand, a 2016 Tesla Model S, along with other items, is up for grabs at the 2016 ASCRS•ASOA Symposium & Congress, and there are 3 ways attendees can register to win. Today at 4:45 p.m. in the Tesla booth, located at the back of the Exhibit Hall, a drawing will be held for a hotel suite and transportation to and from the airport for the 2017 ASCRS•ASOA Symposium & Congress in Los Angeles. On Monday at 4:45 p.m. in the Exhibit Hall, 1 lucky partici- pant's name will be drawn for the all-electric, deep blue Tesla Model S 90D. The car can go from 0 to 60 mph in less than 5 seconds and has a range of 294 miles per charge. It also boasts all-wheel drive and an autopilot feature to aid in steering, changing lanes, and parking. How to enter There are 3 ways attendees can obtain drawing tickets, which they should fill out with their name and badge number and place in the raffle drum at the Tesla booth in the Exhibit Hall. 1. Visit a participating exhibitor's booth. 2. Make a voluntary contribution of $50 or more to the ASCRS Foundation. It's back! How you can win a Tesla and more by Lauren Lipuma EyeWorld Contributing Writer I n Saturday morning's Young Eye Surgeons Residents and Fellows Skills Lab, experienced instructors gave residents and fellows an opportunity to practice performing limbal relax- ing incisions for correcting post- operative astigmatism in cataract patients. Two instructors, Zaina Al-Mohtaseb, MD, Houston, and Leila Raju, MD, New York, began the session by discussing pearls for preoperative planning, surgical tech- nique, and postop follow-up. Although ophthalmologists refer to them as limbal relaxing incisions (LRIs), they're actually peripheral corneal relaxing incisions (PCRIs) because the incisions are made slightly anterior to the true surgical limbus, Dr. Al-Mohtaseb said. The mechanism at work behind PCRIs is a coupling effect: making incisions at the steep meridian re- laxes that meridian but steepens the flat meridian by the same amount, she said. "Technically, doing these inci- sions is not that difficult," Dr. Al- Mohtaseb said. "What really matters is deciding how much you're going to treat and where you're going to do these incisions and how long the degree is." In terms of timing, there's controversy among anterior segment surgeons about whether to per- form PCRIs before or after cataract surgery, the physicians said. Dr. Al- Mohtaseb prefers to perform them at the beginning of the case, before she makes any other incisions, while the eye is still firm. During preoperative planning, she prefers to look at 3 different data points—measurements from 2 different topographers and an op- tical biometer. If there's more than a 10-degree difference or a signifi- cant magnitude shift among these measurements, those are times to consider waiting until after cataract surgery to perform the incisions, she said. Dr. Raju said she prefers to use an autorefractor or a manual ker- atometry measurement in addition to topography measurements. The physicians also discussed the importance of accurately mark- ing the eye. Every surgeon does this differently, and if you're going to do it freehand, be obsessive about the way you do it, Dr. Al-Mohtaseb said. She prefers to make 3 marks—at 6, Mastering limbal relaxing incisions 9, and 12 o'clock, while Dr. Raju prefers to make only 2 marks at 3 and 6 o'clock. There are a number of nomo- grams available for surgeons to use, but most of the lab instructors said they prefer to use the Donnenfeld nomogram or LRIcalculator.com. It's important to remember that you see more of an effect in older patients, so you need to lessen the treatment amount for these patients, the in- structors said. Dr. Al-Mohtaseb said that for against-the-rule astigmatism, she prefers to use toric IOLs rather than PCRIs, unless the patient has a very small amount of astigmatism and she can perform 1 nasal incision. But for with-the-rule astigmatism, she is more likely to do a pair of incisions. The most important part of surgery is stabilizing the eye, Dr. Al- Mohtaseb said. "I like to do incisions on the left with my left hand and incisions on the right with my right hand," she said. "But you have to make sure you're doing 1 constant motion, and I always test it before I do that motion." She prefers to use degree mark- ers rather than millimeter markers because if the corneal diameter is different, degree markers are more accurate, she said. Make an incision in the clear cornea and keep the knife perpendicular to the corneal surface, she added. Postoperatively, if you find you've undercorrected the astig- matism, lengthen your incisions or make new incisions centrally, the in- structors said. If you've overcorrect- ed, make new incisions along the new steep meridian and use a suture if the wound gapes. If your correc- tion is off and there is also residual spherical error, you can perform LASIK or PRK, they added. Although the technique does have some disadvantages, PCRIs are a great way to get a better refractive outcome with cataract surgery, Dr. Al-Mohtaseb concluded. "Each instrument works differ- ently and each nomogram works differently, so you have to find what works for you," she said. EW Editors' note: Drs. Al-Mohtaseb and Raju have no financial interests related to their comments.

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