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3 EW SHOW DAILY ASCRS•ASOA Symposium & Congress, New Orleans 2016 because the surgeon has created a "normal cornea." "A normal cornea will fit better with whatever complex, trifocal, aspheric toric lenses come up," he said. Finally, Dr. Chang was the only panelist in the last category of "Complication Management—Best Save of the Year" to present. His discussion focused on using capsule retractors, like the MST Capsule Retractor (Redmond, Washington), in cases of very dense lenses with pseudoexfoliation. Despite it looking like a sure-fire win for Dr. Chang, Dr. Slade's name appeared on the big screen again, issuing laughs from the audience and panelists alike. EW Editors' note: Dr. Slade has financial interests with Calhoun Vision, Alcon, Novartis (Basel, Switzerland), Carl Zeiss Meditec (Jena, Germany), Bausch + Lomb (Bridgewater, New Jersey), Glaukos (Laguna Hills, California), and ReVision Optics (Lake Forest, California). The other physicians have no financial interests related to their comments. technology a "planned touch-up that gives the patients what they want virtually 100% of the time." Next, the best tip for improving the ocular surface that jived with the audience came from Dr. Slade again. He spoke about the use of autolo- gous tears serum in a filled, scleral contact lens. "It's a simple but magical tech- nique that you can do tomorrow," Dr. Slade said. "It works wonders for your worst dry eyes and other things on the ocular surface as well." When it came time to name the presentation offering the best pearl for astigmatism management, Dr. Slade won yet again, which had fel- low panelists joking about the event being rigged and Dr. Slade pretend- ing to call his wife with the news. "This has never happened to me before," he said. The pearl Dr. Slade offered that impressed the audience so much was on topography-based ablations (WaveLight Allegretto Wave Eye-Q Laser, Alcon, Fort Worth, Texas). "I don't think we treat astig- matism correctly," Dr. Slade said. "For all these devices, for all that we have, we treat based on 1 number, and that's the magnitude." Using a topographically based ablation system, Dr. Slade said sur- geons are treating the actual pattern on the cornea, effectively "normal- izing" the cornea. He alluded to this improving the odds for better outcomes for later cataract surgeries compared to in years past. Dr. Henderson had the audience out of their chairs doing new stretches to help avoid workplace injury, Dr. Lane spoke on preloaded IOLs, and Dr. Lindstrom discussed sublingual conscious sedation (or IV-less cata- ract surgery), to name a few. But it was Dr. Chang's quick talk on recent research that linked intracameral vancomycin to incidents of hem- orrhagic occlusive retinal vasculitis (HOVR) that had him voted as the best presentation in this category. Dr. Chang said that while HOVR is rare and that this research doesn't suggest one shouldn't use vanco- mycin, it has led him and others on the panel to switch to intracameral moxifloxacin. Dr. Chang recom- mended surgeons who are using vancomycin to space procedures out to perhaps avoid the issue in both eyes. Moving on to what the panel thought of new technologies on the horizon, it was Dr. Slade speaking about the Light Adjustable Lens (Calhoun Vision, Pasadena, Califor- nia) that interested the audience the most here. As Dr. Slade explained it, this technology, in phase 2 FDA clinical trials, allows the surgeon to adjust the power of the IOL after placement and after the patient has healed. "It's a digital correction of the lens itself through a polymer tech- nology," he said, adding later in his presentation that he considers this about glaucoma at the time of cata- ract surgery. The other papers Dr. Tipperman presented looked at the comparison of toric IOL outcomes and calculator recommendations for manual and femtosecond laser-assisted cataract surgery, and intraocular lens transec- tion and explantation assisted by a femtosecond laser. Dr. Lee presented the cornea papers. One of the papers he chose looked at refractive outcomes of manual vs. femtosecond laser-assist- ed cataract surgery. Dr. Malyugin said that this study reminded him a bit of the ESCRS FLACS study, with both indi- cating that there's still no concrete proof that the femtosecond laser is safer. Dr. Chan said that she sees FLACS as a safer option for the cor- neal endothelium. Dr. Chang added that because results are good with manual, the numbers need to be huge to show a difference between the 2. Dr. Lee also shared papers on a corneal inlay and DMEK. His quick tip to the audience on DMEK was to watch videos and take advantage of the educational opportunities at meetings. Dr. Noecker highlighted the best glaucoma papers. The first was on the evaluation of a trabecular micro bypass stent with phaco in patients with open angle glaucoma and cataract. This was a study using the iStent (Glaukos, Laguna Hills, California). The iStent is certainly within the skill set of a cataract surgeon, Dr. Chang said, and 1 key skill to have is intraoperative gonioscopy. The second paper was 1 that Dr. Brown had worked on about su- praciliary microstenting concurrent with cataract surgery, specifically looking at the CyPass micro-stent (Transcend Medical, Menlo Park, California). "This is the data that is going before the FDA right now," Dr. Brown said, adding that the expecta- tion is that it will gain FDA approv- al. This would mean there would be more than 1 MIGS device in the market, he said, since currently the iStent is the only available MIGS device. This targets a completely different outflow space and was very effective in the trial, Dr. Brown added. Dr. Desai presented the refrac- tive papers at the session. He shared results with the FluidVision IOL (PowerVision, Belmont, California) and a paper on the Bowman Rough- ness Index in relation to SMILE. Dr. Desai offered his opinion on the best tests for diagnosis of keratoconus, indicating that he thinks topography/tomography are the "gold standard." Other valuable tools include using slit lamp exam or tear film analysis. Dr. Malyugin concluded the session by presenting on cataract papers. He chose 1 paper on the evaluation of a trifocal toric IOL. Trifocals are becoming very popular in Europe and all over the world as well. Dr. Donnenfeld said he thinks that trifocals offer better interme- diate and near, but he is concerned about halos. Dr. Malyugin said there are cur- rently 3 different trifocals approved in Europe, and he knows a number of ophthalmologists who have had these implanted in their own eyes and are happy with the outcomes. The other 2 papers he presented were on a bioanalogic polyfocal IOL and a comparison of different types of corneal incisions, both femtosec- ond and manual. EW Editors' note: The physicians have no financial interests related to their comments. continued from page 1 continued from page 1 Dr. Chang presents on new technologies that can create continuous capsulotomies and intracameral vancomycin's link to incidents of hemorrhagic occlusive retinal vasculitis, among other topics, in the rapid-fire X-Rounds symposium.

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