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3 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. Editors' note: Dr. Lindstrom, Dr. Desai, and Dr. Doane have financial inter- ests related to their presentations. Dr. Chang, Mrs. Steinert, and Dr. Probst have no financial interests related to their presentations. Is it weak economic condi- tions? Have all the candidates for laser vision correction already been treated? Is it due to poor results or complications? Or are we in a new era with a new market of consumers, the millennial population? Taking attendees through vari- ous statistics and studies, Dr. Lind- strom shared why he doesn't think corneal refractive surgery's current market status is due to economic conditions or a lack of candidates. He provided research that shows an increase in patient satisfaction with the procedure and the ability for most patients to reach 20/20 uncor- rected distance visual acuity. Dry eye symptoms that might be associated with laser vision cor- rection are counseled for and treated more often now, and modern algo- rithms have reduced the potential for night vision symptoms to 0.06% in the patient population. Factors that Dr. Lindstrom thinks impact the corneal refractive surgery market are the millennial population, which might not have the finances for an elective proce- dure, might be too young for the tar- get age of the procedure, and might be more accepting of spectacle wear. He also pointed to data that showed ophthalmologists have less interest in refractive surgery and noted that they are doing less to promote the procedure. Focusing on millennials as they grow older and advance in their careers, increasing interest within the specialty itself, and focusing on the advantages of LASIK over alter- natives are all things Dr. Lindstrom said could help recover the refractive surgery market. Earlier, the first session of the day featured presentations on the value of corneal topography, the risk of post-LASIK ectasia, and dry eye disease diagnosis and management. Following these presentations, Neel Desai, MD, Largo, Florida, Louis Probst, MD, Westchester, Illinois, and John Doane, MD, Inde- pendence, Missouri, and Leawood, Kansas, provided five pearls for PRK, LASIK, and SMILE, respectively. Dr. Desai, addressing PRK, said it can have specific benefits for pa- tients with higher refractive errors, thin cornea, or at flap risk. His pearls included: 1. Talking to the patient. Acknowl- edge that PRK takes longer to heal. Remember that word choice is important; Dr. Desai avoids words like "scrape" or "debride." He also said "verbal anesthesia," speaking constantly to patients through- out the procedure, can help calm them. 2. Consistency is key. Consistency in timing and technique can impact bed smoothness and bed hydra- tion/dryness. 3. Technique for epithelium remov- al. Dr. Desai prefers an ethanol well for 20 seconds followed by thorough irrigation, as opposed to manual techniques or use of an Amoils brush. 4. Prevention of haze. Pay atten- tion to treatment parameters and degree of myopia or hyperopia, use mitomycin-C and rinse with chilled balanced salt solution, and avoid postop drops that include DuraSite (InSite Vision, Alameda, California) vehicles. 5. Postop healing. Pretreat all forms of ocular surface disease with the appropriate therapy available and consider the role of biologics. Dr. Probst provided pearls that could help reduce LASIK patients' stress: 1. Use single-use LASIK instruments. These provide peace of mind in that they're consistently clean, smooth, and non-contaminated. 2. Time out/verification. Before you do the treatment, have the technician read off the laser screen while the surgeon checks the in- formation on a printed sheet with objective measurements. 3. Flap/zap LASIK. Complete one eye fully before moving onto any part of the procedure for the second eye. 4. Ask permission. Asking the patient for permission before initiating a procedure shows respect. 5. Empower the patient. When Dr. Probst notices a patient is anxious, he stops, asks them if they would like another relaxing pill, if they would like to check the vision in their right eye (if already treated) before proceeding with the left, or confirm that they're ready to proceed with treatment. Dr. Doane provided clinical pearls for successful SMILE surgeries. 1. Understand the anatomy. SMILE involves working horizontally and in a pocket. 2. Identify the anterior and posterior interface prior to dissection. The most critical part is finding the edge of the lenticule. 3. Start with higher myopes. Until you are comfortable with the pro- cedure, start with higher myopes (5 D or higher). 4. There is a nomogram. It is import- ant to track your outcomes data and consider your own personal nomogram as a result. 5. Appreciate corneal integrity. Just because SMILE has the theoretical potential for greater biomechan- ical stability, Dr. Doane said this does not mean one can treat a patient with early keratoconus with impunity. EW Second continued from page 1 Advancing CATARACT SURGERY LenSx ® LASER ® CENTURION ® VISION SYSTEM IMPORTANT PRODUCT INFORMATION CAUTION: Federal (USA) law restricts this device to sale by, or on the order of, a physician. As part of a properly maintained surgical environment, it is recommended that a backup IOL Injector be made available in the event the AutoSert ® IOL Injector Handpiece does not perform as expected. INDICATION: The Centurion ® Vision System is indicated for emulsification, separation, irrigation, and aspiration of cataracts, residual cortical material and lens epithelial cells, vitreous aspiration and cutting associated with anterior vitrectomy, bipolar coagulation, and intraocular lens injection. The AutoSert ® IOL Injector Handpiece is intended to deliver qualified AcrySof ® intraocular lenses into the eye following cataract removal. The AutoSert ® IOL Injector Handpiece achieves the functionality of injection of intraocular lenses. The AutoSert ® IOL Injector Handpiece is indicated for use with the AcrySof ® lenses SN6OWF, SN6AD1, SN6AT3 through SN6AT9, as well as approved AcrySof ® lenses that are specifically indicated for use with this inserter, as indicated in the approved labeling of those lenses. WARNINGS: Appropriate use of Centurion ® Vision System parameters and accessories is important for successful procedures. Use of low vacuum limits, low flow rates, low bottle heights, high power settings, extended power usage, power usage during occlusion conditions (beeping tones), failure to sufficiently aspirate viscoelastic prior to using power, excessively tight incisions, and combinations of the above actions may result in significant temperature increases at incision site and inside the eye, and lead to severe thermal eye tissue damage. Good clinical practice dictates the testing for adequate irrigation and aspiration flow prior to entering the eye. Ensure that tubings are not occluded or pinched during any phase of operation. The consumables used in conjunction with ALCON ® instrument products constitute a complete surgical system. Use of consumables and handpieces other than those manufactured by Alcon may affect system performance and create potential hazards. AES/COMPLICATIONS: Inadvertent actuation of Prime or Tune while a handpiece is in the eye can create a hazardous condition that may result in patient injury. During any ultrasonic procedure, metal particles may result from inadvertent touching of the ultrasonic tip with a second instrument. Another potential source of metal particles resulting from any ultrasonic handpiece may be the result of ultrasonic energy causing micro abrasion of the ultrasonic tip. ATTENTION: Refer to the Directions for Use and Operator's Manual for a complete listing of indications, warnings, cautions and notes. © 2016 Novartis 12/16 US-CNT-16-E-5196 US-CNT-16-E-5196_PI_EWDN.indd 1 4/6/18 2:03 PM

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