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EW SHOW DAILY 8 ASCRS News Sunday, April 15, 2018 by Ellen Stodola EyeWorld Senior Staff Writer For rapid and accurate diagnosis of dry eye disease by detecting elevated levels of MMP-9 Visit Quidel at Booth 809 quidel.com that intraoperative aberrometry is useful in eyes after refractive surgery. However, he noted that the "missing link" is postoperative IOL position, as there is no prediction for this. He again stressed that intraop- erative OCT helps with better IOL prediction. He also addressed the clinical workflow, suggesting that surgeons should first do biome- try and power calculations, then pre-select the IOL. At that point, intraoperative OCT can be used to verify or adapt the IOL choice. This is especially useful for short or odd eyes. Dr. Findl took some time to dis- cuss toric IOLs, highlighting sources of error with these lenses and esti- mating the posterior surface, noting the work by Douglas Koch, MD, in this area. When considering the best device for Ks, OCT has higher accuracy and includes information on the posterior cornea. In the discussion of toric IOLs, Dr. Findl said that the main source of error is the corneal measurement. To help account for this, he sug- gested using at least two different devices and taking the posterior surface into account or measuring it. He also said to be precise to reduce misalignment, and automated devic- es can aid in this. Dr. Findl highlighted several take-home messages from his lec- ture. For ophthalmologists today, he advocated use of optical biometry, modern formulae and optimized IOL constants, and corneal measure- ments (using two devices). In the future, he expects to potentially see intraoperative measurements refine IOL power selection and the ability to change IOL power in the eye after surgery. EW Editors' note: Dr. Findl has financial interests with Carl Zeiss Meditec (Jena, Germany) and Johnson & Johnson Vision (Santa Ana, California). O liver Findl, MD, Vienna, Austria, gave this year's Binkhorst Lecture, titled "The Challenge of Choos- ing the Right IOL Power." There is a growing demand from patients, Dr. Findl said, and postoperative refraction is the main factor for patient satisfaction. Patients have high demands for multifocal IOLs, toric IOLs, and clear lens exchanges. There are a variety of sources of error, including pupil size, axial length, and postoperative refraction. Dr. Findl discussed optical bi- ometry, which he said has enhanced measurement for axial length. He noted that it was developed in his hometown of Vienna, Austria. Dr. Findl spoke about the value of swept-source OCT and the interest in screening for macular disease with it. Macular screening with OCT biometry provides good detection for cystoid macular edema (CME), macular holes, and epiretinal membrane. However, it could be challenging to use with geographic atrophy and dry AMD. Refraction measurement is one problem in aiming for a specific refractive outcome after surgery because postoperative refraction is often a source of error. He added that there is also variability when looking at different machines. One main issue is trying to predict IOL position. If it's possible to figure out where it will be sitting in the patient's eye, this could be the holy grail of IOL power calcu- lation, he said. It's possible that it could change position after surgery, and capsule shrinkage can alter the IOL position. Other factors that can change IOL position after surgery are fibrosis (which may depend on the material and patient) and haptic de- sign. Dr. Findl specifically discussed a past study comparing single-piece haptics to three-piece haptics. He said that the three-piece haptics tended to have more anterior move- ment/shift, but he noted that these are rarely used in-the-bag today. Dr. Findl discussed studies he has conducted on the effect of the rhexis on IOL position and on neu- ral networks for IOL calculation. Dr. Findl also shared a study looking at intraoperative aberrom- etry-based aphakia refraction in patients with cataract. The study concluded that reproducibility of aphakic measurements was not good enough for IOL power calcu- lation. You also have to take into account that you have corneal changes during surgery. He stressed the importance of double checking preoperative biometry and said Binkhorst Lecture discusses choosing the right IOL power Dr. Findl gives the Binkhorst Lecture during the ASCRS Opening General Session.

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