Eyeworld Daily News

49 EW SHOW DAILY 2018 ASCRS•ASOA Annual Meeting, Washington, D.C. by Vanessa Caceres EyeWorld Contributing Writer outcomes. He shared results that show the tipping point for patient satisfaction is 0.75 D of residual astigmatism; beyond that, patients tend to be less happy with their results. When evaluating residual astigmatism, take a systematic ap- proach to identify the cause, which can range from incorrect placement, incorrect marking, or measurement errors, among other factors. The website astigmatismfix.com is a great resource to help surgeons manage residual astigmatism, Dr. Waring said. Other pearls he shared include watching out for cystoid macular edema, avoiding a YAG until IOL rotation or exchange takes place, and not performing second- eye surgery until problems with the first eye are fixed. When discussing whether surgeons need an expensive array of measurement devices to manage astigmatism and toric IOLs, panelists agreed that the use of tomography and topography along with the var- ious mathematical models available nowadays can work effectively—but surgeons do need more than one measurement to be successful. That's a point that Douglas Koch, MD, Houston, emphasized, as he urged attendees to obtain more than one measurement and to verify the qual- ity of any raw data that they use. He also encouraged attendees to calcu- late for the effect of the posterior cornea and listen closely to patient complaints. "Don't be satisfied with subpar near and distance vision," he said. "Be ready to treat errors that you encounter." EW Editors' note: The program was support- ed by educational grants from Bausch + Lomb (Bridgewater, New Jersey), Carl Zeiss Meditec (Jena, Germany), and Johnson & Johnson Vision (Santa Ana, California). devices for measurements pre- and postoperatively, she advised. In addition to use of an ocular surface disease questionnaire, Dr. Donaldson's staff members also measure tear osmolarity and mea- sure MMP-9 levels. When the ocular surface needs to be further managed, the typical treatments, including artificial tears and cyclosporine (Restasis, Allergan, Dublin, Ireland) or lifitegrast (Xiidra, Shire Pharma- ceuticals, Lexington, Massachusetts), can be helpful. She sometimes also will perform a superficial keratecto- my—something she does more fre- quently nowadays—or try amniotic membrane treatment. George Waring IV, MD, Mount Pleasant, South Carolina, discussed how he aims to improve toric IOL That same survey found that 29% of respondents in the survey thought that 10 or more degrees of residual astigmatism was accept- able—a point that panelists would like to change. "With 7 to 10 degrees, you lose 35% of the power of the toricity," said Rosa Braga-Mele, MD, Toronto, Canada. "Three to 5 degrees is [a better goal]." Kendall Donaldson, MD, Plantation, Florida, aims to leave less than 0.5 D of residual cylinder every time during surgery; one way to help meet astigmatism treatment goals is to optimize the ocular surface before surgery, she said. When taking various measurements to track dry eye and assess the ocular surface, use seasoned techs, and use the same S urgeons treating astigma- tism should aim for no more than 3 to 5 degrees of residual astigmatism; otherwise, the patient's visual results may not be as optimal, according to panelists at Monday morning's "Lens-Based Astigma- tism: Increasing Patient Adoption and Surgical Outcomes in Toric IOL Patients." The popularity of toric IOLs was apparent in the results of the 2017 ASCRS Clinical Survey, which found that while only 10% of survey respondents were using toric IOLs during cataract surgery, nearly 50% said they would use them if there was no extra cost involved, said Richard Lindstrom, MD, Minneap- olis. Tackling astigmatism effectively with toric IOLs Dr. Donaldson says optimizing the ocular surface is crucial for optimal results with toric IOLs.

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