winter 2012 cataract and refractive surgeons offer tips on...
TRANSCRIPT
The Newsmagazine of the Asia Pacific Association of Cataract & Refractive Surgeons
Reporting live from an EyeWorld Corporate Event at the 2011 APACRS meeting, Seoul, Korea
ASIA-PACIFIC
Supplement to EyeWor ld As ia-Pac i f ic
WINTER 2012
APACRS
Cataract and refractive surgeons offertips on targeting optimal outcomes
Apanel of well-respected surgeons gave attendees ofan EyeWorld Corporate Eventtips on how to target optimalclinical outcomes in cataract
and refractive practice during the 24th an-nual meeting of the Asia-Pacific Association of Cataract & Refractive Surgeons, held in October 2011.
The symposium, sponsored by Abbott Medical Optics Singapore Pte.Ltd. (AMO, Santa Ana, Calif., USA), wasmoderated by Han Bor Fam, MD, andHungwon Tchah, MD, and includedtalks from Gerd U. Auffarth, MD, andPerry S. Binder, MD.
High-order aberration correctionDr. Tchah, professor, ophthalmology department, College of Medicine, UlsanUniversity, Seoul, South Korea, opened thesymposium with his talk, “Beyond 20/20,”which focused on how cataract and refractive surgeons can use high-orderaberration correction to achieve 20/20 best uncorrected vision or better.
Dr. Tchah argued that visual acuitydoes not equal the same visual quality andsaid he and others are exploring how to increase visual quality. “Beyond 20/20 is notvision 20/8, but vision with a better quality,”Dr. Tchah said. “To achieve this goal, wavefront technology should be applied.”
Dr. Tchah showed the results of the
This supplement was produced by EyeWorld and sponsored by Abbott Medical Optics Singapore Pte. Ltd.
Copyright 2012 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or thepublisher, and in no way imply endorsement by EyeWorld, ASCRS, or APACRS.
aspheric IOL, Tecnis (AMO), which provided decreased spherical aberration compared with conventional sphericalIOLs, and optical bench tests of severalmultifocal IOLs, “which functioned as theywere intended in terms of higher-orderaberrations.”
Dr. Tchah combines IntraLase technology and the Advanced CustomVueprocedure. This blend of technology byAMO is called iLASIK.
“The custom wavefront is working todecrease higher-order aberrations, in-duced by corneal ablations, resulting in increased visual quality,” Dr. Tchah said.
IntraLase technology allows a surgeonto precision-design his or her patientʼs intracorneal architecture in terms of diame-ter, depth, edge angle, and morphology—creating the optimal stromal bed for the re-fractive procedure. Advanced CustomVuethen uses WaveScan technologyʼs Fourieralgorithms to deliver high resolution, whichresults in accurate and individualized treatment for a wide range of ophthalmicindications. Advanced CustomVue is theonly procedure to offer iris registration, thefirst fully automated method of aligning andregistering wavefront correction, helping toensure precision and accuracy, accordingto AMO.
A recent study that was published inthe Saudi Journal of Ophthalmology titled“Effects of advanced surface ablations and
“It is designed to prevent cell migra-tion along the haptic, and the frosted-edgedesign minimizes edge glare,” Dr. Auffarthsaid.
The offset haptic design providesthree points of fixation of the lens in thecapsule and pushes the optic edge againstthe posterior capsule helping to minimizePCO.
“It is designed for quick and long-termstabilization of the optic and refraction,” Dr.Auffarth said, adding that the aspheric design of the lens also compensates foraverage corneal spherical aberrations.
He pointed to a study that comparedvisual acuity of the Tecnis Multifocal with amonofocal lens. “We get the same qualityof vision with the multifocal as the monofo-cal, which is quite a good sign,” he said.
Dr. Auffarth also noted a study whereresearchers compared patients who wereimplanted with the Tecnis IOL to those implanted with the AcrySof IQ (Alcon, FortWorth, Texas, USA/Hünenberg, Switzer-land).
“We have an advantage with this lens.The difference in spherical aberration isquite interesting—around 0.07 microme-
to what I would call refractive lens surgery,where we are targeting people who haveno cataracts and have a clear lens,” Dr.Auffarth said. “We can remove the lens forrefractive purposes because of highametropia. But we can also do this for patients who have presbyopia. Now theage groups are going down, and itʼs notunusual to do this surgery in a 45-year-oldusing a multifocal lens—thatʼs somethingthat we didnʼt do 15 years ago.”
The Tecnis Multifocal, which hasevolved from a rigid PMMA lens to a mod-ern foldable hydrophobic single-piece IOL,provides patients with advanced imagequality at all distances and in all lightingconditions and a high level of spectacle independence. This lens and the TecnisToric for astigmatism correction are madeof a hydrophobic acrylic material with lowchromatic aberration.
“The details of the lens give you acouple of advantages,” Dr. Auffarth said.
The Tecnis one-piece has a PROTEC360-degree edge design, which has unin-terrupted contact with the posterior capsu-lar bag even at the haptic-optic junction tominimize PCO by limiting LEC migration.
ters,” Dr. Auffarth said. The difference in residual spherical
aberration was 0.078 micrometers with theTecnis showing –0.029 micrometers ofspherical aberration and the IQ showing+0.049 micrometers.
Dr. Auffarth showed a video thatdemonstrated the new injector for the lens,which goes through a 2.2 or 2.3 mm inci-sion.
“The lens is hydrophobic acrylic, butitʼs not as sticky as some of the otherlenses on the market. When we insert thelens into the capsular bag, it easily loosensup so we can align it,” Dr. Auffarth said. “Itunfolds slowly, which is quite nice.”
Dr. Auffarth said that he started im-planting the Tecnis Toric in Heidelberg thisyear and has found that the lens compen-sates for pre-existing cylinder and providesexcellent functional results.
“Ninety percent of the patients whocome into my practice with cylinder can becovered with this lens,” he said.
He added a couple of pearls for theTecnis lens, especially with using the IOLpower calculator provided on the AMOwebsite.
“Do your markings with the patient sitting upward looking straight ahead, otherwise you can alter the position of thelens,” Dr. Auffarth said.
As for the calculator, “always use Kvalues in millimeters, never put it indiopters,” he said. “Depending on the machine you are using and its refractiveindex, you can have slightly different results.”
ReferenceSaudi Journal of Ophthalmology, Volume 25, Issue3, pages 275-280 (July 2011).
Contact informationAuffarth: [email protected]: 858-922-8699, [email protected]: +65 6357 7726, [email protected]: [email protected]
Cataract and refractive surgeons offer tips on targeting optimal outcomes4
Han Bor Fam, MDSingapore
Hungwon Tchah, MDSeoul, Korea
Perry S. Binder, MDIrvine, Calif., USA
Gerd U. Auffarth, MDHeidelberg, Germany
Sponsored by Abbott Medical OpticsSingapore Pte. Ltd.
Tecnis Traditional Spherical IOL
EWAP_Supplement_Jan2012_REV4.qxd:Layout 1 12/16/11 3:05 PM Page 1
Cataract and refractive surgeons offer tips on targeting optimal outcomes2 3
IntraLase femtosecond LASIK on higherorder aberrations and visual acuity outcome” also looked at the technologyʼseffect.
The aim was to “study the changes inwavefront (ocular) and corneal higher-order aberrations (HOAs) and visual acuity(VA) outcomes following wavefront-guidedadvanced surface ablation (ASA) tech-niques and IntraLase femtosecond LASIK(iLASIK) in myopia treatment,” accordingto the abstract. The study was undertakenat the Department of Surgery, Faculty ofMedicine and Health Sciences, UnitedArab Emirates University, Al Ain, as well asthe Department of Ophthalmology, University of Ottawa Eye Institute, Ontario,Canada.
Aberrations with BSCVA were ana-lyzed in 240 eyes that underwent the ASAtechnique, which were equally divided intoa flap-on group “where the epithelial flapwas preserved and reapplied to the photoablated stromal bed and a flap-offgroup where the epithelial flap was discarded during the procedure,” and 138 eyes in the iLASIK group.
Corneal topography and ocular aberration were taken before treatment, as well as 3 months post-op.
Results at 3 months showed that“there was a statistically significant(P<0.001) surgically induced increase inspherical aberration (SA) in each of thetechniques for both ocular and cornealanalysis. iLASIK induced significantly lessocular and corneal HOAs (P<0.001). Themean manifest refractive spherical equiva-lent was closer to attempted correction
compared to other groups (P<0.001).Eighty-three eyes (70%) of flap-on, 80(67%) flap-off, and 94 eyes (68%) in theiLASIK group achieved 20/20 uncorrectedVA. Fifteen eyes (11%) accomplished20/12.5 or better in iLASIK compared to 4(3%) for the flap-on and 7 (6%) for the flap-off ASA group. Only the flap-off treatmentshowed a consistent correlation betweenthe corrected aberrations and visual performance.”
The study showed that all the patientshad comparable 20/20 visual acuity, while11% of iLASIK patients were able toachieve 20/12.15 or better.
Because of the way higher-order aberrations interact with each other, Dr.Tchah said surgeons may not only have todecrease them but also increase them aspart of a customized procedure that aimsfor better quality of vision.
iDesign: One instrument, many usesDr. Binder, clinical professor, Gavin Herbert Eye Institute, Department of Ophthalmology, University of California,Irvine; medical monitor for AMO; and medical director for AcuFocus (Irvine,Calif., USA .), touted the benefits of thenew iDesign diagnostic system during histalk, “Evaluation of the Performance and Acceptability of an Advanced Wavefront-Guided System.”
Currently, the way we acquire patientexam data is slow and many times has tobe repeated because of poor measure-ments, conflict of data because of off-axismeasurements, or incomplete data, Dr.Binder noted.
Besides the traditional paperwork, pa-tients are first refracted with the phoropterafter neutralizing their eyeglasses.
“Depending on the practice, whetherits cataract or refractive, they are thentaken back to a diagnostic room in whichthey have topography, either placido-basedor Scheimpflug-based, or a combination ofthe two,” Dr. Binder said, adding that pa-tients may also have wavefront aberrome-try performed as well as keratometry toassess corneal curvature and measure-ments of the pupils and IOP. Corneal thickness may or may not be done.
“Surgery days come up and patientsmay have to repeat many of thoseprocesses right before the surgery,” Dr.Binder said. “Thatʼs where we are today.We would like to improve efficiency, as wellas decrease the cost for that improved efficiency, while increasing accuracy. Thatwould be a wonderful goal.”
The iDesign Advanced WaveScanStudio, which is now in its fourth genera-tion, takes five sets of ocular measure-ments within a single capture sequence—auto-refraction, high-resolution Hartmann-Shack wavefront aberrometry, full-gradienttopography, and integrated keratometryand pupillometry.
“Within a 3-second single acquisitionsequence, the instrument obtains four different measurement frames, which allows for absolute registration, correctingfor eye movement and pupil shift,” accord-ing to AMO.
“One of the advantages that theiDesign will bring to the table is that the ef-ficiency of the system and accuracy will beincreased because there is one sitting, sothe patient will not be moved,” Dr. Bindersaid. “Weʼre capturing five pieces of infor-mation simultaneously. Not only does thatsave time, but it also allows greater accu-racy. Weʼre now overlaying topographyand aberrometry, and that allows us to pinpoint where the source of the aberrationis coming from.”
The high-definition sensor, which in-creases resolution 4 to 5 times over thecurrent WaveScan instrument, allows formaximized capture rates on highly aber-rated eyes, which means a surgeon willhave the ability to measure complex wave-fronts where heretofore wavefronts couldnot be obtained. “Distortions will have lesseffect on preventing acquisition of theaberrometry,” Dr. Binder said. “This isgoing to increase the percentage of eyesthat can be captured, and thatʼs going to
help the number of eyes we can treat withwavefront-guided surgery, improve our diagnostic capabilities, and maybe evenhelp us select patients who have abnor-malities that we could not detect, such asearly keratoconus patients.”
The full-gradient topography coversmore of the corneal surface than ever be-fore—more than 8.3 mm surface area withtrue central 3-mm data. “The closer we getto the visual axis, the better our predictabil-ity of IOL power will be, especially in eyesthat have had previous refractive surgery,”Dr. Binder said.
Dr. Binder said capturing data fromone instrument is beneficial for both surgeons and patients.
“The situation that weʼre in is that wewant to get more patients examined perunit time without sacrificing the data collection,” he said. “In terms of cost, instead of having five instruments, you basically only have one. Of course on theday of surgery, that would speed up everything. This integrated instrument provides more information needed for optimal outcomes and improves workflow.”
He added that the registered data setsallow for comparisons between measure-ments.
“It allows us to analyze highly aber-rated eyes, has more enhanced precision,and the autorefraction can do a better jobthan most manifest refractions,” he con-cluded.
Dr. Binder said the iDesign is currentlybeing released in Europe as a diagnosticunit.
In the future, he hopes to see softwareplanning between the iDesign and theVISX laser or its successor. “Everythingwill be transferred electronically, and thenwe will improve on efficiency even more,”Dr. Binder said. “The data entry is reducedbecause weʼre only doing it once insteadof twice (aberrometer and VISX) or threetimes (add the IntraLase). Cutting down ondata entry means cutting down on errorswith typing and refractions.”
The option to choose with the WhitestarIn his talk, “Optimizing Phaco Energy andEfficiency,” Dr. Fam said the Whitestar Signature (AMO), a modular ophthalmicmicrosurgical system, is unique in that itsFusion Pump allows doctors to switch between peristaltic and venturi pumpswhile operating.
Dr. Fam is senior consultant andhead, Cataract & Implant Service; seniorconsultant, Refractive Surgery Service andCornea Service, The Eye Institute at TanTock Seng Hospital, National HealthcareGroup, Singapore; and clinical lecturer,National University of Singapore.
“Surgeons can switch from the pumpthey are most familiar or comfortable with,”he said. “The versatility of two pumps in-creases their chances of being able tomatch their needs, as opposed to with asingle machine. Surgeons can take advan-tage of the two pumps because each hasits own advantages. That way, the risks arelower.”
He said the pump-changing option isespecially good for practices with severalsurgeons. “Surgeons can switch withouthaving to invest in two machines,” he said.“From a department standpoint, wherethere is more than one surgeon with differ-ent techniques, the two pumps should beable to suit most people.”
Dr. Fam said the differences in thepumps are subtle. “The venturi has a verygood flow rate, making it highly followable.Unfortunately, if surgeons want a usefulvacuum setting for a certain stage of thesurgery, they would have too high of a flowrate, which would make surgery danger-ous. At that point, they may want to usethe peristaltic pump, which is generallyslower. It all depends on what they want.Versatility is the main point.”
The Whitestarʼs Ellips FX technologyassists surgeons with lens extraction by simultaneously blending longitudinal andtransversal modalities for smoother cutting.It works with any tip style, straight orcurved, and minimizes the risk of thermaldamage.
Finally, the Fusion Fluidics technologyanticipates occlusions and pre-emptivelyadjusts the vacuum before occlusionsbreak, providing better chamber stabilityand improved safety.
Despite the machineʼs impressivetechnology, surgeons should continue tosharpen their surgical skills, Dr. Fam said.
“Technology is just technology,” hesaid. “Surgeons need to optimize theirtechnique before surgery. They cannot relyon technology alone. Because of the ver-satility of the two pumps, the chances ofbeing able to match the technique with asingle machine are much higher. Surgeonscan take advantage of the two pumps be-cause each pump has its advantages anddisadvantages.”
Talking about IOLsFinally, Dr. Auffarth, chairman, Departmentof Ophthalmology, University of Heidelberg,shared his experiences with the Tecnislenses, both multifocal and toric, in his talk,“Maximizing Patient Outcomes with Multifo-cal and Toric IOLs.”
“We are now at the point where weare moving from medical cataract surgery
EWAP_Supplement_Jan2012_REV3.qxd:Layout 1 12/16/11 1:55 PM Page 3
Cataract and refractive surgeons offer tips on targeting optimal outcomes2 3
IntraLase femtosecond LASIK on higherorder aberrations and visual acuity outcome” also looked at the technologyʼseffect.
The aim was to “study the changes inwavefront (ocular) and corneal higher-order aberrations (HOAs) and visual acuity(VA) outcomes following wavefront-guidedadvanced surface ablation (ASA) tech-niques and IntraLase femtosecond LASIK(iLASIK) in myopia treatment,” accordingto the abstract. The study was undertakenat the Department of Surgery, Faculty ofMedicine and Health Sciences, UnitedArab Emirates University, Al Ain, as well asthe Department of Ophthalmology, University of Ottawa Eye Institute, Ontario,Canada.
Aberrations with BSCVA were ana-lyzed in 240 eyes that underwent the ASAtechnique, which were equally divided intoa flap-on group “where the epithelial flapwas preserved and reapplied to the photoablated stromal bed and a flap-offgroup where the epithelial flap was discarded during the procedure,” and 138 eyes in the iLASIK group.
Corneal topography and ocular aberration were taken before treatment, as well as 3 months post-op.
Results at 3 months showed that“there was a statistically significant(P<0.001) surgically induced increase inspherical aberration (SA) in each of thetechniques for both ocular and cornealanalysis. iLASIK induced significantly lessocular and corneal HOAs (P<0.001). Themean manifest refractive spherical equiva-lent was closer to attempted correction
compared to other groups (P<0.001).Eighty-three eyes (70%) of flap-on, 80(67%) flap-off, and 94 eyes (68%) in theiLASIK group achieved 20/20 uncorrectedVA. Fifteen eyes (11%) accomplished20/12.5 or better in iLASIK compared to 4(3%) for the flap-on and 7 (6%) for the flap-off ASA group. Only the flap-off treatmentshowed a consistent correlation betweenthe corrected aberrations and visual performance.”
The study showed that all the patientshad comparable 20/20 visual acuity, while11% of iLASIK patients were able toachieve 20/12.15 or better.
Because of the way higher-order aberrations interact with each other, Dr.Tchah said surgeons may not only have todecrease them but also increase them aspart of a customized procedure that aimsfor better quality of vision.
iDesign: One instrument, many usesDr. Binder, clinical professor, Gavin Herbert Eye Institute, Department of Ophthalmology, University of California,Irvine; medical monitor for AMO; and medical director for AcuFocus (Irvine,Calif., USA .), touted the benefits of thenew iDesign diagnostic system during histalk, “Evaluation of the Performance and Acceptability of an Advanced Wavefront-Guided System.”
Currently, the way we acquire patientexam data is slow and many times has tobe repeated because of poor measure-ments, conflict of data because of off-axismeasurements, or incomplete data, Dr.Binder noted.
Besides the traditional paperwork, pa-tients are first refracted with the phoropterafter neutralizing their eyeglasses.
“Depending on the practice, whetherits cataract or refractive, they are thentaken back to a diagnostic room in whichthey have topography, either placido-basedor Scheimpflug-based, or a combination ofthe two,” Dr. Binder said, adding that pa-tients may also have wavefront aberrome-try performed as well as keratometry toassess corneal curvature and measure-ments of the pupils and IOP. Corneal thickness may or may not be done.
“Surgery days come up and patientsmay have to repeat many of thoseprocesses right before the surgery,” Dr.Binder said. “Thatʼs where we are today.We would like to improve efficiency, as wellas decrease the cost for that improved efficiency, while increasing accuracy. Thatwould be a wonderful goal.”
The iDesign Advanced WaveScanStudio, which is now in its fourth genera-tion, takes five sets of ocular measure-ments within a single capture sequence—auto-refraction, high-resolution Hartmann-Shack wavefront aberrometry, full-gradienttopography, and integrated keratometryand pupillometry.
“Within a 3-second single acquisitionsequence, the instrument obtains four different measurement frames, which allows for absolute registration, correctingfor eye movement and pupil shift,” accord-ing to AMO.
“One of the advantages that theiDesign will bring to the table is that the ef-ficiency of the system and accuracy will beincreased because there is one sitting, sothe patient will not be moved,” Dr. Bindersaid. “Weʼre capturing five pieces of infor-mation simultaneously. Not only does thatsave time, but it also allows greater accu-racy. Weʼre now overlaying topographyand aberrometry, and that allows us to pinpoint where the source of the aberrationis coming from.”
The high-definition sensor, which in-creases resolution 4 to 5 times over thecurrent WaveScan instrument, allows formaximized capture rates on highly aber-rated eyes, which means a surgeon willhave the ability to measure complex wave-fronts where heretofore wavefronts couldnot be obtained. “Distortions will have lesseffect on preventing acquisition of theaberrometry,” Dr. Binder said. “This isgoing to increase the percentage of eyesthat can be captured, and thatʼs going to
help the number of eyes we can treat withwavefront-guided surgery, improve our diagnostic capabilities, and maybe evenhelp us select patients who have abnor-malities that we could not detect, such asearly keratoconus patients.”
The full-gradient topography coversmore of the corneal surface than ever be-fore—more than 8.3 mm surface area withtrue central 3-mm data. “The closer we getto the visual axis, the better our predictabil-ity of IOL power will be, especially in eyesthat have had previous refractive surgery,”Dr. Binder said.
Dr. Binder said capturing data fromone instrument is beneficial for both surgeons and patients.
“The situation that weʼre in is that wewant to get more patients examined perunit time without sacrificing the data collection,” he said. “In terms of cost, instead of having five instruments, you basically only have one. Of course on theday of surgery, that would speed up everything. This integrated instrument provides more information needed for optimal outcomes and improves workflow.”
He added that the registered data setsallow for comparisons between measure-ments.
“It allows us to analyze highly aber-rated eyes, has more enhanced precision,and the autorefraction can do a better jobthan most manifest refractions,” he con-cluded.
Dr. Binder said the iDesign is currentlybeing released in Europe as a diagnosticunit.
In the future, he hopes to see softwareplanning between the iDesign and theVISX laser or its successor. “Everythingwill be transferred electronically, and thenwe will improve on efficiency even more,”Dr. Binder said. “The data entry is reducedbecause weʼre only doing it once insteadof twice (aberrometer and VISX) or threetimes (add the IntraLase). Cutting down ondata entry means cutting down on errorswith typing and refractions.”
The option to choose with the WhitestarIn his talk, “Optimizing Phaco Energy andEfficiency,” Dr. Fam said the Whitestar Signature (AMO), a modular ophthalmicmicrosurgical system, is unique in that itsFusion Pump allows doctors to switch between peristaltic and venturi pumpswhile operating.
Dr. Fam is senior consultant andhead, Cataract & Implant Service; seniorconsultant, Refractive Surgery Service andCornea Service, The Eye Institute at TanTock Seng Hospital, National HealthcareGroup, Singapore; and clinical lecturer,National University of Singapore.
“Surgeons can switch from the pumpthey are most familiar or comfortable with,”he said. “The versatility of two pumps in-creases their chances of being able tomatch their needs, as opposed to with asingle machine. Surgeons can take advan-tage of the two pumps because each hasits own advantages. That way, the risks arelower.”
He said the pump-changing option isespecially good for practices with severalsurgeons. “Surgeons can switch withouthaving to invest in two machines,” he said.“From a department standpoint, wherethere is more than one surgeon with differ-ent techniques, the two pumps should beable to suit most people.”
Dr. Fam said the differences in thepumps are subtle. “The venturi has a verygood flow rate, making it highly followable.Unfortunately, if surgeons want a usefulvacuum setting for a certain stage of thesurgery, they would have too high of a flowrate, which would make surgery danger-ous. At that point, they may want to usethe peristaltic pump, which is generallyslower. It all depends on what they want.Versatility is the main point.”
The Whitestarʼs Ellips FX technologyassists surgeons with lens extraction by simultaneously blending longitudinal andtransversal modalities for smoother cutting.It works with any tip style, straight orcurved, and minimizes the risk of thermaldamage.
Finally, the Fusion Fluidics technologyanticipates occlusions and pre-emptivelyadjusts the vacuum before occlusionsbreak, providing better chamber stabilityand improved safety.
Despite the machineʼs impressivetechnology, surgeons should continue tosharpen their surgical skills, Dr. Fam said.
“Technology is just technology,” hesaid. “Surgeons need to optimize theirtechnique before surgery. They cannot relyon technology alone. Because of the ver-satility of the two pumps, the chances ofbeing able to match the technique with asingle machine are much higher. Surgeonscan take advantage of the two pumps be-cause each pump has its advantages anddisadvantages.”
Talking about IOLsFinally, Dr. Auffarth, chairman, Departmentof Ophthalmology, University of Heidelberg,shared his experiences with the Tecnislenses, both multifocal and toric, in his talk,“Maximizing Patient Outcomes with Multifo-cal and Toric IOLs.”
“We are now at the point where weare moving from medical cataract surgery
EWAP_Supplement_Jan2012_REV3.qxd:Layout 1 12/16/11 1:55 PM Page 3
The Newsmagazine of the Asia Pacific Association of Cataract & Refractive Surgeons
Reporting live from an EyeWorld Corporate Event at the 2011 APACRS meeting, Seoul, Korea
ASIA-PACIFIC
Supplement to EyeWor ld As ia-Pac i f ic
WINTER 2012
APACRS
Cataract and refractive surgeons offertips on targeting optimal outcomes
Apanel of well-respected surgeons gave attendees ofan EyeWorld Corporate Eventtips on how to target optimalclinical outcomes in cataract
and refractive practice during the 24th an-nual meeting of the Asia-Pacific Association of Cataract & Refractive Surgeons, held in October 2011.
The symposium, sponsored by Abbott Medical Optics Singapore Pte.Ltd. (AMO, Santa Ana, Calif., USA), wasmoderated by Han Bor Fam, MD, andHungwon Tchah, MD, and includedtalks from Gerd U. Auffarth, MD, andPerry S. Binder, MD.
High-order aberration correctionDr. Tchah, professor, ophthalmology department, College of Medicine, UlsanUniversity, Seoul, South Korea, opened thesymposium with his talk, “Beyond 20/20,”which focused on how cataract and refractive surgeons can use high-orderaberration correction to achieve 20/20 best uncorrected vision or better.
Dr. Tchah argued that visual acuitydoes not equal the same visual quality andsaid he and others are exploring how to increase visual quality. “Beyond 20/20 is notvision 20/8, but vision with a better quality,”Dr. Tchah said. “To achieve this goal, wavefront technology should be applied.”
Dr. Tchah showed the results of the
This supplement was produced by EyeWorld and sponsored by Abbott Medical Optics Singapore Pte. Ltd.
Copyright 2012 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or thepublisher, and in no way imply endorsement by EyeWorld, ASCRS, or APACRS.
aspheric IOL, Tecnis (AMO), which provided decreased spherical aberration compared with conventional sphericalIOLs, and optical bench tests of severalmultifocal IOLs, “which functioned as theywere intended in terms of higher-orderaberrations.”
Dr. Tchah combines IntraLase technology and the Advanced CustomVueprocedure. This blend of technology byAMO is called iLASIK.
“The custom wavefront is working todecrease higher-order aberrations, in-duced by corneal ablations, resulting in increased visual quality,” Dr. Tchah said.
IntraLase technology allows a surgeonto precision-design his or her patientʼs intracorneal architecture in terms of diame-ter, depth, edge angle, and morphology—creating the optimal stromal bed for the re-fractive procedure. Advanced CustomVuethen uses WaveScan technologyʼs Fourieralgorithms to deliver high resolution, whichresults in accurate and individualized treatment for a wide range of ophthalmicindications. Advanced CustomVue is theonly procedure to offer iris registration, thefirst fully automated method of aligning andregistering wavefront correction, helping toensure precision and accuracy, accordingto AMO.
A recent study that was published inthe Saudi Journal of Ophthalmology titled“Effects of advanced surface ablations and
“It is designed to prevent cell migra-tion along the haptic, and the frosted-edgedesign minimizes edge glare,” Dr. Auffarthsaid.
The offset haptic design providesthree points of fixation of the lens in thecapsule and pushes the optic edge againstthe posterior capsule helping to minimizePCO.
“It is designed for quick and long-termstabilization of the optic and refraction,” Dr.Auffarth said, adding that the aspheric design of the lens also compensates foraverage corneal spherical aberrations.
He pointed to a study that comparedvisual acuity of the Tecnis Multifocal with amonofocal lens. “We get the same qualityof vision with the multifocal as the monofo-cal, which is quite a good sign,” he said.
Dr. Auffarth also noted a study whereresearchers compared patients who wereimplanted with the Tecnis IOL to those implanted with the AcrySof IQ (Alcon, FortWorth, Texas, USA/Hünenberg, Switzer-land).
“We have an advantage with this lens.The difference in spherical aberration isquite interesting—around 0.07 microme-
to what I would call refractive lens surgery,where we are targeting people who haveno cataracts and have a clear lens,” Dr.Auffarth said. “We can remove the lens forrefractive purposes because of highametropia. But we can also do this for patients who have presbyopia. Now theage groups are going down, and itʼs notunusual to do this surgery in a 45-year-oldusing a multifocal lens—thatʼs somethingthat we didnʼt do 15 years ago.”
The Tecnis Multifocal, which hasevolved from a rigid PMMA lens to a mod-ern foldable hydrophobic single-piece IOL,provides patients with advanced imagequality at all distances and in all lightingconditions and a high level of spectacle independence. This lens and the TecnisToric for astigmatism correction are madeof a hydrophobic acrylic material with lowchromatic aberration.
“The details of the lens give you acouple of advantages,” Dr. Auffarth said.
The Tecnis one-piece has a PROTEC360-degree edge design, which has unin-terrupted contact with the posterior capsu-lar bag even at the haptic-optic junction tominimize PCO by limiting LEC migration.
ters,” Dr. Auffarth said. The difference in residual spherical
aberration was 0.078 micrometers with theTecnis showing –0.029 micrometers ofspherical aberration and the IQ showing+0.049 micrometers.
Dr. Auffarth showed a video thatdemonstrated the new injector for the lens,which goes through a 2.2 or 2.3 mm inci-sion.
“The lens is hydrophobic acrylic, butitʼs not as sticky as some of the otherlenses on the market. When we insert thelens into the capsular bag, it easily loosensup so we can align it,” Dr. Auffarth said. “Itunfolds slowly, which is quite nice.”
Dr. Auffarth said that he started im-planting the Tecnis Toric in Heidelberg thisyear and has found that the lens compen-sates for pre-existing cylinder and providesexcellent functional results.
“Ninety percent of the patients whocome into my practice with cylinder can becovered with this lens,” he said.
He added a couple of pearls for theTecnis lens, especially with using the IOLpower calculator provided on the AMOwebsite.
“Do your markings with the patient sitting upward looking straight ahead, otherwise you can alter the position of thelens,” Dr. Auffarth said.
As for the calculator, “always use Kvalues in millimeters, never put it indiopters,” he said. “Depending on the machine you are using and its refractiveindex, you can have slightly different results.”
ReferenceSaudi Journal of Ophthalmology, Volume 25, Issue3, pages 275-280 (July 2011).
Contact informationAuffarth: [email protected]: 858-922-8699, [email protected]: +65 6357 7726, [email protected]: [email protected]
Cataract and refractive surgeons offer tips on targeting optimal outcomes4
Han Bor Fam, MDSingapore
Hungwon Tchah, MDSeoul, Korea
Perry S. Binder, MDIrvine, Calif., USA
Gerd U. Auffarth, MDHeidelberg, Germany
Sponsored by Abbott Medical OpticsSingapore Pte. Ltd.
Tecnis Traditional Spherical IOL
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