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    Blade versus laser for astigmatism correction

    Physician discusses treatment with toric IOLs and corneal limbal-relaxing incisions


    LRIs can be created manually or by laser. Several nomograms can guide LRI creation, but with-the-rule and against-the-rule astigmatism behave differently and patients must be treated differently depending on age.

    “We must be careful with LRIs, because small degrees of axis deviations can reduce the effects especially with high degrees of astigmatism,” Dr. Donaldson said. “Introduction of the femtosecond laser may add something to our treatment.”

    Comparison of manual and femtosecond laser incisions with penetrating keratoplasty showed the femtosecond laser was safe and effective, with fewer perforations during treatment and better uncorrected visual acuity levels. The manual group had larger axis shifts, which the femtosecond laser has reduced. No nomograms have yet been published, but current guidelines indicate that LRIs should be place at 80% of the corneal thickness and 33% should be subtracted from the manual treatment.

    “With toric IOLs, the femtosecond laser provides better centration and more accurate alignment with intrastromal marking LRIs,” Dr. Donaldson said. “With femto-LRIs, they are more precise, reproducible, and predictable. The accuracy is currently limited by evolving nomograms.”

    For more articles in this issue of Ophthalmology Times’ Conference Brief, click here.




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