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    Learn how curiosity propels astigmatism innovations

    Perhaps none so much as Graham D. Barrett, MD, a “pre-eminent expert in cataract and refractive surgery, and corneal and anterior segment disorders and surgery,” who was chosen to deliver the 2016 Charles D. Kelman Innovator Lecture at this year’s American Society of Cataract and Refractive Surgery meeting.

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    “Perhaps no other innovation has dramatically changed ophthalmology the way Dr. Kelman did when he introduced phaco in 1967,” said Prof. Barrett, clinical professor, University of Western Australia, and consultant ophthalmic surgeon at the Lions Eye Institute as well as Sir Charles Gairdner Hospital. “It was a wonderful example of creativity.”

    Creativity underlies innovation, and at the core of innovation is a natural curiosity, inspiration, and persistence, Prof. Barrett said.

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    “I’ve been curious about a lot of things, but since the beginning, it’s been astigmatism,” he said, adding he first became intrigued by the phenomenon in his earliest days as a resident.

    “I was intrigued by the concept of intraoperative keratometry, and thought a semi-quantitative device would be helpful,” he told attendees. So he made one. And 35 years later, he stumbled upon it in a kitchen cupboard “and found it still works.”

    Imaging as data source

    Imaging the eye and using that data to better understand astigmatism was another innovation.

    Prof. Barrett found taking an original image and superimposing a rotated image would allow the observer to look down and see the amount of astigmatism a patient had.

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    “It would give you the axis of astigmatism and the magnitude of the astigmatism,” he said.

    Using an enhanced keratometer, “by aligning the handle and selecting the most circular image, you can quantify the amount of astigmatism,” he said, and he began to use these routinely on his patients.

    But what was still unclear after all the discussions about measurement and what they meant was how to actually correct this astigmatism during the time of surgery.

    “I wanted to know what the impact of the incision was on the astigmatism and how that factored into toric IOL alignment,” he said.

    Axis varies, centroid value does not

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