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    Innovations change face of modern cataract surgery

    Evolution continues in 2017 with techniques, technologies

     

     

    Diagnostics

    Dr. Packer said the Pentacam AXL is novel—it is a complete biometer, providing anterior segment tomography data, posterior cornea surface measurements, and axial length.

    “Surgeons who are doing refractive cataract surgery and who already have an optical biometer and a topographer may not be inclined to buy another expensive diagnostic instrument, but the Pentacam AXL may be of interest to someone whose old topographer is fading,” Dr. Packer said. “Calculating toric IOL power using actual posterior cornea surface measurements rather than a regression formula has been shown to improve refractive outcomes.”

    For example, reported data show that the percentage of eyes left with <0.5 D of residual astigmatism is about 80% when surgeons use the Barrett Formula for toric IOL power calculations, but is above 90% using patient-specific posterior cornea astigmatism data and iris registration.

    “The difference may seem small, but looking at it from another perspective, it means that for every 10 patients operated on, there is potentially one less unhappy patient,” Dr. Packer said. “For a surgeon who does a large volume of toric IOL cases, the numbers begin to add up.”

    Dr. Osher gave rave reviews to the markerless Zeiss Cataract Suite system as a solution for making toric IOL alignment accurate and easy. With this system, the OCT alignment image acquired with the IOLMaster 700 is stored onto a thumb drive and imported into the Callisto eye.

    The latter device matches the preoperative image to the patient’s eye and displays the target meridian as an overlay seen through the OPMI Lumera microscope.

    “In my American Society of Cataract and Refractive Surgery (ASCRS) Innovators award lecture in 2009, I described techniques that would overcome the inaccuracy of ink markings for guiding toric IOL alignment,” Dr. Osher said. “Compared with what we have had, the markerless Zeiss Cataract Suite is just spectacular.”

    For Dr. Donnenfeld, the most exciting advance in diagnostics software for cataract surgery is the cloud-based surgical planning platform developed by Veracity Innovations. The company was acquired by Carl Zeiss Meditec in August 2017.

    “This system provides one-step access to all of our diagnostic instruments and uses advanced IOL formulas to provide surgeons with IOL and surgical technique recommendations for patients undergoing cataract surgery,” Dr. Donnenfeld said.

    Dr. Osher said he was disappointed by the demise of Clarity Medical Systems in 2017.

    “Intraoperative aberrometry-based aphakia refraction took a big hit this year with publication of a study in the British Journal of Ophthalmology that concluded the technique may not be feasible given the high rate of measurement failures and large variations of the readings,” Dr. Osher said.

    In 2018, Alcon Laboratories is expected to introduce its ORA System with VerifEye Lynk. This new technology integrates the VERION image-guided system and ORA System technologies and introduces software updates designed to enhance preoperative measurements and planning, intraoperative guidance, and postoperative data analysis.

    “Perhaps with better automation, integration, and with iris registration, which is now only available on the LENSAR laser, interest in FLACS will increase,” Dr. Packer said.

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