Intraoperative fine tuning of sphere & cylinder

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Intraoperative fine tuning of sphere & cylinder"

Transcription

1 Intraoperative fine tuning of sphere & cylinder Hussein Ali Alex. University ESOIRS 2015 Intraoperative fine tuning of sphere 1

2 IOL power calculation r requirements - Axial length by IOL Master - Precise Keratometry - Prediction of ELP Prediction of ELP Accuracy of ELP Depends on : - IOL formula - Surgical technique to implant the IOL in the capsular bag at the plane of the zonules anterior displacement gives myopic shift posterior displacement gives hyperopic shift - Refine your lens constant your technique should be consistent 2

3 Variables affecting estimation of final IOL position (ELP ) - surgical variations in capsulorhexis - IOL thickness, material, haptics design Configuration of capsulorhexis CCC maintains a consistent ELP CCC should be round, central &smaller than IOL optic with circumferential capsular overlap of IOL optic - CCC larger than IOL optic : forces of capsular contraction displace the IOL Anteriorly - Small CCC can cause capsular Phimosis or capsular block syndrome & should be enlarged 3

4 Influence of IOL haptics design - The floppier haptics of 1-piece IOL have minimal early axial displacement but do not offer resistance to capsular contraction - there early forward IOL shift of 3-piece IOL after one month it may better resist capsular contraction & over perform the 1-piece IOL & provide more predictable ELP. ( Savini et al 2014 ) Diopteric changes in eyes with reversed IOLs the Diopteric change depends on IOL design: - Anterior biconvex IOLs with similar anterior & posterior radii : no change - Posterior biconvex IOLs have smaller posterior radius & results in myopic shift - Convex-plano IOLs results in hyperopic shift 4

5 IOLs placed in the sulcus IOL power should be decreased depending on IOL power when placed in the sulcus D D no change D 17.0 D 0.5 D D 27.0 D 1.0 D D 35.0 D 1.0 D Perfect centration of IOL IOL Decentration causes defocus,asigmatism,hoa & coma - Intraoperative cent ration of IOL optic on the visual axis is important especially in aspheric, Toric & multifocal IOLs - IOLs with zero spherical aberration have better visual outcome in IOL decentration 5

6 Perfect centration of IOL Causes of Decentration : - in out of the bag placement - big capsular bag - IOL in sulcus - radial bag tears - capsular Phimosis Causes of Decentraton : Asymmetric, eccentric or irregular CCC result in asymmetric capsular forces & delayed optic Decentration, tilt & shift in ELP If zonules are weak insert a CTR 6

7 Perfect centration of IOL Premium IOLs are contraindicated in : - super prolate cornea - decentered visual axis in Keratoconus - decentred corneal refractive surgery Correction of Astigmatism 7

8 . Astigmatism decreases visual acuity through meridional blur As little as 0.5 D may result in glare, ghosts, haloes & image blur Patients with PC-IOLs are sensitive to minor degrees of astigmatism Determining what to correct? Planning correction with cataract surgery is based on corneal astigmatism not on refractive astigmatism Planning correction and enhancement in Aphakic & pseudophakic eyes is based on refraction 8

9 Measurement of astigmatism Manual & auto-keratometer Corneal topography IOL Master. Corneal topography Confirm Keratometry measurements Detect cornea with risks of ectasia. Keratoconus Marginal corneal disease Detect asymmetric cornea 9

10 Preoperative measurements Readings from different devices do not always correlate & there is disagreement in axis location between these devices especially with low astigmatism Astigmatic power & axis is best determined by a combined assessment of 2 or 3 devices Preoperative steep axis determination Inaccurate measurement of steep axis may result in under correction of astigmatism Axis deviation of 5,10,15 degrees will result in 17%,33% or 50% reduction in effect 10

11 Pre operative markings Once the patient is draped, it can be hard to identify the horizontal meridian. Eye rotation may occur in supine position : - Cyclotortion - Change of patient position on operating table or head tilt. Preoperative markings Keratometry is recorded with the patient upright whereas ocular surgery is performed with the patient supine Cyclotortion may occur when the patient assumes a supine position. 11

12 Preoperative marking of the eye 2 steps: o clock meridians A marking pen covers 10 degrees at the limbus Use an insulin syringe for marking Steep Axis marking: Axis of IOL orientation. 12

13 Strategies for minimizing preoperative astigmatism Phaco incision on steep axis ( 0.5D) Paired CCIs on steep axis (1-1.5 D). PCRIs ( 1-2 D ) Toric IOL (1-4 D) Used alone or in combination. On axis incision Today cataract incisions are small & induce small amount of astigmatism - A 3.2mm CCI results in SIA of D - Making the incision less than 2.4 mm wide does not reduce SIA much because incisions stretch during IOL implantation.( Hill 2008 ). 13

14 On axis incision vs Temporal incision Many surgeons prefer operating temporally on all eyes Giang 2006 did not find significant difference between SIA induced by temporal & on axis CCI, Opposite clear corneal incision The same keratome can be used to make an opposite CCI. It corrects D of astigmatism Results are variable & regression may occur. 14

15 The surgically induced astigmatism - No incision is astigmatic ally neutral. The cataract incision changes the vector of preoperative astigmatism. -The two are added together to create the post operative astigmatism. - The new astigmatism has a new power & axis.. A big mistake is to place a Toric IOL or PCRI at Keratometric or topographic axis & do not consider SIA. 15

16 The surgically induced astigmatism calculator Surgeon downloads the SIA calculator Enter incision location, steep K, flat K, flat meridian & postoperative steep & flat K After 10 cases, he can obtain the magnitude of his SIA. Determining surgically induced astigmatism For use with on-line toric IOL calculator Surgically Induced Astigmatism Calculator SIAC.xls Free, downloadable stand-alone Microsoft Excel program. Warren E. Hill, MD, FACS 16

17 . Astigmatism effect of major cataract incision ( SIA ) : CCI 3mm 0.5 D SIA Corneal incision > limbal > scleral Superior CCI > temporal. Coaxial > biaxial. Peripheral Corneal Relaxing Incisions PCRIs are successful in Correcting moderate astigmatism beyond 2 D astigmatism risks overweight benefits 17

18 Contraindications to PCRIs Keratoconus. Peripheral corneal pathology. Prior RK. Severe dry eye. Autoimmune disease PCRIs The results of PCRIs are variable & depend on - incision length & depth - size of optical zone relative to corneal diameter - patient age - type of astigmatism 18

19 PCRIs Nomograms J. Gills D.Koch R.Lindsrom B.Wallace L.Nichamin E.Donnenfeld Improved nomograms NAPA (Nichamine age & pachymetry adjusted) nomograms based on patient s age angular nomograms Pachymetry adjusted nomograms 19

20 Improved nomograms Consider astigmatic effect of major cataract incision www LRIcalculator.com uses vector analysis to calculate where to make LRIs based on preoperative Keratometry & surgeon induced astigmatism Creates a surgical diagram & plan of location & length of LRIs that can be copied & brought to operating room. 20

21 Surgical procedure pachymetric reading Over the entire arc length of intended incision To achieve predictable permanent results incision must be 90% of corneal thickness Surgical procedure Center the guide instrument on the cornea Knife perpendicular. 0.5 mm inside limbus. Press firmly to full depth. Extend incision from mark to mark. 21

22 Toric IOLs Proper selection of patients Regular corneal astigmatism ( 1 D 4 D ) Intact capsule and zonules Central round CCC ( 5 mm ) In the bag fixation Cyl Powers, SN6AT2-T5 *Based on an average human eye AcrySof Toric IOL Model Cylinder Power of IOL Cylinder Corneal Plane* SN6AT SN6AT SN6AT SN60T

23 Cyl Powers, soon, SN6AT6-T9 *Based on an average human eye AcrySof Toric IOL Model Cylinder Power of IOL Approx cylinder Corneal Plane* SN6AT SN6AT SN6AT SN6AT Determine the vector sum of preoperative corneal astigmatism & SIA before selecting the IOL Online Toric power calculators are available 23

24 AcrySof IQ Toric IOL Calculator Makes precise surgical planning easy! Intuitive input Patient data Keratometry IOL spherical power Surgically induced astigmatism Incision location Powerful output Recommended IOL model and spherical equivalent power Optimal axis placement Magnitude and axis of anticipated residual astigmatism Final dialing & axis alignment 24

25 Toric IOL Pros: Excellent predictability. No induced irregular astigmatism. Rapid visual rehabilitation. Cons: High cost. Less effective in correcting asymmetrical bowtie. Correcting corneal astigmatism with lens at IOL planeproduces distortion. LRIs Vs Toric IOL LRIs Pros: Easy - safe. Patient will not pay. Incisions do not rotate. Can be enhanced postoperatively Can enhance Toric IOLs Works well for asymmetric cornea. 25

26 LRIs Vs Toric IOL LRIs Cons: Less predictable in high astigmatism Less effective in young age. FB sensation. Not suitable in dry eye rheumatoid disease, post RK. 26

Incision along Steep Axis

Incision along Steep Axis Toric IOL An option or a must? ~ 15% cataract surgical patients >1.5 D Options: spectacles, CLs, Incision along steep axis, LRI, AK, toric IOL, Excimer Laser or a combination Walter J. Stark, MD Professor

More information

Management of Astigmatism in Cataract Surgery

Management of Astigmatism in Cataract Surgery Management of Astigmatism in Cataract Surgery Jonathan B. Rubenstein, M Vice- Chairman and eutsch Family Professor of Ophthalmology irector of Refractive Surgery Rush University Medical Center Financial

More information

AcrySof IQ Toric IOL (SN6ATT) Surgeon Keys for Success & Acknowledgement

AcrySof IQ Toric IOL (SN6ATT) Surgeon Keys for Success & Acknowledgement AcrySof IQ Toric IOL (SN6ATT) Surgeon Keys for Success & Acknowledgement Alcon Laboratories, Inc is pleased to announce the availability of the AcrySof IQ Toric intraocular lens, and delighted that you

More information

What is the main target for all phaco surgeons?

What is the main target for all phaco surgeons? CORRECTION C O OF ASTIGMATISM DURING CATARACT SURGERY Abdallah dllh K. Hassouna, M.D. Sherein S. Wahba, M.D. Ain Shams University 2009 Main target What is the main target for all phaco surgeons? Main Target

More information

Cataract Surgery after Myopic Refractive Procedures. Ray Guard Eye Center Huang Wei-Jen, MD

Cataract Surgery after Myopic Refractive Procedures. Ray Guard Eye Center Huang Wei-Jen, MD Cataract Surgery after Myopic Refractive Procedures Ray Guard Eye Center Huang Wei-Jen, MD Financial Disclosures : * No financial interest on products mentioned Cataract Surgery after Myopic Refractive

More information

To select a patient for Multifocal IOL, One Diopter of Astigmatism is the maximum permissible amount.

To select a patient for Multifocal IOL, One Diopter of Astigmatism is the maximum permissible amount. In modern cataract surgery, freedom from spectacles is becoming more and more important. To select a patient for Multifocal IOL, One Diopter of Astigmatism is the maximum permissible amount. 1 History

More information

Phacoemulsification: Considerations for Astigmatism Management Jason P. Brinton, MD and Thomas A. Oetting, MS, MD June 10, 2011

Phacoemulsification: Considerations for Astigmatism Management Jason P. Brinton, MD and Thomas A. Oetting, MS, MD June 10, 2011 Phacoemulsification: Considerations for Astigmatism Management Jason P. Brinton, MD and Thomas A. Oetting, MS, MD June 10, 2011 Introduction Patient expectations for cataract surgery have increased significantly

More information

User Manual. Panacea IOL & Toric Calculator. Version 8(6.0)

User Manual. Panacea IOL & Toric Calculator. Version 8(6.0) User Manual Panacea IOL & Toric Calculator Version 8(6.0) Content Introduction...3 Use instructions and generalities...7 IOL Power & Toric Calculator...7 IOL Power Calculator... 9 Add Multifocal Graphic

More information

Providing Optimal Optics For Your Astigmatic Cataract Patients. While the cornea remains relatively stable and prolate throughout life

Providing Optimal Optics For Your Astigmatic Cataract Patients. While the cornea remains relatively stable and prolate throughout life Providing Optimal Optics For Your Astigmatic Cataract Patients David I. Geffen, OD, FAAO Why keep the crystalline lens? While the cornea remains relatively stable and prolate throughout life Unless we

More information

Overview. Addressing Astigmatism with Toric IOL Implantation: Pre-Operative and Operative Considerations. Where are we now? How have we progressed?

Overview. Addressing Astigmatism with Toric IOL Implantation: Pre-Operative and Operative Considerations. Where are we now? How have we progressed? Addressing Astigmatism with Toric IOL Implantation: Pre-Operative and Operative Considerations Jason Wang, M.D. Spring Symposium 2012 OMNI Eye Specialists / Spivack Vision Center March 3, 2012 Overview

More information

Incisional techniques still have a place in the era of toric intraocular lenses

Incisional techniques still have a place in the era of toric intraocular lenses OCULAR SURGERY NEWS US EDITION Volume 27 Number 15 AUGUST 10, 2009 A SLACK Incorporated publication Incisional techniques still have a place in the era of toric intraocular lenses Refining the science

More information

Cataract Surgery in Small Eyes Richard S. Hoffman, MD Clinical Associate Professor of Ophthalmology Oregon Health & Science University No Financial Interests Anatomic Classification Short AC depth with

More information

Versus Reality. cover story eyetube.net. Debunking some of the conventional wisdom about the implantation of these lenses. By Ike K.

Versus Reality. cover story eyetube.net. Debunking some of the conventional wisdom about the implantation of these lenses. By Ike K. eyetube.net Toric IOLs: Myth Versus Reality Debunking some of the conventional wisdom about the implantation of these lenses. By Ike K. Ahmed, MD, FRCSC A large percentage of the people presenting for

More information

Current Trends in Modern Cataract Surgery. Jose Ivan Quiceno, MD Division of Ophthalmology Scripps Clinic Medical Group

Current Trends in Modern Cataract Surgery. Jose Ivan Quiceno, MD Division of Ophthalmology Scripps Clinic Medical Group Current Trends in Modern Cataract Surgery Jose Ivan Quiceno, MD Division of Ophthalmology Scripps Clinic Medical Group Current Trends in Modern Cataract Surgery Modern cataract surgery is not only a rehabilitative

More information

Insert to. January 2011. Comfort and confidence for all IOL calculations

Insert to. January 2011. Comfort and confidence for all IOL calculations Insert to January 2011 Comfort and confidence for all IOL calculations Advanced Optical Biometry and Keratometry with LENSTAR LS 900 CONTENTS Lenstar and Ray-Tracing Calculations...3 By Jaime Aramberri,

More information

IOL : POWER CALCULATION & SELECTION

IOL : POWER CALCULATION & SELECTION Chapter - 3 IOL : POWER CALCULATION & SELECTION Precise IOL power calculation is essential for optimal benefits of implant surgery. Prior to1975, IOL power was calculated on the basis of clinical history,

More information

Curtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State

Curtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State Curtin G. Kelley, M.D. Director of Vision Correction Surgery Arena Eye Surgeons Associate Clinical Professor of Ophthalmology The Ohio State University Columbus, Ohio Refractive Errors Myopia (nearsightedness)

More information

Femtolaser and ocular surgery

Femtolaser and ocular surgery Femtolaser and ocular surgery Safety Quick visual recovery Excellent vision without glasses It is an ultrafast laser using a near infrared light to create cuts in ocular tissues First used in corneal refractive

More information

Cataract Surgery Patient Information

Cataract Surgery Patient Information Cataract Patient Information 1. Within the human eye, there is a normal structure called the lens. In youth, this lens is clear, and light rays pass through and are focused by this lens as well as the

More information

final corrected draft

final corrected draft Archived at the Flinders Academic Commons http://dspace.flinders.edu.au/dspace/ This is the author s final corrected draft of this article. It has undergone peer review. Citation for the publisher s version:

More information

EUROPEAN JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH www.ejpmr.com

EUROPEAN JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH www.ejpmr.com ejpmr, 2015,2(3), 436-440 EUROPEAN JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH www.ejpmr.com Tumram et al. SJIF Impact Factor 2.026 Research Article ISSN 3294-3211 EJPMR CLINICAL OUTCOME OF TORIC IOL

More information

Hitting Refractive Targets The Lens Approach

Hitting Refractive Targets The Lens Approach Hitting Refractive Targets The Lens Approach Mark Packer, MD, FACS Clinical Associate Professor Department of Ophthalmology Oregon Health & Science University Drs. Fine, Hoffman & Packer, LLC Eugene, Oregon

More information

Kerry D. Solomon, MD, is Director of the Carolina Eyecare Research Institute at Carolina Eyecare Physicians in Charleston, S.C.

Kerry D. Solomon, MD, is Director of the Carolina Eyecare Research Institute at Carolina Eyecare Physicians in Charleston, S.C. I think the ideal diagnostic technology for all of us would be a device where we could take a measurement, make an adjustment based on the patient s history, including past surgery, and come up with an

More information

OMNI EYE SPECIALISTS. The Intraocular Lens

OMNI EYE SPECIALISTS. The Intraocular Lens OMNI EYE SPECIALISTS Intraocular Lens Options In Cataract Surgery Or Refractive Lens Exchange Surgery Your decision to have vision surgery is important and the doctors at Omni Eye Specialists will explain

More information

Course # Intra Corneal Ring Segments Contact Lens Management of Irregular Astigmatism

Course # Intra Corneal Ring Segments Contact Lens Management of Irregular Astigmatism Course # 772 Intra Corneal Ring Segments Contact Lens Management of Irregular Astigmatism Intra Corneal Ring Segments Contact Lens Management of Irregular Astigmatism Financial Disclosure I do not own

More information

Keratoconus is one of the most challenging corneal

Keratoconus is one of the most challenging corneal Corneal Remodeling Using the Keraring A variety of thicknesses, arc lengths, and optical zone sizes allows tailoring of the procedure to the individual patient. BY DOMINIQUE PIETRINI, MD; AND TONY GUEDJ

More information

Innovations in Refractive Surgery

Innovations in Refractive Surgery Innovations in Refractive Surgery Edward E. Manche, MD Byers Eye Institute Stanford University School of Medicine Financial Interest Disclosures AMO D Best Doctors A Calhoun Vision R Avellino Laboratories

More information

How do we use the Galilei for cataract and refractive surgery?

How do we use the Galilei for cataract and refractive surgery? How do we use the Galilei for cataract and refractive surgery? Douglas D. Koch, MD Mariko Shirayama, MD* Li Wang, MD, PhD* Mitchell P. Weikert, MD Cullen Eye Institute Baylor College of Medicine Houston,

More information

Correction of Keratometric Astigmatism: Incisional Surgery

Correction of Keratometric Astigmatism: Incisional Surgery 6 Correction of Keratometric Astigmatism: Incisional Surgery Louis D. Nichamin CORE MESSAGES 2 Options to reduce astigmatism include manipulation of the main incision, supplemental peripheral relaxing

More information

Keratoconus Detection Using Corneal Topography

Keratoconus Detection Using Corneal Topography Keratoconus Detection Using Corneal Topography Jack T. Holladay, MD, MSEE, FACS ABSTRACT PURPOSE: To review the topographic patterns associated with keratoconus suspects and provide criteria for keratoconus

More information

Cornea and Refractive Surgery Update

Cornea and Refractive Surgery Update Cornea and Refractive Surgery Update Fall 2015 Optometric Education Dinner Sebastian Lesniak MD Matossian Eye Associates Disclosures: None Bio: Anterior Segment and Cornea Surgery Fellowship Wills Eye

More information

MAke A difference in someone s life

MAke A difference in someone s life MAke A difference in someone s life Fitting guide En del av Multilens contents Introduction 1 Applications 2 characteristics 2 Fitting philosophy 3 Fitting process 4 Ideal fit 5 Comfort vs lens awarness

More information

VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment)

VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment) CustomVue Advantage Patient Information Sheet VISX Wavefront-Guided LASIK for Correction of Myopic Astigmatism, Hyperopic Astigmatism and Mixed Astigmatism (CustomVue LASIK Laser Treatment) Statements

More information

Optimizing outcomes with toric IOLs

Optimizing outcomes with toric IOLs digital.eyeworld.org The news magazine of the American Society of Cataract & Refractive Surgery Optimizing outcomes with toric IOLs Supplement to EyeWorld May 2015 Supported by an educational grant from

More information

EDITORIAL SPOTLIGHT. ASSORT Toric Calculator. Available at

EDITORIAL SPOTLIGHT. ASSORT Toric Calculator.  Available at INNOVATIVE TORIC IOL CALCULATORS AND HOW TO USE THEM Surgeons describe tools they have created to improve toric IOL calculations and to fix refractive surprises. EDITORIAL SPOTLIGHT BY NOEL ALPINS, FRANZCO,

More information

The Pentacam: Precision, Confidence, Results, and Accurate Ks!

The Pentacam: Precision, Confidence, Results, and Accurate Ks! The Pentacam: Precision, Confidence, Results, and Accurate Ks! Produced under an unrestricted educational grant from Oculus, Inc. This monograph is based on an informational symposium presented at the

More information

RefracOve Cataract Surgery

RefracOve Cataract Surgery Disclosures Advances in Cataract Surgery 2014 Doug Devries, O.D. February 2014 Douglas K. Devries Consultant or Speakers Bureau for Allergan AMO Odyssey Medical Essilor B & L TearLab Nicox Akorn Premium

More information

Pre-Op to Post-Op: A Complete Optometrist s Guide to Advanced Technology IOLs.

Pre-Op to Post-Op: A Complete Optometrist s Guide to Advanced Technology IOLs. Pre-Op to Post-Op: A Complete Optometrist s Guide to Advanced Technology IOLs. Your Role in Guiding Patients Through Cataract Surgery As an optometrist, you ve been guiding your patients through their

More information

Managing Astigmatism in your Cataract Practice

Managing Astigmatism in your Cataract Practice Managing Astigmatism in your Cataract Practice KAREN S. BACHMAN, COMT, COE, OCS THE EYE INSTITUTE OF UTAH Disclaimer Ms. Bachman: Member of Alcon Speakers Alliance Mr. Larson: Employee of Corcoran Consulting

More information

Posterior Corneal Astigmatism: Is It Important? MP Weikert, MD Baylor College of Medicine October 23, 2011

Posterior Corneal Astigmatism: Is It Important? MP Weikert, MD Baylor College of Medicine October 23, 2011 : Is It Important? MP Weikert, MD Baylor College of Medicine October 23, 2011 Corneal Imaging What major challenge do we face when imaging the cornea? Measuring the curvature & refractive power of the

More information

Management of Corneal Astigmatism by Limbal Relaxing Incisions during Cataract Surgery

Management of Corneal Astigmatism by Limbal Relaxing Incisions during Cataract Surgery Management of Corneal Astigmatism by Limbal Relaxing Incisions during Cataract Surgery Mohammad Ali Zare, MD 1 Mehdi Hosseini Tehrani, MD 2 Mohsen Gohari, MD 3 Mahmood Jabbarvand, MD 1 Mohammad Naser Hashemian,

More information

What are your options for correcting astigmatism?

What are your options for correcting astigmatism? What are your options for correcting astigmatism? If you depend upon eyeglasses, you may have experienced the inconvenience of not being able to find your glasses when you really need them. Eyeglasses

More information

Premium IOL Implantation Calculations in Post-LASIK Cataract Eyes Using ASCRS IOL Calculator

Premium IOL Implantation Calculations in Post-LASIK Cataract Eyes Using ASCRS IOL Calculator Premium IOL Implantation Calculations in Post-LASIK Cataract Eyes Using ASCRS IOL Calculator Sahiba K Chailertborisuth, Saneha K. C. Borisuth, Navaneet S.C. Borisuth, MD, PhD Virdi Eye Clinic & Laser Vision

More information

Crystalens upside-down yields myopic shift

Crystalens upside-down yields myopic shift Dealing With The Refractive Surprise Richard S. Hoffman, MD Clinical Associate Professor of Ophthalmology Casey Eye Institute Oregon Health and Science University No Financial Interest Why The Surprise?

More information

Maximising Treatment Outcomes with Premium IOL Technology. Saturday 13 September 2014 XXXII Congress of the ESCRS London, UK.

Maximising Treatment Outcomes with Premium IOL Technology. Saturday 13 September 2014 XXXII Congress of the ESCRS London, UK. Supplement February 2015 Maximising Treatment Outcomes with Premium IOL Technology Saturday 13 September 2014 XXXII Congress of the ESCRS London, UK Sponsored by Introduction Thanks to advances in lens

More information

Intraocular Lens Power Calculations: Correction of Defocus

Intraocular Lens Power Calculations: Correction of Defocus 4 Intraocular Lens Power Calculations: Correction of Defocus Jack T. Holladay Financial interest: Dr. Holladay is author of the Holladay formula and provides consultation for A-scan companies that use

More information

SCHWIND CAM Perfect Planning wide range of applications

SCHWIND CAM Perfect Planning wide range of applications SCHWIND CAM Perfect Planning wide range of applications ORK-CAM PresbyMAX PALK-CAM PTK-CAM 2 SCHWIND CAM the system solution The latest version of the modular SCHWIND CAM represents an even more efficient

More information

Irregular astigmatism:

Irregular astigmatism: Irregular astigmatism: definition, classification, topographic and clinical presentation Ming X. Wang, MD, PhD Clinical Associate Professor of Ophthalmology of University of Tennessee Director, Wang Vision

More information

Ectatic Conditions. Train Wrecks! Get on track with innovative designs. GP Lens Designs for Keratoconus

Ectatic Conditions. Train Wrecks! Get on track with innovative designs. GP Lens Designs for Keratoconus Train Wrecks! Get on track with innovative designs. Mark Andre, FAAO Associate Professor of Optometry Pacific University Also affiliated with CooperVision, Inc. as a consultant and speaker. Ectatic Conditions

More information

A STUDY ON SURGICALLY INDUCED ASTIGMATISM FOLLOWING SMALL INCISION CATARACT SURGERY

A STUDY ON SURGICALLY INDUCED ASTIGMATISM FOLLOWING SMALL INCISION CATARACT SURGERY A STUDY ON SURGICALLY INDUCED ASTIGMATISM FOLLOWING SMALL INCISION CATARACT SURGERY *Vinay KV 1, Sudheendra AN 2, Vishal K 3 and Beena DN 4 1, 3 Department of Anatomy, K. S. Hegde Medical Academy, Mangalore,

More information

Insert to October 2013 THE COMPLETE PICTURE. Experiences with the ALADDIN system. Sponsored by Topcon

Insert to October 2013 THE COMPLETE PICTURE. Experiences with the ALADDIN system. Sponsored by Topcon Insert to October 2013 THE COMPLETE PICTURE Experiences with the ALADDIN system Sponsored by Topcon THE COMPLETE PICTURE Advantages of The Aladdin How this all-in-one optical biometer edged out the IOLMaster

More information

PRACTITIONER S FITTING GUIDE. Keratoconus Irregular Cornea Post Graft

PRACTITIONER S FITTING GUIDE. Keratoconus Irregular Cornea Post Graft PRACTITIONER S FITTING GUIDE Keratoconus Irregular Cornea Post Graft Four lens designs to fit all corneal shapes... One simple systematic approach to fitting Featuring Easy-to-fit using a simple systematic

More information

ABrand New Refraction Meas urement Instrument

ABrand New Refraction Meas urement Instrument PW ABrand New Refraction Meas urement Instrument The TOPCON KR-9000PW WAVEFRONT ANALYZER incorporates comprehensive measurement of the eye's total optical system which has not been achieved until now,

More information

Minimally Invasive Surgery: Femtosecond Lasers and Other Innovative Microsurgical Techniques

Minimally Invasive Surgery: Femtosecond Lasers and Other Innovative Microsurgical Techniques Minimally Invasive Surgery: Femtosecond Lasers and Other Innovative Microsurgical Techniques Julio Narváez MD Associate Professor of Ophthalmology Loma Linda University Non-Refractive Applications of Femtosecond

More information

CustomVue Treatments for Monovision in Presbyopic Patients with Low to Moderate Myopia and Myopic Astigmatism

CustomVue Treatments for Monovision in Presbyopic Patients with Low to Moderate Myopia and Myopic Astigmatism CustomVue Treatments for Monovision in Presbyopic Patients with Low to Moderate and Myopic Introduction Pre-Operative Examination Surgical Technique 1 2 IMPORTANT INFORMATION CustomVue Monovision treatments

More information

ADVANCED IOL POWER CALCULATIONS. Jack T. Holladay, MD, MSEE, FACS

ADVANCED IOL POWER CALCULATIONS. Jack T. Holladay, MD, MSEE, FACS Jack T. Holladay, M.D., M.S.E.E., F.A.C.S. ADVANCED IOL POWER CALCULATIONS Jack T. Holladay, MD, MSEE, FACS I. Formulas and Measurements A. Variables Used to Predict ACD 1. Binkhorst 2-1981 - AL 2. Holladay

More information

This morning... Indications for surgery Normal cataract operation Common complications Premium IOLs

This morning... Indications for surgery Normal cataract operation Common complications Premium IOLs This morning... Indications for surgery Normal cataract operation Common complications Premium IOLs Cataract surgery is the commonest operation in the western world Age Success Poor vision 300,000 ops

More information

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement)

Informed Consent for Refractive Lens Exchange (Clear Lens Replacement) Mark Packer, M.D. Informed Consent for Refractive Lens Exchange (Clear Lens Replacement) This surgery involves the removal of the natural lens of my eye, even though it is not a cataract. The natural lens

More information

CORRECTION OF ASTIGMATISM WITH TORIC IOL

CORRECTION OF ASTIGMATISM WITH TORIC IOL CORRECTION OF ASTIGMATISM WITH TORIC IOL V. Jšinsks, R. Žemitienė, D. Jrušitienė Ntion Center of Ophthmoogy, Lithuni GLASSES CONTACT LENSES LRI OCCI LASIK TORIC IOL 22nd Congress of the DGII in Heideberg,

More information

KERATOCONUS IS A BILATERAL, ASYMMETRIC, CHRONIC,

KERATOCONUS IS A BILATERAL, ASYMMETRIC, CHRONIC, Comparison of and Intacs for Keratoconus and Post-LASIK Ectasia MUNISH SHARMA, MD, AND BRIAN S. BOXER WACHLER, MD PURPOSE: To evaluate the efficacy of single-segment Intacs and compare with double-segment

More information

Custom Cataract Surgery. Laser and Lens Options

Custom Cataract Surgery. Laser and Lens Options Custom Cataract Surgery Laser and Lens Options What is a Cataract? More than fifty percent of people over the age of 60, and many younger than that, suffer from cataracts. In fact, cataracts are so common

More information

IOL Calculation After LASIK. Chapter (3)

IOL Calculation After LASIK. Chapter (3) the cornea (P) may be considered as the sum of the power of the anterior (Pa) and posterior (Pp) corneal surfaces, as shown in the formula: P = Pa + Pp = (n2 n1)/r1 + (n3 n2)/r2, where n1 is the refractive

More information

Cataract Testing. What a Patient undergoes prior to surgery

Cataract Testing. What a Patient undergoes prior to surgery Cataract Testing What a Patient undergoes prior to surgery FINANCIAL DISCLOSURE I have no financial interest or relationships to disclose What do most Technicians find to be the most mundane yet very important

More information

Optimizing refractive outcomes

Optimizing refractive outcomes APACRS The news magazine of the Asia-Pacific Association of Cataract & Refractive Surgeons Supplement to EyeWorld Asia-Pacific Winter 2014 Asia-Pacific Surgical management of astigmatism Sponsored by Abbott

More information

Clinical Study Minimizing Surgically Induced Astigmatism at the Time of Cataract Surgery Using a Square Posterior Limbal Incision

Clinical Study Minimizing Surgically Induced Astigmatism at the Time of Cataract Surgery Using a Square Posterior Limbal Incision Ophthalmology Volume 2011, Article ID 243170, 4 pages doi:10.1155/2011/243170 Clinical Study Minimizing Surgically Induced Astigmatism at the Time of Cataract Surgery Using a Square Posterior Limbal Incision

More information

The Digital Microscope Platform. Heads-up Surgery with Integrated Applications

The Digital Microscope Platform. Heads-up Surgery with Integrated Applications The Digital Microscope Platform Heads-up Surgery with Integrated Applications 3 D D I G I T A L I now routinely use heads-up 3D surgery in all my retinal and cataract cases, and I believe many surgeons

More information

Is there a fundamental limit of efficacy when aberrations arising from one point along visual axis (lens) are corrected at another point (cornea)?

Is there a fundamental limit of efficacy when aberrations arising from one point along visual axis (lens) are corrected at another point (cornea)? Is there a fundamental limit of efficacy when aberrations arising from one point along visual axis (lens) are corrected at another point (cornea)? Ming Wang, M.D.,Ph.D. Medical Director of Refractive Surgery,

More information

Laser Refractive Cataract Surgery with the LenSx Laser

Laser Refractive Cataract Surgery with the LenSx Laser Laser Refractive Cataract Surgery with the LenSx Laser a Novartis company LenSx Laser 2 3 An Evolving Definition of Cataract Average Age of US Cataract Patient is Projected to Decline Today: earlier diagnosis

More information

ADVANCED IOL POWER CALCULATIONS. Jack T. Holladay, MD, MSEE, FACS

ADVANCED IOL POWER CALCULATIONS. Jack T. Holladay, MD, MSEE, FACS Jack T. Holladay, M.D., M.S.E.E., F.A.C.S. ADVANCED IOL POWER CALCULATIONS Jack T. Holladay, MD, MSEE, FACS I. Formulas and Measurements A. Variables Used to Predict ACD 1. Binkhorst 2-1981 - AL 2. Holladay

More information

The Promise of No Glasses

The Promise of No Glasses The Promise of No Glasses 4/10/2016 JTH 1 or Contact Lenses! Jack T. Holladay, MD, MSEE, FACS Clinical Professor of Ophthalmology Baylor College of Medicine Houston, Tx Financial Disclosure I have the

More information

For additional information on fitting ClearKone, please visit to view fitting videos, case studies, NaFL pictures and more.

For additional information on fitting ClearKone, please visit  to view fitting videos, case studies, NaFL pictures and more. For additional information on fitting ClearKone, please visit www.fitsynergeyes.com to view fitting videos, case studies, NaFL pictures and more. ClearKone Restoring vision. Changing lives. FITTING GUIDE

More information

IOL Power Calculations for Postrefractive Surgery Eyes

IOL Power Calculations for Postrefractive Surgery Eyes eyetube.net The Creator s Forum: IOL Power Calculations for Postrefractive Surgery Eyes Olsen Formula By Thomas Olsen, MD, PhD The calculation of IOL power in an eye that has undergone corneal refractive

More information

AcrySof IQ (SN60WF):

AcrySof IQ (SN60WF): AcrySof IQ (SN60WF): AcrySof IQ provides dramatically improved image quality to the proven AcrySof Natural Single-Piece platform. This is true because AcrySof IQ has been shown to reduce spherical aberration,

More information

TREATMENT OF KERATOCONUS WITH INTACS INTRASTROMAL RINGS ICI (7 MM) AND ISK (6 MM). UP TO 3 YEARS IN 72 EYES.

TREATMENT OF KERATOCONUS WITH INTACS INTRASTROMAL RINGS ICI (7 MM) AND ISK (6 MM). UP TO 3 YEARS IN 72 EYES. TREATMENT OF KERATOCONUS WITH INTACS INTRASTROMAL RINGS ICI (7 MM) AND ISK (6 MM). UP TO 3 YEARS IN 72 EYES. Manuel Ignacio Vejarano Restrepo, MD Head Department of Cornea and Refractive Surgery Medical

More information

WHAT IS A CATARACT, AND HOW IS IT TREATED?

WHAT IS A CATARACT, AND HOW IS IT TREATED? 4089 TAMIAMI TRAIL NORTH SUITE A103 NAPLES, FL 34103 TELEPHONE (239) 262-2020 FAX (239) 435-1084 DOES THE PATIENT NEED OR WANT A TRANSLATOR, INTERPRETOR OR READER? YES NO TO THE PATIENT: You have the right,

More information

INTRACOR. An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the

INTRACOR. An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the INTRACOR An excerpt from the presentations by Dr Luis Ruiz and Dr Mike Holzer and the Round Table discussion moderated by Dr Wing-Kwong Chan in the 1 Dr Luis Ruiz Presbyopia treatment with INTRACOR Luis

More information

Laser Assisted Cataract Surgery

Laser Assisted Cataract Surgery Laser Assisted Cataract Surgery: The New Frontier The Joseph H. Wyatt DO Lecture Brian D. Ranelle D.O. Texas Eye and Laser Center Ft. Worth and Hurst, Texas Laser Assisted Cataract Surgery The New Frontier

More information

Timothy D. McGarity, M.D.

Timothy D. McGarity, M.D. Timothy D. McGarity, M.D. Dr. McGarity received his B.S. in Microbiology, honors, at the University of Arkansas, Fayetteville, and his M.D. at the University of Arkansas for Medical Sciences, Little Rock.

More information

Power Diameter Base curve SOFT TORIC CONTACT LENS PROF.DR.SAMIHA ABOULMAGD 1

Power Diameter Base curve SOFT TORIC CONTACT LENS PROF.DR.SAMIHA ABOULMAGD 1 Fitting Soft Contact Lens Prof. Dr. Samiha Aboulmagd MD Head of fophthalmology l Department Al-Azhar University 2010 1 Fitting of contact lens Power Diameter Base curve 2 PROF.DR.SAMIHA ABOULMAGD 1 Fitting

More information

PhysIOL FineVision Micro F. vs. ZEISS AT LISA tri 839MP

PhysIOL FineVision Micro F. vs. ZEISS AT LISA tri 839MP PhysIOL FineVision Micro F vs. ZEISS AT LISA tri 839MP PhysIOL FineVision Micro F vs. ZEISS AT LISA tri 839MP Material 25% hydrophilic acrylic 25 % hydrophilic acrylic with hydrophobic surface properties

More information

THE BEST OF BOTH WORLDS Dual-Scheimpflug and Placido Reaching a new level in refractive screening

THE BEST OF BOTH WORLDS Dual-Scheimpflug and Placido Reaching a new level in refractive screening THE BEST OF BOTH WORLDS Dual-Scheimpflug and Placido Reaching a new level in refractive screening GALILEI G4 Clinical Applications Corneal Implant Planning The comes with a licensable corneal inlay software

More information

The ASCRS Clinical Survey revealed

The ASCRS Clinical Survey revealed Supplement to EyeWorld September 2015 Supplement to EyeWorld September 2015 Modernizing cataract surgery: Navigating success with toric multifocal IOLs Supported by an educational grant from Abbott Medical

More information

Financial Disclosure. So what s the problem? 7/13/12 FEMTOSECOND LASER CATARACT SURGERY: FAD OR FUTURE? Laser Cataract Surgery: the claim

Financial Disclosure. So what s the problem? 7/13/12 FEMTOSECOND LASER CATARACT SURGERY: FAD OR FUTURE? Laser Cataract Surgery: the claim FEMTOSECOND LASER CATARACT SURGERY: FAD OR FUTURE? Douglas D. Koch, M.D. Cullen Eye Institute Baylor College of Medicine Houston, Texas Financial Disclosure I have a financial interest with the following

More information

Clinical Study Visual and Refractive Outcomes of a Toric Presbyopia-Correcting Intraocular Lens

Clinical Study Visual and Refractive Outcomes of a Toric Presbyopia-Correcting Intraocular Lens Ophthalmology Volume 16, Article ID 745821, 6 pages http://dx.doi.org/1.1155/16/745821 Clinical Study Visual and Refractive Outcomes of a Toric Presbyopia-Correcting Intraocular Lens Alice T. Epitropoulos

More information

3D Visualization and Guidance System

3D Visualization and Guidance System 3D Visualization and Guidance System O P H T H A L M O L O G Y TrueVision is revolutionizing the way surgeons perform ophthalmic procedures. Their continuum of innovations is driving a movement into high

More information

CONSENT FOR CATARACT SURGERY

CONSENT FOR CATARACT SURGERY CONSENT FOR CATARACT SURGERY INTRODUCTION The natural crystalline lens can become cloudy due to aging, trauma, disease or medications. This condition is called a cataract. When cataracts become visually

More information

The future of cataract surgery has arrived

The future of cataract surgery has arrived The future of cataract surgery has arrived A cataract clouding of the eye s natural lens as a result of aging or injury is the leading cause of preventable blindness worldwide. 1 Cataract surgery is one

More information

Paragon RG-4 Fitting Reference Guide

Paragon RG-4 Fitting Reference Guide PARAGON VISION SCIENCES Paragon RG-4 Fitting Reference Guide* & Certification Manual 2008 *This document is an abbreviated version and does not replace the FDA approved professional fitting guide. Lenses

More information

Pseudo-accommodative Cornea (PAC) for the Correction of Presbyopia

Pseudo-accommodative Cornea (PAC) for the Correction of Presbyopia Pseudo-accommodative Cornea (PAC) for the Correction of Presbyopia Alaa El Danasoury, FRCS Magrabi Hospitals & Centers Surgical options for the Correction of Presbyopia Monovision Reversal of Presbyopia:

More information

IOL Power Calculation After Myopic LASIK. Hany Helaly, Lecturer of Ophthalmology, Faculty of Medicine, Alexandria University.

IOL Power Calculation After Myopic LASIK. Hany Helaly, Lecturer of Ophthalmology, Faculty of Medicine, Alexandria University. IOL Power Calculation After Myopic LASIK Hany Helaly, Lecturer of Ophthalmology, Faculty of Medicine, Alexandria University. SUPERVISORS Prof. Dr. Mohammad El-Hifnawy Professor of Ophthalmology Faculty

More information

IN TORIC IOLS ADVANCEMENTS. Supplement to MARCH 25, 2015

IN TORIC IOLS ADVANCEMENTS. Supplement to MARCH 25, 2015 Supplement to MARCH 25, 2015 ADVANCEMENTS IN TORIC IOLS This Ocular Surgery News supplement is produced by SLACK Incorporated and sponsored by Alcon Laboratories, Inc. 2 OCULAR SURGERY NEWS US EDITION

More information

RELEX SMILE AND SMILE EXTRA.. OUR 1 YEAR RESULTS AND PATIENTS SURVEY

RELEX SMILE AND SMILE EXTRA.. OUR 1 YEAR RESULTS AND PATIENTS SURVEY RELEX SMILE AND SMILE EXTRA.. OUR 1 YEAR RESULTS AND PATIENTS SURVEY DR SANDIP MITRA MD FRCS CORNEA AND REFRACTIVE FELLOW (ROYAL VICTORIA EYE AND EAR HOSPITAL, AUSTRALIA) RELEX SMILE UNIT AT THE ALZAHRA

More information

7/24/2014 ORBSCAN. Dr. HARITHA

7/24/2014 ORBSCAN. Dr. HARITHA ORBSCAN Dr. HARITHA Cornea is the most powerful refractive element, contributing 43D of total 60D power of eye. Anterior surface elliptical, HD-11.5mm VD-10.6mm. Posterior surface- circular,avg D- 11.5mm

More information

Uncorrected astigmatism can cause visual

Uncorrected astigmatism can cause visual Spatial Vision and Astigmatism Correction What is the minimum amount of astigmatism that should be corrected? By Eloy A. Villegas, PhD; and Pablo Artal, PhD Uncorrected astigmatism can cause visual quality

More information

Keratorefractive Surgery for Post-Cataract Refractive Surprise. Moataz El Sawy

Keratorefractive Surgery for Post-Cataract Refractive Surprise. Moataz El Sawy Keratorefractive Surgery for Post-Cataract Refractive Surprise Moataz El Sawy Departmentof Ophthalmology, Faculty of Medicine,MenoufiyaUniversity, Egypt mfelsawy@yahoo.co.uk Abstract: Purpose: To evaluate

More information

The Toric Solution: Exceeding Expectations in Patients with Astigmatism. Saturday 5 October XXXI Congress of the ESCRS Amsterdam, The Netherlands

The Toric Solution: Exceeding Expectations in Patients with Astigmatism. Saturday 5 October XXXI Congress of the ESCRS Amsterdam, The Netherlands ESCRS A EUROPEAN OUTLOOK ON THE WORLD OF OPHTHALMOLOGY The Toric Solution: Exceeding Expectations in Patients with Astigmatism Saturday 5 October XXXI Congress of the ESCRS Amsterdam, The Netherlands Sponsored

More information

Seeing Better: Optimizing Surgically Induced Astigmatism Correction Factors for Cataract Surgery * Erin Milne and Nelson Winkler Erin Milne is a Senior in Genomics and Molecular Genetics. After graduation

More information

XXXII nd Congress of the ESCRS, London, September 13, 2014 Instructional Course # 7. LASIK: basic steps for safety and great results

XXXII nd Congress of the ESCRS, London, September 13, 2014 Instructional Course # 7. LASIK: basic steps for safety and great results XXXII nd Congress of the ESCRS, London, September 13, 2014 Instructional Course # 7 LASIK: basic steps for safety and great results Microkeratomes Jérôme C. VRYGHEM, M.D. Brussels Eye Doctors Brussels

More information

SARAH PHYLLIPS. Now, a cataract procedure as unique as your eye itself. TABLE 1. Age: 68.2. Depth (ACD) 3.48 0.36 Axial LengTH 23.79 0.

SARAH PHYLLIPS. Now, a cataract procedure as unique as your eye itself. TABLE 1. Age: 68.2. Depth (ACD) 3.48 0.36 Axial LengTH 23.79 0. TABLE 1 Baseline data SARAH PHYLLIPS Age: 68.2 mean ± Standard Deviat Anterior Chamber Depth (ACD) 3.48 0.36 Axial LengTH 23.79 0.55 Keratometry (K) 43.10 1.04 Now, a cataract procedure as unique as your

More information

Pseudophakic Residual Astigmatism

Pseudophakic Residual Astigmatism Korean J Ophthalmol Vol. 18:116-120, 2004 Pseudophakic Residual Astigmatism Jung Gn Bae, MD, Sung Jin Kim, MD, Young In Choi, MD* Department of Ophthalmology, Eulji University College of Medicine, *Hana

More information