Astigmatism: a New Standard of Care Bridging the Gap to Cataract Refractive Surgery

Total Page:16

File Type:pdf, Size:1020Kb

Astigmatism: a New Standard of Care Bridging the Gap to Cataract Refractive Surgery A Sponsored Supplement From Astigmatism: A New Standard of Care Bridging the Gap to Cataract Refractive Surgery A high proportion of cataract patients are significantly astigmatic (1) – and this can compromise their quality of vision post-surgery (2). There are diverse methods to address astigmatism at the time of the cataract surgery, but not all are equally effective (3). Could advanced instrumentation and toric IOLs change the standard of care? The consensus at Alcon Axis Advanced Workshop, held in Barcelona, Spain, on October 26, 2018, is that it can – even in patients with only mild astigmatism. Andrzej Dmitriew, Department of Ophthalmology, Poznan University of Medical Sciences, Szpital św. Wojciecha Poznan, Poland Kjell Gunnar Gundersen, IFocus Eye Clinic AS, Haugesund, Norway Norbert Pesztenlehrer, Department of Ophthalmology, Petz Aladár County Teaching Hospital, Gyor, Hungary Humberto Carreras, Eurocanarias Oftalmologica, Las Palmas de Gran Canaria, Spain www.alcon.com 2 Sponsored Feature Part I: The “As little as 0.5D Sidebar 1. importance of post-surgical post operative astigmatism astigmatism can astigmatism correction results (1); patients significantly affect Andrzej Dmitriew, Poland implanted with patients’ non-toric IOLs Why bother correcting astigmatism in cataract surgery patients? Because as little functional vision.” Pre-operative corneal as 0.5D post-surgical astigmatism can astigmatism: significantly affect patients’ functional vision – Andrzej (2) – and toric IOLs can now address not • 78% (n=85 650) ≥0.5 D just 2D astigmatism and over, but 1D and Dmitriew • 42% (n=46 003) ≥1.0 D below (4). We can completely change our • 21% (n=22 899) ≥1.5 D attitude to mildly astigmatic patients: it is no • 11% (n=11 651) ≥2.0 D longer necessary to accept compromises worsening then the visual acuity (1). This that leave them with poor functional vision. conclusion was based on very significant Post-operative refractive And this change in at titude is well overdue: patient numbers: 110,000 pre-operative astigmatism results: consider the prevalence data, based on readings and 40,000 post-operative the real-world recent studies. Among readings. Similarly, data from the Swedish • 90% (n=35907) ≥0.5 D cataract patients, 70 percent or more Cataract Registry indicate that 60 percent • 58% (n=22886) ≥1.0 D showed ≥0.5D of corneal astigmatism and of patients remain with 0.5D of corneal • Visual acuity tended to may benefit from astigmatism correction astigmatism after surgery (Sidebar 1 (6)). worsen postoperatively (1, 5); furthermore when a non-toric IOL In Dmitriew’s opinion, therefore, it with increased astigmatism is implanted in an astigmatism patient, is misguided to apply arbitrary cut-offs (ρ=−0.44, P<0.01) the astigmatism magnitude might beneath which astigmatism is left untreated; be higher after cataract I advise all surgeons to move towards surgery than before correcting astigmatism wherever possible, even where post-operative astigmatism is predicted to be under one diopter. It really should be part of the standard of care! Sponsored Feature 3 Part II: Sidebar 3. Benefits of astigmatism Astigmatism correction with toric IOLs (3) treatment Kjell Gundersen, Norway Toric IOLs provide better postoperative UCDV- A Preoperative astigmatism is common compared to non-toric and is not reduced by cataract surgery and non-toric IOLs + and monofocal IOL implantation (1). Therefore, to improve visual outcomes, relaxing incision we must correct astigmatism when we treat cataracts. Unfortunately, many cataract surgeons simply don’t care Greater spectacle about astigmatism! But the rest of us Toric independence with do have some options (Sidebar 2). IOLs toric IOLs than non-toric, Limbal relaxing incisions will reduce combination of non-toric astigmatism in most cases, but are not as effective, precise and predictable as toric and relaxing incision IOLs (3). Laser vision correction can be useful in patients with high astigmatism, Lower postoperative astigmatism but is not universally applicable: those with stable keratoconus and 6D with toric IOLs compared astigmatism or above may be better with non-toric IOLs and served by use of toric IOLs. Furthermore, combination of non-toric IOLs remember the ocular surface (Sidebar + relaxing incision Sidebar 2. Astigmatism treatment options • Toric lens Figure 1. Benefits of astigmatism correction with toric IOLs (3) • Laser vision correction - PRK 5); most cataract patients are over 50 better functional outcomes and - LASIK years of age – either they have a dry spectacle independence – and fewer - SMILE eye problem, or the laser will create post-operative complications – than • Limbal relaxing incisions one! Leaving a mild refractive error is combinations of non-toric IOLs and - Arcuate (manual or far preferable to instigating chronic dry relaxing incisions (3). And the impact FLACS) eye disease. on workflow is minimal – it takes only - Opposite clear corneal Toric IOLs, however, give better a little more surgeon time to implant incision (pay attention outcomes than relaxing incisions or laser a toric as opposed to a non-toric lens. to nomogram) surgery (3), and better uncorrected In my opinion, therefore, the toric distance vision. Even at very low values lens is unquestionably the best option of astigmatism, toric IOLs provide (Sidebar 3). www.alcon.com 4 Sponsored Feature Andrzej Dmitriew, Poland an incision’s effect on a specific axis. Cornea, astigmatic correction and visual outcomes... however, is a living biomechanical structure; Failure to account for posterior corneal But how exactly should we manage cataract it does not react to incisions as if it were a astigmatism in toric IOL calculations can patients with astigmatism? First, we should simple monofocal lens, and therefore older lead to overcorrection in eyes that have WTR appreciate that predictable results require a formulas cannot always predict its behavior. anterior corneal astigmatism and under stable platform. A history of over 100 million Barrett toric calculator utilizes centroid vector correction in eyes that have ATR anterior procedures provides abundant evidence for calculations for improved SIA accuracy. corneal astigmatism.” (13) the rotational stability of the AcrySof® IQ Therefore, I strongly recommend the Accounting for PCA is also assisted by Toric IOL: mean Acrysof rotation is 2.72 new Alcon Online Toric Calculator, not advances in instrumentation. But what degrees, versus 3.79 degrees for TECNIS® least because it is based on the Barrett option should we choose? I believe that Toric (7). Similarly, 91.9 percent of AcrySof ® algorithm, which is superior to ray- the best keratometry tool is the one IQ Toric implantations rotate by 5 degrees tracing software and other formulae that works best for you. I use VERIONTM or less versus 82.8 percent for TECNIS® (Figure 2, Table 2 (8, 9)). for measuring axis and astigmatism Toric (Table 1 (7)). “Because SIA is a vector, it has both magnitude, and a Scheimpflug camera Second, we should be aware of new magnitude and angular direction, and and Pentacam as a control approach. This concepts in astigmatism treatment – not both vector components must be included approach helps avoid significant surprises; least, work on posterior corneal astigmatism when calculating the median or mean for example, by identifying patients with (PCA). The large difference between with- SIA in a group of cases... It is critical to posterior keratoconus or other corneal the-rule (WTR) and against-the-rule (ATR) account for posterior corneal astigmatism pathology that could cause deviation from patients, in terms of refractive outcomes, in cataract patients to achieve optimal pre-operative predictions. Feel free to is due to PCA. Ignoring posterior corneal post-operative outcomes.” (11) use any biometer for K values, but you astigmatism may yield incorrect estimation “It is important to consider posterior must always remember to optimize lens of total corneal astigmatism. Failure to corneal astigmatism in toric calculations constants for each device separately – that’s account for it in toric IOL calculations may as the posterior cornea acts as a minus very important. result in significant residual astigmatism lens ... Both the anterior and posterior Accurate location of the principal due to overcorrection in eyes with WTR corneal surfaces contribute to the total meridian is very important in irregular astigmatism and undercorrection in those corneal astigmatism.” (12) corneas, and is the main reason to with ATR astigmatism. Using the devices “Posterior corneal astigmatism can impact use topography, but you can also use that calculate total corneal astigmatism based on anterior corneal measurements AcrySof® IQ Toric TECNIS® Toric only, WTR astigmatism was overestimated by 0.5 to 0.6 D and ATR astigmatism was IOL rotation, degrees (95 percent CI) 2.72 (2.35-3.08)* 3.79 (3.36-4.22)* underestimated by 0.2 to 0.3 D (8). The old Alcon calculator didn’t allow Rotation ≤5 degrees 91.9 percent* 81.8 percent* for PCA, and therefore wasn’t ideally predictive; The new Barrett calculator Rotation ≤10 degrees 97.8 percent* 93.2 percent* theoretically accounts for PCA in WTR and ATR eyes (9), axial length and anterior Rotation ≤15 degrees 98.6 percent* 96.4 percent* chamber depth in ELP estimates permitting more precise astigmatic prediction (10). Rotation ≤20 degrees 98.9 percent 97.4 percent Based on the Douglas D. Koch and Li Wang ≤ theory, Surgically Induced Astigmatism (SIA) Rotation 30 degrees 99.5 percent 99.4 percent is a vector, it has both magnitude and angular Rotation >30 degrees 0.50 percent 0.60 percent direction, and both vector components must be included when calculating the median or CI = confidence interval; IOL = intraocular lens mean SIA in a group of cases (11). Previous approaches to SIA calculation were based *P < 0.05. only on the numerical average for a specific meridian or axis, and hence only accounted for Table 1. Toric intraocular lens rotation: percentage of eyes demonstrating rotational stability (7). Sponsored Feature 5 topography to distinguish between regular • Consider refining your outcomes by within cataract surgery, but not and symmetrical astigmatism.
Recommended publications
  • Fact Sheet: Refractive Errors
    Fact Sheet: Refractive Errors More than 11 million Americans have common vision problems that can be corrected with the use of prescriptive eyewear such as glasses or contact lenses.1 These conditions are known as refractive errors and they occur when the eye doesn’t correctly bend, or ―refract,‖ light as it enters the eye. Common refractive errors include the following: o Nearsightedness (also called myopia)—A condition where objects up close appear clearly, while objects far away appear blurry. With nearsightedness, light comes to focus in front of the retina instead of on the retina. o Farsightedness (also called hyperopia)—A common type of refractive error where distant objects may be seen more clearly than objects that are near. However, people experience farsightedness differently. Some people may not notice any problems with their vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any distance, near or far. o Astigmatism—A condition in which the eye does not focus light evenly onto the retina, the light-sensitive tissue at the back of the eye. This can cause images to appear blurry and stretched out. o Presbyopia—An age-related condition in which the ability to focus up close becomes more difficult. As the eye ages, the lens can no longer change shape enough to allow the eye to focus close objects clearly. Refractive errors are one of the most common—and correctable—causes of visual impairment in the United States. According to a recent study led by the National Eye Institute (NEI), approximately half of all American adults don’t have the 20/20 vision physicians consider optimal due to refractive errors.2 Women experience refractive error more frequently than men: Twenty-six percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older.
    [Show full text]
  • Complicated Coding Issues in Combined Lens and Retina Surgery by Riva Lee Asbell
    BUSINESS OF RETINA CODING FOR RETINA Complicated Coding Issues in Combined Lens and Retina Surgery BY RIVA LEE ASBELL s an increasing number of vitreoretinal surgeons TIPS perform combined retina and lens procedures, the • Modifier -58 was used with the first code because it coding and compliance issues may be different represents a procedure that is more extensive than from typical retina-only procedures. This review the original procedures. Apresents some of these issues along with suggestions for • With the second code, modifier -59 is used to break managing them when coding and billing Medicare. the bundle. Modifier -79 is used because the proce- dure is unrelated to the prior surgery. NCCI BUNDLING ISSUES • Unless the bundle is broken, an ambulatory surgery Dealing with the code edit pairs found in the center (ASC) will not be reimbursed for its facility National Correct Coding Initiative entails using modi- fee for the cataract surgery and IOL. fier -59 to break the bundles, which just happens to Be aware that the latest revisions in cataract poli- be always on the list of the Office of the Inspector cies (local coverage determinations [LCDs]) for some General’s work plan each year. Just because a bundle Medicare administrative contractors (MACs) require can be broken does not mean it should be broken. So that a formal form be filled out documenting the specific use the modifier judiciously. difficulties the patient is having with activities of daily liv- ing as a result of the cataract. HISTORY: A full-thickness macular hole in the left eye had been repaired using vitrectomy and silicone oil that was sub- The newest version of LCDs from some of the MACs sequently removed 8 weeks later.
    [Show full text]
  • Managing a Patient with Post-Radial Keratotomy and Sjogren's Syndrome with Scleral Contact Lenses
    Managing a patient with Post-Radial Keratotomy and Sjogren's Syndrome with Scleral Contact Lenses Case Report 1 Candidate #123 Abstract: Surgeons used radial keratotomy (RK) in the past as an attempt to flatten the corneal shape and reduce refractive myopia in a patient. In the present day, many post-RK patients suffer from poor, fluctuating vision due to an irregular corneal shape induced from this procedure. Rigid gas permeable lenses, such as scleral lenses, are an excellent solution to improve and stabilize vision. Scleral lenses help recreate an optimal refractive surface to enhance vision for the patient. Patients with specific dry eye symptoms can receive a therapeutic benefit from scleral lens use as the lens acts as a protective barrier for corneal hydration. This is a case report on a patient suffering from both ocular and systemic conditions resulting in decreased vision and discomfort from severe dry eye. She has been successfully fit with scleral lenses to improve signs and symptoms. Key Words: Radial keratotomy (RK), dry eye, Sjogren's syndrome, scleral lens 2300 East Campbell Avenue, Unit 316 Phoenix, AZ 85016 [email protected] (480) 815-4135 1 Introduction: Patients may present to their eye care provider with multiple conditions impacting 2 both their ocular and systemic health. Ocular comorbidities frequently lead to visual impairment 3 and decreased quality of life. To suitably manage these coinciding ailments, it is essential to 4 obtain an early and proper diagnosis. [1] In some instances, similar approaches can help alleviate 5 patient symptoms in managing these comorbidities. 6 7 The goal of refractive surgery is to eliminate the dependency on glasses and contact lenses.
    [Show full text]
  • Intraocular Lens (IOL) Surgery Opacification
    Eye (2002) 16, 217–241 2002 Nature Publishing Group All rights reserved 1470-269X/02 $25.00 www.nature.com/eye RH Trivedi1, L Werner1, DJ Apple1, SK Pandey1 REVIEW Post cataract- and AM Izak1 intraocular lens (IOL) surgery opacification Abstract opacification; anterior capsule opacification; silicone; calcification; glistening; snowflake; Intraocular lens (IOL) implantation has no interlenticular opacification; piggyback; doubt been one of the most satisfying posterior capsule opacification advances of medicine. Millions of individuals with visual disability or frank blindness from cataracts had and continue to Introduction have benefit from this procedure. It has been reported by ophthalmologists that the Implanting an intraocular lens (IOL) into an modern cataract-intraocular lens (IOL) adult eye after cataract surgery is an surgery is safe and complication-free most of extremely successful procedure since its 1 the time. This makes the watchword for any invention by Sir Harold Ridley. It is often cataract surgeon to be ‘implantation,’ difficult to imagine another medical specialty ‘implantation,’ ‘implantation.’ In the mid- implanting foreign material with such a high 1980s, as IOLs were evolving rapidly, the success rate. Decreased incidence of watchword of the implant surgeon was postoperative complications of cataract-IOL ‘fixation,’ ‘fixation,’ ‘fixation.’ Most surgery led us to become complacent and less techniques, lenses and surgical adjuncts now vigilant regarding assessment and careful allow us to achieve the basic requirement for testing of new ocular prosthesis and surgical successful IOL implantation, namely long- procedures. However, despite the positive term stable IOL fixation in the capsular bag. evolution of cataract-IOL surgery, but However despite this advancement some concurrent with this era of probably decreased items ‘slipped through cracks.’ In this article, vigilance, we are now unfortunately we would like to alert the reader to a new identifying some serious problems.
    [Show full text]
  • Medicare and Coding Issues
    3/6/2014 What Ophthalmologists Presented by Joy Newby, LPN, CPC, PCS Need to Know About Newby Consulting, Inc. Medicare and Coding 5725 Park Plaza Court Indianapolis, IN 46220 Illinois Society of Eye Physicians and Surgeons Voice: 317.573.3960 Chicago Ophthalmological Society Fax: 866-631-9310 Annual Joint Meeting March 7, 2014 E-mail: [email protected] This presentation was current at the time it was published and is intended to provide useful information in regard to the subject Agenda matter covered. Newby Consulting, Inc. believes the information is as authoritative and accurate as is reasonably possible and that the sources of information used in preparation of the manual are reliable, but no assurance or warranty of completeness or accuracy is intended or given, and all warranties of any type are disclaimed. • ICD-10 - Are we close to being ready? The information contained in this presentation is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Any five-digit numeric Physician's Current Procedural Terminology, Fourth Edition (CPT) codes service descriptions, instructions, and/or guidelines are copyright 2013 (or such other date of publication of CPT as defined in the federal copyright laws) American Medical Association. 4 International Classification of Diseases, International Classification of Diseases, Tenth Tenth Revision (ICD-10) Revision, Clinical Modification (ICD-10-CM)
    [Show full text]
  • Scleral Lenses to Manage Dry Eye Symptoms
    Contact us today Scleral Lens for Management of to learn how scleral lenses Dry Eye Symptoms can make a difference in your life. Affix your practice address label here. Scleral lens vaulting the cornea, maintaining a cushion of tears. Blanchard Contact Lenses supplies the specialty GP lens industry with leading lens designs of the highest quality. Our mission is to consistently design and develop innovative specialty GP lenses utilizing cutting edge manufacturing methods, while maintaining unique partnerships with eye care professionals to improve all aspects of the contact lens wearer experience. Scleral Lenses for the Management of Dry Eye Symptoms Chronic Dry Eye Disorders Dry eye can occur or be caused by How msd™ and Onefit™ Scleral Lenses Work According to a consumer survey1, many conditions. Some are: 48% of adults report dry eye msd™ and Onefit™ scleral lenses are • Age related symptoms. Of those, 42% have made of materials that let oXygen pass • Gender (occurs more with women) trouble reading print as a result of dry through the lens promoting long term eye. Nineteen percent report using • Medications and/or medical conditions cornel health and comfort. The lens over the counter drops to help with • Environmental conditions design provides a thin cushion of fluid the condition, but two thirds of those • Post Refractive Surgery (LASIK and that stays between the lens and eye who use drops find that they are not msd™ Mini-Scleral Lens RK), post-surgery, or post-injury providing immediate relief of dry eye comfortably fit to eye. effective. symptoms and long term wearing Patients with dry eye symptoms may comfort.
    [Show full text]
  • Refractive Status and Optical Components of Premature Babies with Or Without Retinopathy of Prematurity at 7 Years Old
    116 Original Article Refractive status and optical components of premature babies with or without retinopathy of prematurity at 7 years old Yang Wang, Lian-Hong Pi, Ru-Lian Zhao, Xiao-Hui Zhu, Ning Ke Department of Ophthalmology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China Contributions: (I) Conception and design: Y Wang, LH Pi, N Ke; (II) Administrative support: LH Pi; (III) Provision of study materials or patients: LH Pi, N Ke; (IV) Collection and assembly of data: Y Wang, RL Zhao, XH Zhu; (V) Data analysis and interpretation: Y Wang; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Ning Ke. Department of Ophthalmology, Children’s Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders (Chongqing), China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China. Email: [email protected]. Background: This study aimed to investigate the refractive status and optical components of premature babies with or without retinopathy of prematurity (ROP) at 7 years old and to explore the influence of prematurity and ROP on the refractive status and optical components. Methods: From January 2009 to February 2011, premature babies receiving fundus photographic screening (FPS) were recruited and divided into non-ROP group and ROP group.
    [Show full text]
  • Bilateral Retinal Detachment After Implantable Collamer Lens Surgery
    Trends in Ophthalmology L UPINE PUBLISHERS Open Access Journal Open Access DOI: 10.32474/TOOAJ.2018.01.000110 ISSN: 2644-1209 Case Report Bilateral Retinal Detachment after Implantable Collamer Lens Surgery Mohamad Rosman* and Tong Weihan Singapore National Eye Centre, Singapore Received: April 04, 2018; Published: April 19, 2018 *Corresponding author: Mohamad Rosman, Singapore National Eye Centre, Refractive Surgery (Head of Department), Singapore Abstract A 46-year-old man, with moderate myopia, underwent Implantable Collamer Lens (ICL) surgery in both eyes on different dates. In the post-operative period, both of his eyes sustained the complication of rhegmatogenous retinal detachment (RD). After RD in the risk of RD. This did not prevent RD from developing in this eye as well. RD is a potential complication of ICL surgery and all the first eye, prophylactic 360-degree laser photocoagulation was performed on the second eye pre-operatively to hopefully reduce patients, regardless of degree of myopia, should be counselled about the risk pre-operatively. It will be prudent to monitor patients closely in the post-operative period, to detect this potential complication early. With subsequent early intervention, patients can Keywordshave a good :final Implantable visual outcome. Collamer Lens; Retinal detachment; Myopia; Laser photocoagulation Abbreviations: ICL: Implantable Collamer Lens; RD: Retinal Detachment; PIOL: Phakic Intraocular Lenses; LASIK: Laser Assisted in Situ Keratomileusis; VA: Visual Acuity Introduction revealed -6.00D spherical and-1.00D cylindrical components Various modern surgical options exist for correcting patients’ in the right eye, and -5.00D spherical and -1.50D cylindrical refractive errors. They range from minimally invasive surgery, components in his left eye.
    [Show full text]
  • Refractive Errors a Closer Look
    2011-2012 refractive errors a closer look WHAT ARE REFRACTIVE ERRORS? WHAT ARE THE DIFFERENT TYPES OF REFRACTIVE ERRORS? In order for our eyes to be able to see, light rays must be bent or refracted by the cornea and the lens MYOPIA (NEARSIGHTEDNESS) so they can focus on the retina, the layer of light- sensitive cells lining the back of the eye. A myopic eye is longer than normal or has a cornea that is too steep. As a result, light rays focus in front of The retina receives the picture formed by these light the retina instead of on it. Close objects look clear but rays and sends the image to the brain through the distant objects appear blurred. optic nerve. Myopia is inherited and is often discovered in children A refractive error means that due to its shape, your when they are between ages eight and 12 years old. eye doesn’t refract the light properly, so the image you During the teenage years, when the body grows see is blurred. Although refractive errors are called rapidly, myopia may become worse. Between the eye disorders, they are not diseases. ages of 20 and 40, there is usually little change. If the myopia is mild, it is called low myopia. Severe myopia is known as high myopia. Lens Retina Cornea Lens Retina Cornea Light rays Light is focused onto the retina Light rays Light is focused In a normal eye, the cornea and lens focus light rays on in front of the retina the retina. In myopia, the eye is too long or the cornea is too steep.
    [Show full text]
  • Distribution of Anterior and Posterior Corneal Astigmatism in Eyes with Keratoconus
    Distribution of Anterior and Posterior Corneal Astigmatism in Eyes With Keratoconus MOHAMMAD NADERAN, MOHAMMAD TAHER RAJABI, AND PARVIZ ZARRINBAKHSH PURPOSE: To investigate the magnitude, with-the-rule ERATOCONUS (KC) IS A PROGRESSIVE, USUALLY (WTR) or against-the-rule (ATR) orientation, and vec- bilateral ectatic corneal disorder, characterized by 1,2 tor components (Jackson astigmatic vectors [J0 and J45] K corneal thinning and protrusion. KC starts at and blurring strength) of the anterior and posterior puberty and progresses to the third or fourth decade of corneal astigmatism (ACA and PCA) in patients with life, causing myopia and astigmatism, which results in keratoconus (KC) in a retrospective study, and to try to severe vision distortion and sometimes even blindness.1 find suitable cutoff points for ACA and PCA in an Astigmatism is a refractive error that is mostly caused by attempt to discriminate KC from normal corneas. toricity of the anterior corneal surface leading to visually DESIGN: Retrospective age- and sex-matched case- significant optical aberration. Both the anterior and poste- control study. rior corneal surfaces contribute to the total corneal METHODS: Using the Pentacam images, the aforemen- astigmatism. Recently, the direct and quantitative mea- tioned parameters were compared between 1273 patients surement of the posterior corneal measurements in a with KC and 1035 normal participants. clinical setting has been possible with new imaging tech- RESULTS: The mean magnitude of the ACA and PCA nologies such as slit-scanning, Scheimpflug, or optical was 4.49 ± 2.16 diopter (D) and 0.90 ± 0.43 D, respec- coherence devices.3,4 tively. The dominant astigmatism orientation of the Assessment of the corneal astigmatism plays an impor- ACA was ATR in KC patients and WTR in normal par- tant role in vision correction procedures such as rigid gas- ticipants (P < .001), while for the PCA it was WTR in permeable lens prescription or intraocular lens (IOL) im- KC patients and ATR in normal participants (P < .001).
    [Show full text]
  • Florida Board of Medicine and Florida Board Of
    FLORIDA BOARD OF MEDICINE AND FLORIDA BOARD OF OSTEOPATHIC MEDICINE APPROVED INFORMED CONSENT FORM FOR CATARACT OPERATION WITH OR WITHOUT IMPLANTATION OF INTRAOCULAR LENS DOES THE PATIENT NEED OR WANT A TRANSLATOR, INTERPRETOR OR READER? YES _____ NO_____ TO THE PATIENT: You have the right, as a patient, to be informed about your cataract condition and the recommended surgical procedure to be used, so that you may make the decision whether or not to undergo the cataract surgery, after knowing the risks, possible complications, and alternatives involved. This disclosure is not meant to scare or alarm you; it is simply an effort to make you better informed so that you may give or withhold your consent to cataract surgery and should reflect the information provided by your eye surgeon. If you have any questions or do not understand the information, please discuss the procedure with your eye surgeon prior to signing. WHAT IS A CATARACT, AND HOW IS IT TREATED? The lens in the eye can become cloudy and hard, a condition known as a cataract. Cataracts can develop from normal aging, from an eye injury, various medical conditions or if you have taken certain medications such as steroids. Cataracts may cause blurred vision, dulled vision, sensitivity to light and glare, and/or ghost images. If the cataract changes vision so much that it interferes with your daily life, the cataract may need to be removed to try to improve your vision. Surgery is the only way to remove a cataract. You can decide to postpone surgery or not to have the cataract removed.
    [Show full text]
  • Understanding Intraocular Lenses: the Basics of Design and Material
    FocalPoints Clinical Modules for Ophthalmologists VOLUME XXXIII NUMBER 8 AUGUST 2015 Understanding Intraocular Lenses: The Basics of Design and Material Steven Dewey, MD REVIEWERS AND CONTRIBUTING EDITORS CONSULTANTS D. Michael Colvard, MD, Lisa B. Arbisser, MD, Editors for Cataract Surgery Ricardo G. Glikin, MD Sharon L. Jick, MD, Basic and Clinical Science Course Faculty, Section 11 Richard S. Hoffman, MD Dasa V. Gangadhar, MD, Practicing Ophthalmologists Advisory Committee for Education Focal Points Editorial Review Board Eric Paul Purdy, MD, Bluffton, IN CONTENTS Editor in Chief; Oculoplastic, Lacrimal, and Orbital Surgery Lisa B. Arbisser, MD, Bettendorf, IA Cataract Surgery Introduction 1 Syndee J. Givre, MD, PhD, Raleigh, NC Neuro-Ophthalmology Historical Perspectives 1 Deeba Husain, MD, Boston, MA Overview of IOL Specifications 3 Retina and Vitreous Katherine A. Lee, MD, PhD, Boise, ID IOL Materials 4 Pediatric Ophthalmology and Strabismus Biocompatibility 4 W. Barry Lee, MD, FACS, Atlanta, GA Light-Blocking Chromophores 6 Refractive Surgery; Optics and Refraction Optical Clarity 6 Ramana S. Moorthy, MD, FACS, Indianapolis, IN Ocular Inflammation and Tumors Optic Opacification 6 Sarwat Salim, MD, FACS, Milwaukee, WI IOL Design 7 Glaucoma Single-Piece Versus 3-Piece Design 7 Elmer Y. Tu, MD, Chicago, IL Cornea and External Disease Optic Configuration and Power 8 Aspheric Optics 9 Focal Points Staff Multifocal Design 10 Susan R. Keller, Acquisitions Editor Extended Depth-of-Focus IOLs 13 Kim Torgerson, Publications Editor D. Jean Ray, Production Manager Complications of IOLs 13 Debra Marchi, CCOA, Administrative Assistant Secondary Cataract Formation 13 Dysphotopsias 14 Clinical Education Secretaries and Staff Louis B. Cantor, MD, Senior Secretary for Clinical Education, Conclusion 15 Indianapolis, IN Christopher J.
    [Show full text]