Cataract & Refractive

Could phakic IOLs some day emerge as the dominant refractive surgical approach, particularly considering the past problems with early innovations? This is a difficult question to answer but one that has been debated over recent years.

As with any IOL implantation technique, there are some potential complications that must be considered. In general, the number of complications is low, and most of them are either easy to avoid or easy to repair

The US Navy is proceeding with a programme allowing LASIK with IntraLase flap creation in naval aviators.

A rising number of phakic IOLs are steadily making their way into clinics, with each one offering its own unique property to set it apart from the competition. Documented studies will tout the benefits of each lens and, in many cases, will compare phakic lenses in head-to-head studies. Naturally, all studies are important and the benefits a particular kind of lens affords in a certain type of patient, is absolutely critical if a surgeon is to make an informed decision on his or her choice of lens. However, just as important as the choice of lens, is the surgical technique employed to implant the lens. A good technique will, amongst other things, reduce the incidence of potential complications that could ensue as a result of surgery and it will lead to a faster recovery time.

A new fixed combination of dexamethasone and netilmicin offers an effective and safe way to control ocular inflammation after cataract surgery.

An update of the ESCRS and ASCRS survey on the most common complications involving foldable IOLs.

Alcon has received FDA approval for the AcrySof ReSTOR intraocular lens (IOL) for the correction of aphakia following cataract surgery in patients with or without presbyopia.

Pre-soaked IOLs may provide an excellent way to deliver fourth-generation fluoroquinolones to prevent endophthalmitis.

Research into the remarkable workings of the human eye have led to the acknowledgement of the presence of inherent higher order aberrations (HOAs) of the cornea, such as coma and spherical aberration. These aberrations are known to lead to optical degradation with the most significant culprit being spherical aberration.

Refinements in lens technology have probably acted as the greatest catalyst for the recent upsurge in interest that has been witnessed in multifocal intraocular lenses (MIOLs). Coupled with the CE and FDA approvals of several second generation MIOLs, the number of refractive lens exchange (RLE) procedures that have been conducted in individuals over the age of 45 years seeking spectacle independence, has soared.

Although presbyLASIK is still, by no means, perfect, it seems to present a good solution for certain cases, particularly in myopes and hyperopes.

At three months, 88% had monocular uncorrected near vision of J2 or better and 95% had J3 or better. A total of 84% were able to read newspaper-sized print without spectacles and 84% were satisfied or very satisfied with the results

I am not convinced that using two very different types of lenses in one patient is the best way to maximize the visual system

The femtosecond laser has the potential to be the ultimate corneal incision device - the possibilities are nearly limitless

Managing patient expectations, matching the lens and the right lens power to the right patient, showing the patient you care and keeping the patient fully informed are all key strategies to securing patient satisfaction.

We take a look at some interesting developments in the fast-moving area of presbyopia research and development.

The surgeon does not change gloves in between cases but simply rinses with 0.5% chlorhexidine/70% isopropyl alcohol solution. Despite the simplicity of this, the rates of infection in Dr V hospitals is lower than US rates

The wavefront guided approach has certainly yielded the best outcomes in my practice; patient satisfaction rate is very high, while the retreatment rate is extremely low at 2.3%

Its almost time to close the door on 2006 and welcome another new year. But, before we do that we wanted to take you on a journey through the highs and lows of the past twelve months by reflecting on some of the most significant events to shape your industry this year.

At the ESCRS congress in September, Peter Barry presented the full ESCRS endophthalmitis study results and controversially stated that, not only is the incidence of endophthalmitis higher than reported in the literature, but the risk of infection is further increased by clear corneal incisions and the use of silicon IOLs.

Zyoptix Aspheric, Bausch & Lomb's recent addition to its refractive armamentarium, has been found to induce significantly less amounts of spherical aberrations compared with conventional LASIK treatment, according to Dr Wing Kwong Chan, senior consultant and head of refractive surgery services at Singapore National Eye Center (SNEC). This technology could be most beneficial to patients with high order myopia or large pupils, and for professionals requiring best-possible night vision.

A better informed patient is a goal that all healthcare professionals strive for. Better informed patients are able to make better choices about their healthcare and give informed consent for a procedure.

Ophthalmologists have been seeking to achieve the same quality and surgical success for high ametropia as has already been achieved for moderate ametropias. The analysis of refractive outcomes of procedures such as the Ferrara Ring implantation to correct early keratoconus, thermokeratoplasty to correct hypermetropia and corneal transplantation frequently reveals the presence of a residual ametropia that results in low or moderate visual acuity. It is our belief that the Artisan phakic intraocular lens (IOL) (Advanced Medical Optics) could go some way to adressing this issue. Hence, after mastering the surgical procedures involved for the implantation of the phakic IOL and its indication as an option for refractive surgery, we looked to assess the benefits of secondary lens implantation in the correction of residual ametropia and the impact it has on patient quality of life.

Refractive surgery dates back to the 19th century, when L.J. Lans demonstrated the effect of applying heat to the cornea to treat astigmatism. Once considered only by the courageous, refractive surgery has now become an everyday alternative form of visual correction, made possible by improvements in our understanding of corneal anatomy and physiology and the development of remarkable new tools.

Safety, with respect to loss of best spectacle-corrected visual acuity, records better results for phakic IOL implantation than for LASIK with higher corrections

Combined surgical management of coexisting cataract and glaucoma has recently gained popularity because of the several advantages that it presents. These advantages include, decreased risk, easier management of early and long-term postoperative intraocular pressure (IOP) and performing just one surgical procedure to manage both problems.

The development of presbyopia in hyperopic people aged between 45 and 65 is a serious refractive problem that, until recently, has had no practical solution. Individuals in this category are not usually considered to be "patients" but, nevertheless, face real problems with their everyday near and distance sight. We call this problem "hyperopic presbyopia".

80% of Tecnis patients and 85% of ReSTOR patients were very happy with all aspects of their vision, with the majority of patients in both groups deciding not to return to glasses, even for intermediate vision

The May 2005 acquisition of VISX saw AMO inherit a large installed base of refractive surgery technologies, which not only complemented its refractive IOL portfolio, but also transformed AMO into the world's leading refractive surgical company.

December 2005 witnessed the launch of Carl Zeiss Meditec's latest model for customized refractive surgery; the CRS-Master 2.1. Equipped with a new wave of design enhancements, topography-guided therapy has now been added as a new functionality mode to the system.