Winter 08 NEW

CALIFORNIA
OPTOMETRIC LASER
ASSOCIATES, INC.
News For
Co-Managing Optometrists
Winter, 2008
COLA, Inc. is...
• An innovative optometric
corporation that provides
administrative services to
ophthalmologists and
optometrists, with the
goal of fostering the best
co-management of refractive and other comanaged patients.
THE SURGICAL REHABILITATION OF THE POST-RADIAL KERATOTOMY EYE
by Mark Mandel, M.D.
• Contracted with over
800 optometrists, 10
surgeons and 12 surgical
centers throughout California.
• The easiest, most flexible
and legally safest way to
practice surgery patient
co-management.
Inside this issue:
Furlong Vision
gives to HOPE
2
Pull-Out and
Save!
Surgeon Panel
3
Co-Management
Marketing Basics
3
New Website and 4
Contest
ILEA - A Case
Study
5
COLA Contact
Information
6
Upcoming Events
6
Between the late 1970s and the
mid-1990s, radial keratotomy
was the refractive procedure of
choice for low to moderate
myopia. Although most of these
patients continue to be stable,
there are an increasing number
of post-radial keratotomy patients who seek consultation
either because of residual or
new onset myopia, progressive
(consecutive) hyperopia, and/or
or the development of a cataract.
In the post-RK patient who
presents with myopia, it is critical to differentiate between
residual myopia, regression of
the RK effect back towards myopia, and the development of a
nuclear sclerotic cataract. By
taking a careful history and performing a diligent examination of
the eye, armed with a few caveats, one can arrive at the correct
diagnosis, recommend the appropriate optical or surgical treatment, and properly educate the
patient as to the realistic expectations.
Late regression of the RK effect
back towards myopia is extremely rare. Initial undercorrection of the higher myope is somewhat more common. However,
the most likely cause of progressive myopia following radial keratotomy is the development of a
nuclear sclerotic cataract. If a
patient does not correct to
20/20, care must be taken to rule
out the possibility of irregular
astigmatism rather than the cataract as a cause for decreased best
corrected visual acuity. Oftentimes, irregular astigmatism and
cataract coexist. A hard contact
lens over-refraction will eliminate
the component of irregular astig-
Surgical Options for Treating Presbyopia
Baby boomers are the fastest
growing segment of the population. Someone turns 50 every 8
seconds and this trend will continue until 2011. Most baby
boomers are used to being very
active and, for the most part,
not worrying about seeing
things up close. Presbyopia is
certainly not a life threatening
event, but is definitely a major
inconvenience. We all like to
think of ourselves as eternally
youthful, but reading glasses get
in the way of that image. Traditionally reading glasses, bifocals
and contact lenses have been
available to help correct this
problem. They all work, but do
not necessarily fit the lifestyle
most of us have become accustomed to.
There are now four ways to surgically correct Presbyopia: Near
Vision Multi-focal LASIK or PRK,
Monovision LASIK or PRK, Multifocal or Accommodating IOL, and
matism and allow one to differentiate between irregular astigmatism and cataract. Additionally, the use of the hard contact
lens over-refraction data in the
eventual calculation of the lens
implant power is extremely
helpful.
In the patient with progressive
hyperopia, the RK continues to
have a flattening effect even
years following the initial procedure. This is especially true if
the eye has undergone one or
more post-RK enhancements,
had a small optical zone, or 16
or more incisions. Also, it is
important to determine
whether the patient experiences
diurnal fluctuation of vision
throughout the day which is
common in the consecutive
hyperope. This must be thoroughly discussed with the patient because following either
cataract surgery or post-RK
LASIK surgery, the diurnal fluctuation will persist. Additionally, the consecutive hyperopia
may continue to progress.
(Continued on page 2)
by Michael Gordon, M.D.
CK- Conductive Keratoplasty.
Below is a brief description of
each procedure.
PML/Near Vision Multi-focal
LASIK/PRK - This procedure
was developed in Europe based
on principles we have observed
here after many years of successful vision correcting surgery.
Ophthalmologist colleagues
over the last five years have
perfected a technique to pro(Continued on page 2)
Page 2
FVC Partners with
HOPE Services to give
Gift of Sight
Dr. Michael Furlong is a
strong believer in giving
back to his community. In
2002, he launched Gift of
Sight - a cooperative program with a local charity
that provides free eye
exams, vision correction
and post op care to individuals in the Bay Area
who cannot afford corrective procedures. The
program has been a huge
success, greatly improving
people's lives, both personally and professionally.
For the past three years,
FVC has partnered with
HOPE Services, a local
nonprofit that provides
programs and services to
3,000 individuals with
developmental disabilities
such as mental retardation, cerebral palsy, epilepsy and autism. HOPE
enables infants, young
people, adults and seniors
to live and participate in
their communities.
On August 14th, 2008, Dr.
Furlong closed his clinic
and performed surgery on
10 HOPE Services clients
and staff members at no
cost to them. The San
Jose Mercury News covered the event. Since
launching the Gift of Sight,
Dr. Furlong has:
• Donated more than
$300,000 in services
• Helped improve the
quality of life of more
than 50 individuals
• Worked with more than
10 local nonprofits
To learn more about the
Gift of Sight and hear an
interview regarding the
program and HOPE, go to
www.furlongvision.com/
gift_of_sight.html.
Gordon Binder & Weiss
Vision Institute has always
encouraged the optometric
community to partner in
patient care. If you have an
interest in learning more
about the practice and comanagement, please contact
Dr. Mick Tartaglia at (858)
455-6800.
NEWS FOR CO-MANAGING OPTOMETRISTS
Surgical Rehabilitation, cont.
Once glasses or contact lenses
are no longer a treatment option,
there are a number of surgical
procedures which can be helpful
for these patients. In the post-RK
patient with residual myopia with
or without astigmatism, or the
low hyperope (up to +4.00) with
or without astigmatism, LASIK is
an excellent choice. Although the
post-operative results are not as
accurate as in a virgin eye, these
patients are generally thrilled with
the results. Those with diurnal
fluctuation must be carefully informed that the fluctuation will
continue post-LASIK. A surface
procedure such as LASEK or PRK
with Mitomycin-C can also be
performed. The use of Mitomycin
-C is critical to diminish the potential for surface scarring. I do
not recommend EPI-LASIK be-
cause the epithelium is often
adherent to the radial incisions.
For the post-RK patient with a
cataract or in the high hyperope
with or without astigmatism, the
removal of the crystalline lens
with the placement of either a
monofocal spherical or toric
IOL, or Crystalens can have
outstanding results. Again, patients with pre-operative diurnal
fluctuation will continue to experience post-operative diurnal
fluctuation, and patients who
have pre-operative irregular
astigmatism diminishing their
best corrected visual acuity will
also have post-operative diminished best corrected visual acuity due to the irregular astigmatism. However, in the post-RK
patient with a cataract or in the
high hyperope, the results of
lens-based surgery are excellent.
These patients must understand
that in almost every case, in
order to obtain vision close to
emmetropia, a post-lens extraction LASIK will be required.
In summary, the post-RK patient
with residual or new onset
myopia or consecutive hyperopia, even with relatively high
amounts of astigmatism, can be
helped with either corneal or
lens-based refractive surgery or
a combination of both. These
patients are often extremely
visually disabled and are tremendously grateful for the improvement in vision. Of course, realistic expectations are always
critical.
providing a good range of functional near vision.
the cornea to a new shape.
This is done by contracting the
corneal collagen in the periphery of the cornea to steepen
the curve in the center. It does
not remove any corneal tissue,
but because the cornea has
some elastic memory, typically
some of the effect is lost over
time. This may necessitate enhancing the initial surgery some
months, or even years, later. It
remains the simplest and safest
of the procedures we perform,
but is limited to emmetropes
and low hyperopes. CK is a
monovision procedure, so there
is some compromise in distance
vision.
For more photos and a diagnosis/
treatment guide, visit www.colainc.com
Presbiopia, cont.
vide multifocality, or more of a
panfocus, by inducing negative
spherical aberration and creating
a corneal shape that is prolate.
The beauty of this procedure is
that it preserves one’s distance
vision while improving the near
vision, so depth perception
should not be affected as it can be
in monovision. It applies to people who are emmetropes, hyperopes (<3D) and myopes (<5D).
The risks are the same as LASIK/
PRK.
Monovision LASIK/PRKMonovision is an adaptive process
by the brain, and can take a few
weeks to be comfortable. It is a
procedure we have been doing
for 25-30 years and works very
well. LASIK and PRK are Excimer
laser procedures in which corneal
tissue is removed by the laser by
breaking the chemical bonds of
the corneal protein (there is no
heat). Because the cornea is
sculpted and not bent, this procedure tends to be very stable over
time, and carries the same risks as
traditional LASIK/PRK. We prefer a modified Monivision in which
we aim for 1 – 1.25D of add to
preserve distance acuity while
Multifocal/Accommodating
IOL- This technique is one
where the natural lens of the
eye, the root cause of the Presbyopia vision change, is replaced
with a prosthetic lens. The
unique design of these lenses
permits them to act similar to
the natural lens. Once reserved
for those with lens changes that
produced visually significant cataracts, we now use the same
techniques in restoring reading
and distance vision for those of
any age. The risks of this surgery
are identical with those of cataract surgery. Since this involves
making a small incision in the eye
and removing and replacing the
natural lens, complications may
include retinal detachment, glaucoma, infection and even loss of
vision. These complications are
rare but need to be discussed as
always during the informed consent process.
Conductive Keratoplasty
(CK) - is a very safe and effective procedure that utilizes Radio Frequency energy to bend
Cataract surgery should now be
considered a form of refractive
surgery, and as such our patients deserve sharp uncorrected vision. More than 25%
of cataract patients have greater
than 0.75 D of corneal astigmatism, which should be addressed
by the surgeon in pre-operative
planning. For these patients,
successful surgery is only part of
the process to achieve sharp
uncorrected vision.
COLA NORTHERN CALIFORNIA SURGEON PANEL
To learn more about our distinguished panel of surgeons and view their complete C.V.s,
please visit the listed center websites, or visit www.colainc.com
Amin Ashrafzadeh, M.D.
Modesto
has specialized training in performing LASIK eye surgery and other corneal
procedures such as corneal transplantation and anterior segment reconstruction. Dr. “Ash” is a Diplomate of the Am. Board of Ophthalmology
and a member of the Am. Academy of Ophthalmology and the Am. Society
of Cataract and Refractive Surgery.
www.mchenrylasik.com
V. Nicholas Batra, M.D.
Bay Area / San Jose
Bart Carey, M.D.
Bay Area / San Jose
Specializes in Corneal and Refractive Surgery as well as in the diagnosis and
treatment of conditions and diseases of the cornea, anterior segment, and
external eye structures. Dr. Batra is a member of the Am. Board of Ophthalmology, the Am. Academy of Ophthalmology, and the Am. Society of
Cataract and Refractive Surgery,
www.batravision.com
Specializes in Refractive Surgery, Cataract Surgery, General Ophthalmology
and is certified to perform both laser vision correction and Intacs corneal
ring segments for the correction of myopia. Dr. Carey is a member of the
Stanford Refractive Network and is a Board Certified members of the Am.
Academy of Ophthalmology.
www.careyvision.com
Michael Furlong, M.D.
San Jose / Bay Area
Mark R. Mandel, M.D.
San Jose / Bay Area
Lee Schwartz, M.D.
Berkeley / Bay Area
Internal Marketing:
Back to Basics
By Janet Walker
For the past ten years, I have helped ODs
and MDs market their LASIK, and more
recently, lens implant, practices. For MDs,
building and maintaining solid relationships
with ODs who understand how to comanage and how to promote comanagement in their practices is of key
importance. For ODs, covering the basics
of internal marketing has been, and still is,
the best way to build a LASIK and implant
co-management practice.
This article, adapted from a September
2002 issue of Optometric Management,
holds marketing advice that is as relevant
today as it was six years ago. Are you
covering all of the basics to market and
build your co-management practice?
• Posters, countertop displays, video-
is a fellowship trained specialist in corneal and refractive surgery, specialized in small incision cataract and laser refractive surgeries. Dr. Furlong
continues to teach others about the latest vision surgery advances by offering regular continuing education courses to other medical professionals in
the Bay Area.
www.furlongvision.com
is a fellowship trained specialist in corneal and refractive surgery. Dr.
Mandel teaches and lectures throughout the U.S. and abroad to eye surgeons on different aspects of cataract, corneal, and refractive surgery. He
also teaches at the University of California, Berkeley, UCSF, and at the
California Pacific Medical Center in San Francisco. www.optimaeye.com
•
•
Is a fellowship trained corneal specialist and an Assistant Clinical Professor
at U.C. Berkeley and at the Ca. Pacific Medical Center in San Francisco. He
has authored numerous research and clinical articles and is board certified
by both the Am. Board of Ophthalmology and by the Am. Board of Internal
Medicine.
www.pacificeyespecialists.com
Stephen Turner, M.D.
San Jose / Bay Area
Is a LASIK and refractive surgery specialist. Dr. Turner is currently an Assistant Clinical Professor of ophthalmology at the University of Ca. Medical
Center in San Francisco. He is a Board Certified Ophthalmologist and a
trained fellow at the Am. College of Surgeons. Dr. Turner lectures extensively throughout the Bay area.
www.turnereye.com
Stephen Wilmarth, M.D.
•
Sacramento
is Board Certified by the Am. Board of Ophthalmology and is a Fellow of
the Am. Academy of Ophthalmology. He serves as an Expert Reviewer for
the Medical Board of California. Dr. Wilmarth performs state-of-the-art
refractive surgery and small incision cataract removal with intraocular lens
implantation and oculoplastic surgery.
www.wilmartheye.com
•
tapes and brochures. The COLA
marketing department, your surgeon's office, and device and lens
manufacturers can provide in-office
displays and promotional materials.
These items are also available from
companies that sell practice promotional materials, such as Patient Education Concepts.
Place these point-of-purchase displays in your office waiting room,
contact lens training area and exam
lanes. Whenever possible, these
items should promote your qualifications as well as your surgeon’s.
Staff interactions. When patients
make appointments, have your staff
ask, "Is this for glasses, contact
lenses or Laser Vision Correction?"
Doing so proactively announces that
you provide full-scope refractive
care.
Train your staff to handle LASIK and
implant inquiries and consider designating a surgery coordinator. Often
times, your surgeon's office or the
laser or lens manufacturer will have
available staff-training materials and
workshops.
On-hold phone message. It's never
ideal to put someone on hold, but it
happens in busy practices. Take
advantage of such time with an educational on-hold phone message that
explains your LASIK and implant comanagement services to your pa-
COLA SOUTHERN CALIFORNIA SURGEON PANEL
To learn more about our distinguished panel of surgeons and view their complete C.V.s,
please visit the listed center websites, or visit www.colainc.com
Carl Hartman, M.D.,
Orange Co. / Long Beach
is a Diplomate of the Am. Board of Ophthalmology, a Fellow of the Am.
College of Surgeons, and a Full Clinical Professor of Ophthalmology at
the University of California. He is certified in all types of refractive care,
from IntraLasik to the newest wavefront technologies and advanced
surface ablation.
www.longbeachlaser.com.
John A. Hovanesian, M.D.
Orange Co.
Is a specialist in refractive surgery, cataracts, cornea and external disease.
He is an assistant professor at the Jules Stein Eye Institute and teaches
surgical technique to hundreds of doctors. He has published numerous
research studies and has lectured internationally on refractive surgery,
optics, and corneal disease.
www.harvardeye.com.
Michael Gordon, M.D.
San Diego
was the first surgeon in the U.S. to use the Summit excimer laser to correct nearsightedness and has taught excimer laser techniques all over the
world. He is Fellowship trained in Corneal and External Diseases, Board
Certified by the Am. Board of Ophthalmology and a member of the Am.
Society for Cataract and Refractive Surgery.
www.gbwvision.com
Diana Kersten, M.D.
Orange Co.
David Wallace, M.D.
Los Angeles
specializes in laser vision correction and refractive procedures. Her ophthalmology training was completed at Harvard Medical School. She is a
fellow of the Am. College of Surgery and is board certified by the Am.
Board of Ophthalmology. Dr. Kersten has served as an associate professor at the Univ of California in Irvine.
www.harvardeye.com
is a board-certified ophthalmologist specializing in LASIK, PRK, and other
methods of vision correction. He is a Fellow of the Am. Academy of Ophthalmology and a member of the Am. Society of Cataract and Refractive
Surgery. He co-invented and developed three computer-based diagnostic
instruments used worldwide.
www.la-sight.com
Jack Weiss, M.D.
San Diego
specializes in corneal and refractive treatments. He performs topical anesthesia, small incision cataract surgery. He is experienced in LASIK, PRK,
Intracorneal Segments (INTACS), CK, and Advanced Lens Implant Technology. He is board certified and a fellow of the American Academy of
Ophthalmology.
www.gbwvision.com
New Website &
CONTEST!
tients.
• Web site. An increasing number of
optometric practices have Web sites
that allow patients to request appointments, download office forms, access
office hours and driving directions and
reorder contact lenses. This is another
excellent venue to provide information
about your co-management services.
Consider forming a mutual Web-link
between your practice and your surgeon's office.
• Testimonials. Written testimonials
from your LASIK patients are powerful. With your patients' permission,
display them in your office. Frame
them on the wall or collect them in a
binder for the waiting room. You can
also share excerpts of testimonials in
office newsletters or on your Web
site.
• Direct mailings. Most optometric practices send patients recall letters and
newsletters (either in print or in electronic form). These are opportune
vehicles for providing information
about LASIK and implant technology.
Some patients can enroll in a flexible
spending account (FSA) through their
employers. A direct mailing reminding
patients to enroll can serve as the "call
to action" to have LASIK. These accounts allow patients to allocate pretax dollars to have the procedure. FSA
enrollment periods vary according to
employer, but they typically end in
November or December.
• "Meet the surgeon" seminars. Conduct LASIK seminars so your patients can informally meet your
refractive surgeon. You can tie the
seminar in with a trunk show for
sunglasses or viewing a LASIK procedure.
w w w. c o l a i n c . c o m
Enter to Win!
•
Patient Information & Financing
1.
2.
•
Member Section with Fee Schedules and Form Downloads
•
News and Continuing Education Events (Register Online)
3.
Vist w w w . c o l a i n c . c o m
Under “Contact Us” send us your current e-mail
address for news and notification of upcoming events
You’ll be entered to win one of many prizes including a new ipod!
Winter, 2008
Page 5
The Acrysof Toric IOL: The New Standard for Correcting Astigmatism at the Time of Cataract Surgery
by Bart Carey, M.D.
Until recently, astigmatism was corrected
at the time of cataract surgery by placing
limbal relaxing incisions (LRI’s) along the
steep cylinder axis. Though a simple
procedure, the predictability of LRI’s is
poor, dependent upon factors such as
corneal thickness, incision placement,
wound healing, and the accuracy of the
surgeon’s nomogram.
The Alcon Acrysof IOL is the most popular lens platform for patients worldwide.
The AcrySof Toric IOL adds astigmatic
correction to the posterior lens surface,
offering precise astigmatic correction by
offsetting corneal astigmatism, independent of variables such as corneal wound
healing.
The AcrySof Toric IOL is currently available in three astigmatic powers, correcting the following amount of cylinder at
the corneal plane: SN60T3 = 1.03D,
SN60T4 = 1.55D and SN60T5 = 2.06D.
Greater amounts of cylinder may be corrected by adding LRI’s at the time of surgery or performing laser vision correction
postoperatively. Higher power toric lens
models will be available next year.
and placement is performed using the
Alcon Toric IOL Calculator, available online at www.acrysoftoriccalculator.com.
Once the desired spherical equivalent
IOL power has been chosen, keratometric data is input to determine toric IOL
model and axis placement, also taking
into account any surgically-induced astigmatism. When placing the toric IOL (or
any other IOL), it is advantageous to
minimize incision size and induced astigmatism. In our practice, for some time,
we have performed micro co-axial phaco
through a 2.2 mm incision, with foldable
Determination of proper toric IOL model
(Continued on page 6)
IntraLase Enabled Anterior Lamellar Keratoplasty - A Case Study
Corneal Transplant Surgery
was first performed in 1906,
however; it has only been in
the past 5-10 years that selective transplants have advanced
with consideration of the diseased segment of the cornea.
In the past there has been difficulty in properly diagnosing and
measuring segments of the
cornea and difficulty in implementing treatment to these
measurements.
Visante Anterior Segment Optical Coherence Tomography
(Carl Zeiss Meditec, Dublin,
CA) has revolutionized our
ability to evaluate the Anterior
Segment. It allows for precise
measurements. IntraLase Femtosecond Laser (Advanced
Medical Optics, Irvine, CA) has
revolutionized microscopic
ophthalmic surgery with giving
surgeons the capacity to plan
exact incision planes. This new
surgical "knife" gives a level of
precision never experienced in
the past.
Combining the diagnostics of
the Visante OCT and the IntraLase FS Laser creates a powerful combination that has only
been dreamt about in the past.
The following case presentation
is one to demonstrate the marriage of refractive surgery with
classic corneal surgery.
Case Presentation
19 year old patient with history
of contact lens ulcer 2 months
previously developed a dense
central corneal scar (Photo 1).
The scar reduced the vision to
counting finger vision in this
eye. The most common surgical option considered for this
patient would be a full thickness corneal transplant surgery
or possibly a deep anterior
lamellar keratoplasty.
On the High Resolution Visante
OCT image its depth is measured to be 270 microns, (Photo
2).
The patient underwent IntraLase Enabled Anterior Lamellar Keratoplasty by removing the anterior 270 microns
and replacing it with clear donor tissue, cut to same exact
size. The post operative
change can be easily noted in
the Visante image taken only 10
days after the IntraLase Lamellar Keratoplasty. The patient’s
vision has improved to 20/50
from counting figure preoperatively.
The clinical recovery was very
rapid, similar to LASIK eye
surgery, and the new corneal
transplant was placed without
any sutures.
This case presentation proves
the power of Visante
and the IntraLase that
was able to bring this
advanced therapy to
this patient. The patient is able to keep his
own endothelial layer
and therefore virtually
eliminating the possibility of corneal transplant
rejection. Patient
avoided a 1 year recovery period required for
full corneal transplant
or even Deep Anterior
Lamellar Keratoplasty.
Even at 10 days postoperatively with an
incompletely healed
epithelium, this patient
was 20/50 uncorrected
and back to work with
greatly improved vision.
At the 3 ½ month
post-operative visit he
was noted to have a
refraction of 6.00+2.00x090 in the
right eye (unaffected
eye) à 20/20 and an
UCVA of 20/50 in the
left eye (surgical eye)
and with a refraction
of -1.25+1.00x104 .
by Amin Ash, MD
Pre Op
Post Op
Amin Ashrafzadeh, MD (Dr. Ash) is the first surgeon in Northern
California to perform the IntraLase Enabled Keratoplasty surgeries at
Northern California Laser Center, Modesto, California.
PRSRT
First-Class Mail
U.S. Postage
PAID
Permit No. 1633
San Bernardino, CA
Setting the Standard in Refractive Surgery Management
CALIFORNIA
OPTOMETRIC LASER
ASSOCIATES
A Co-Management company
for optometrists, by
optometrists.
COLA, Inc. resources have allowed the development of robust comanagement systems that provide efficient communications between the
surgeon and the O.D. In addition, COLA helps to ensure high quality
by credentialing each surgeon, center and co-manager.
303 West Joaquin Ave, Suite 250
San Leandro, California 94577
Phone: 877.414.COLA
So. Cal: 949.462.0888
E-mail: [email protected]
We’re On the Web!
www.colainc.com
Upcoming Events
January (TBD):
Orange County:
PML - “Presbyopic Multifolcal
LASIK” - Michael Gordon,
M.D. and Jack Weiss, M.D.
Tuesday, March 10:
Los Alamitos:
“Solving Your Patients’ Vision
and Cosmetic Complaints.” Carl T. Hartman, M.D.
Feb / March—TBD
San Jose:
“Post RK and Refractive
Procedures” - Mark Mandel,
M.D. , Stephen Turner, M.D.,
Nicholas Batra, M.D.
To Register, go to
www.colainc.com, call
949.462.0888 or email
[email protected]
The Acrysof Toric IOL cont.
IOL placement through the
same micro incision.
The Alcon Acrysof IOL has
many advantages, some particularly suited to the rotational
stability needed for predictable
toric correction. The hydrophobic acrylic material is flexible, biocompatible, and bioadhesive. Stableforce haptics
ensure centration. As a result
eyes with an Acrysof lens tend
to have minimal postoperative
inflammation, but maximal lens
rotational stability and optimal
lens centration in the capsular
bag. FDA studies of the Acrysof Toric IOL have shown average rotational deviation from
the intended axis of less than 4
degrees.
Initially during surgery, the
toric IOL is rotated to a position approximately 15 degrees
shy of final desired axis. Then
at the time of viscoelastic removal the lens is nudged to
final position based upon preoperative corneal markings.
This lens stays where it is
placed (though perhaps more
good news is that any rotational errors may be cured by
easy rotation of the IOL in the
capsular bag back to desired to
position).
Implantation of the Acrysof
Toric IOL is the most predictable way to correct astigmatism at the time of cataract
surgery, and may be the lens of
choice for patients with as little
as 0.75D or more of preexisting corneal astigmatism
(depending on axis). In our
practice, it has replaced LRI’s as
the preferred method of astigmatism correction for our
cataract patients. The highest
level of success is dependent
on several factors including
precise determination of IOL
power and cornel astigmatism,
predictable micro-incisional
phacoemsulficiation, and pre-
cise rotational IOL placement.
Even more exciting will be the
addition of this technology to
the ReSTOR apodized diffractive multifocal IOL, adding the
option of complete spectacle
freedom for our astigmatic
patients.
In our next issue:
• Nutrition and Eye
Care – a medical journal update
• Reducing the Need for
LASIK Enhancement
by 65%