OCTOBER 2020 | SUPPLEMENT TO EYEWORLD | 9
Platinum sponsors: Allergan, Kala Pharmaceuticals, Novartis, and Sight Sciences
Bronze sponsors: Eyevance and Johnson & Johnson Vision
Reversing a toric decision
One patient Dr. Beckman saw for a toric evaluation
had 3 D of irregular astigmatism. Looking at the
location of the astigmatism and the mires on Placido
imaging, Dr. Beckman knew something else was afoot.
"When I did my dry eye workup, I noted he had a rapid
tear breakup time, staining, lid margins were a mess,"
he said. After 2 weeks treating the dry eye, the patient's
vision was so much better that he didn't need a toric
IOL. His astigmatism was actually 0.5 D. Though this
was before the algorithm was developed, Dr. Beckman
said it highlights the importance of knowing what
you're treating and eliminating other factors before you
jump into cataract surgery.
Topography and Placido imaging indicated 3 D of irregular astigmatism. The patient, however,
didn't have corneal astigmatism that merited a toric IOL, rather dry eye and blepharitis. Once
OSD was addressed, the irregular astigmatism decreased and mires became regular.
Source: Kenneth Beckman, MD
Keratoconus?
Though not a cataract surgery evaluation, Dr.
Beckman also described a patient he saw for
keratoconus and crosslinking consultation. He observed
irregular cones on topography and determined it was
due to the tear film. After treating the dry eye, the
topography normalized and the patient didn't even
have keratoconus. "This is a great example of how
the tear film may affect corneal measurements for
any surgery and needs to be optimized before moving
forward," he said.
Top: A patient referred for keratoconus evaluation showed irregular topographies of the right
and left eye. Bottom: The patient was diagnosed with severe dry eye, which after treatment
resolved and revealed the patient did not have keratoconus.
Source: Kenneth Beckman, MD
