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2 | SUPPLEMENT TO EYEWORLD DAILY NEWS, JULY 24, 2021 STEP FORWARD INTO THE NEXT GENERATION OF CATARACT SURGERY Biometer with Image Guidance streamlines workflow I n any relationship, communication is key to success, and Robert Melendez, MD, has found that this is true of the relationship between some of his diagnostic and surgical equipment. In 2020, Dr. Melendez brought the ARGOS ® Biometer with Image Guidance (Alcon) into his practice, seeking a "more robust biometer to better predict postoperative refractive outcomes." One of the main advantages he cited is its connectivity and integra- tion with his other devices, including the LenSx ® Femtosecond Laser System (Alcon). "The preoperative image is taken with the ARGOS ® Biometer and sent to the LenSx ® Laser for image verifi- cation," Dr. Melendez explained. "If I did not have the ARGOS ® Biometer, I would have to mark the eye manually to account for any cyclorotation. As we all know, we are trying to achieve the absolute most accurate postoperative refractive outcomes, and when the LenSx ® Laser is creating arcs to correct corneal astigmatism, the image quality and location of the arcs is paramount." In addition to integration with the LenSx ® Laser, 1 the data from the ARGOS ® Biometer can be used with rule astigmatism, I try to reduce it to 0–0.25 D, using arcs with the LenSx ® Laser and sometimes in combination when needed for significantly higher levels of astigmatism." Dr. Melendez discussed a specific case where a 20-year-old patient with a unilateral cataract preop was –8.75 +6.00 x 090 20/50 in his right eye. The ARGOS ® Biometer and IOLMaster 700* both recommended a 23.0 D T8 toric IOL. The ARGOS ® Biometer, however, suggested an additional corneal arc to achieve more correction of the patient's corneal astigmatism. Dr. Melendez per- formed FLACS with the LenSx ® Laser with the suggested corneal arcs based off of the ARGOS ® Biometer internal LRI nomogram and left the patient nearsighted given his younger age and to closely match his left eye. This patient's vision postop month 1 was –1.75 +0.50 x 107 20/25+2 in his operated eye. In addition to communication between devices and user-friendly plan- ning software, Dr. Melendez has found the ARGOS ® Biometer able to penetrate even very dense cataracts. "I had a case where the IOLMaster 700* could not penetrate a dense cataract for a measurement, whereas the ARGOS ® Biometer did quite easily with the new mode called enhanced retinal visualization (ERV), Robert Melendez, MD "As a refractive cataract surgeon trying to achieve excellent postoperative refractive outcomes, having seamless lines of technologies that accurately predict refractive outcomes … is critically important." —Robert Melendez, MD the Digital Marker Microscope 2 and the ORA System ® with AnalyzOR™ for intraoperative guidance and postop as- sessment, 3 all part of the Alcon Cataract Refractive Suite. When it came to bringing this new biometer with swept-source OCT into his practice, Dr. Melendez said he had some apprehension because he was so used to the IOLMaster 500* (Carl Zeiss Meditec). He has found the support for the ARGOS ® Biometer to be "superb" and said the surgical planning software built into the ARGOS ® Biometer is "very user friendly." It prompts the surgeon to select a monofocal IOL or multifocal/ trifocal option, standard or toric, arcs or no arcs. "With the click of a button you can select or deselect with or without arcs, and the ARGOS ® Biometer provides a predictive postoperative refractive out- come," Dr. Melendez said. "For exam- ple, when choosing a toric IOL, it will provide information as to when the axis will be flipped to choose a lower pow- ered toric IOL. You can also add arcs when a T3 IOL is too high and flip the axis. Arcs alone in these cases reduce the astigmatism to a significantly low level approaching 0.25 D of residual astigmatism. I try to keep the astigma- tism with the rule because it decreases with age, and I try to reduce it to about 0.25–0.50. In cases with against-the-

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