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BOOST YOUR REFRACTIVE AND CATARACT SURGERY PRACTICE RESCAN can be helpful in DMEK, DSEK, and lamellar keratoplasty cases, Dr. Singh finds it useful in glaucoma surgery. He said intraoperative OCT can show the canal opening in real time during canaloplasty procedures and it can show where the XEN Gel Stent (Allergan) is located between the tenons and subcon- junctiva. "I think we're taking OCT now from a glaucoma perspective to the next level," he said. One of the tools that Dr. Tyson finds helps with surgical efficiency is the miLOOP (Carl Zeiss Meditec). He said he has used the tool, which is composed of an expanding nitinol filament that goes around a cataract for manual, zero-ener- gy nuclear fragmentation, for thousands of cases. "Probably 70% of my cases I'm using miLOOP on. This is not being used just in those super dense cataracts," he said. Dr. Tyson described the device as "very capsular bag friendly" and zonular friendly because the cutting forces go inward, not outward. He said his practice studied nearly 300 eyes that had cataract surgery with the miLOOP, femtosecond la- ser fragmentation, or phaco only. He said there was a 36% reduction in effective phaco time in the miLOOP group. Dr. Tyson has found he's able to use the miLOOP with different types of cata- racts and different pupil sizes (even small pupils). "Even with poor zonule cases, I don't need to use any second instruments usually because it's already been pre-sec- tioned. I sit in the center of the eye with the phaco, and everything comes right to it," he said. "I don't need to go deep in the bag, so there's that safety factor where I'm working in a safe space." From a cost standpoint, Dr. Tyson said he's been able to do more cases with the miLOOP, so he thinks it's worth spend- ing a little extra money because it helps him get to the number of cases he needs to within an allotted time. "If I can add on an extra two or three premium lens cases, that more than makes up for the extra cost of me utiliz- ing the miLOOP," he said. Then there's reduced chair time in the postop period. "I was getting clearer corneas, less complications, happier referring doctors," he said. Dr. Chu said his practice has had a similar experience with miLOOP, finding it especially helpful with small pupil cases, while Dr. Yeu said that it's able to help with gummy lenses or thick lenses with a fibrous posterior capsule. "The value of what the miLOOP can do for your patient outcomes is quite incredible from an endothelial cell count perspective in particular," she said. As a glaucoma specialist with pseu- doexfoliation patients, Dr. Singh said he's found the miLOOP to be a safer option rather than cracking or chopping the cat- aract. He said he has a femtosecond laser but there are cases where femto won't fragment—dense or white cataracts—and this is where miLOOP can step in. There are a few situations where the miLOOP is not the ideal tool, and these include cases with capsule integrity con- cerns, small capsular complexes, or when the patient might have excessive head movement. With these technologies and more, Dr. Chu said Carl Zeiss Meditec is a source for innovation that is "helping improve our outcomes, grow our practic- es, and make patients happier around the world." Y. Ralph Chu, MD, practices at Chu Vision in Bloomington, Minnesota. He can be contacted at yrchu@chuvision.com. Lisa Nijm, MD, JD, practices at Warrenville EyeCare & LASIK in Warrenville, Illinois. She can be contacted at lnijm@ realworldophthalmology.com. Inder Paul Singh, MD, practices at The Eye Centers of Racine and Kenosha in Racine and Kenosha, Wisconsin. He can be con- tacted at ipsingh@amazingeye.com. Farrell "Toby" Tyson, MD, practices at Tyson Eye in Cape Coral, Florida. He can be contacted at tysonfc@hotmail.com. Elizabeth Yeu, MD, practices at Virginia Eye Consultants in Norfolk, Virginia. She can be contacted at eyeulin@gmail.com. The physicians have financial interests with Carl Zeiss Meditec. Copyright 2021 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed in this publication do not necessarily reflect those of the staff and leadership of EyeWorld and ASCRS, and in no way imply endorsement by EyeWorld and ASCRS. continued from page 7 "The value of what the miLOOP can do for your patient outcomes is quite incredible from an endothelial cell count perspective in particular." —Elizabeth Yeu, MD

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