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A t the ASCRS•ASOA Symposium & Congress, John Vukich, MD, co-moderated "The Management of Astigma- tism" symposium and opened the program with a presentation on data based on the 2013 ASCRS Clinical Survey. This survey represents 1,041 unique ASCRS members, focusing on the most compelling and controver- sial issues facing the membership. A key section of this survey was based on astigmatism management. Different categories of astigmatism were addressed including the following: • Femtosecond vs. manual arcuate incisions • Acceptable residual cylinder levels with multifocal IOLs • Toric IOLs and related power and axis issues • Overall case management of astigmatic patients Dr. Vukich used the data from this large study to address current practice behaviors for the membership and discuss educational gaps and opportunities for future ASCRS programs. When asked where laser-assisted cataract surgery may provide a significant clinical benefit versus conventional cataract surgery, 57% of respondents believed there were significant clinical benefits for fem- tosecond arcuates over manual inci- sions. Interestingly, this number was much higher for U.S. surgeons, with nearly 70% believing that a fem- tosecond arcuate may be clinically superior to a manual incision. Approximately 55% of the ASCRS membership saw benefits with capsulorhexis creation. Dr. Vukich discussed a hot topic for the management of multifocal IOL patients as well: the average ac- ceptable postop residual error and how it affects visual quality or satis- faction. The respondents reported that 0.71 D was the average accept- able postop cylinder error after implantation before they believed there was a statistically significant reduction in visual quality or patient satisfaction. When looking at the data in another manner, 45% of the membership indicated that 0.75 D or more cylinder was acceptable for these patients. Acceptable residual sphere was slightly lower, with an average acceptable postop error of 0.61 D before it impacts visual quality or satisfaction for multifocal patients, and 35% indicating that 0.75 D or more was acceptable. When asked how they manage significant postoperative astigma- tism levels in multifocal levels, only 52% of the survey respondents stated that they use an excimer laser to address this refractive error. In fact, 32% of the ASCRS member respondents reported never performing a laser vision correction enhancement on a multifocal IOL patient due to residual refractive error. Toric IOLs averaged 19% of all cataract procedures, however this number was lower in the U.S. at 15%. Survey data showed that ASCRS members believe on average that 7.2 degrees of postoperative rotational error from the intended axis is acceptable before it starts to affect visual quality and acuity in toric IOL patients. Surprisingly, 33% of respondents stated that 10 degrees or more of postoperative rotational error is acceptable. There was a 50/50 split of opinion when it came to flipping the axis with toric IOLs: half of the population aims for the lowest amount of residual astigmatism, even if it means flipping the axis. The other half of survey respondents believe in never flipping the axis, but aiming for the lower residual astigmatism in the same axis. Dr. Vukich discussed ASCRS members' preferences for diagnos- tics. There is no consensus "go to" machine for toric IOL astigmatism power decisions. Overall the by John Vukich, MD Management of astigmatism symposium addressing ASCRS membership practice patterns John Vukich, MD 14 There is a 50/50 split of membership beliefs when it comes to flipping the axis or aiming for lower residual astigmatism levels with toric IOLs. IOLMaster (Carl Zeiss Meditec, Jena, Germany) was the most commonly used device, however topography and manual keratometry were also common choices. This is similar when it comes to toric IOL astigma- tism axis decisions, with topography diagnostic devices appearing the rough preference, with the IOLMaster and manual Ks also being used. However, no single category of diagnostics was used by more than 40% of respondents for driving power or axis decisions. When presented with a case study of a 25-year-old low to moder- ate myope with 2.5 D of astigma- tism, the membership showed high confidence in laser vision correction as the procedure of choice, with 92% selecting this treatment. How- ever, when presented with a cataract patient with 1.25 D of astigmatism, the membership was much more conservative, with only 50% choosing a toric IOL. Overall, Dr. Vukich was excited about sharing these key practice patterns and educational gaps. The data from the 2013 ASCRS membership survey was used to drive some of the ASCRS program- ming at this year's meeting and provided the foundation for several CME education symposiums, based on topics such as astigmatism management. The 2014 survey took place at this year's annual meeting, and an EyeWorld supplement will be published this fall with a summary of the key findings. May 2014 "When asked where laser- assisted cataract surgery may provide a significant clinical benefit versus conventional cataract surgery, 57% of respondents believed there were significant clinical benefits for femtosecond arcuates over manual incisions."

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