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EW Chicago 2012 11 What role does advanced technology play in your practice? tion formulas in order to get the best implant power. Our group is working with Lenstar and Alcon to incorporate the LENSTAR testing into such innova- tions as patient identification in the operating room. We're using the LENSTAR biometer to take a picture and identify sentinel vessels, iris markers such as nevi, and similar landmarks. The LENSTAR can use those phenomena to align the images in order to identify the patient's steep axis once the patient is in the OR. If there is cyclotorsion after a patient is in the reclining position, the LENSTAR biometer realigns the images so the surgeon can be assured of acting on the true astigmatic axis. In the future, I predict we'll be using biometers like the LENSTAR biometer in conjunction with phaco machines to ensure the bar code scanned into the phaco ma- chine matches what the LENSTAR biometer found as an appropriate lens. It'll act as another layer to ensure surgeons are implanting the proper lens power. The LenSx Laser We've been incredibly lucky to be among the first groups to incorpo- rate the LenSx Laser for refractive cataract surgery. In a study I pre- sented at the 2011 International Society of Refractive Surgery (ISRS) meeting, 1 I compared the femtosec- ond laser with manual capsulotomy in terms of effective lens position (ELP) and refractive outcomes. In the study, I looked at 26 patients who underwent surgery with manual capsulotomy and 22 patients who had surgery with femtosecond incisions (both groups implanted with the SN60WF lens [Alcon]). The two study groups were comparable in terms of demograph- ics and axial lengths, keratometry, and anterior chamber depth. We didn't perform any astigmatic limbal relaxing incisions; we were looking only at the spherical outcome. We found that 59% more of those in the femtosecond group reached 20/20 uncorrected vision. To further test the accuracy of the LenSx Laser over manual meth- ods, we implanted an additional 23 patients with the IQ ReSTOR IOL (Alcon) and 28 patients with the AcrySof IQ Toric IOL (Alcon). In the IQ ReSTOR IOL group, 12 under- went capsulotomy with the LenSx Laser and 11 via manual procedures. The toric group was split equally. In all cases, the accuracy to within 0.25 D of the target was significantly bet- ter with the LenSx Laser. In my hands, the worst outcomes were in the toric group with manual meth- ods, where 21% were within 0.25 D. At 1 month post-op, 100% of the patients implanted with the IQ ReSTOR IOL/LenSx Laser had 20/25 or better, compared to 36% with the manual procedure. Likewise, 82% of the SN60WF/LenSx Laser and 71% of the AcrySof IQ Toric IOL/LenSx Laser patients reached 20/25 or better at month 1 post-op compared to 54% and 36%, respectively, in the manual keratometry group. Advanced technologies, predictable results As the cataract surgery market con- tinues to grow, new technologies are being developed to meet this need. Devices such as the LENSTAR optical biometer, the LenSx Laser, and the Wavetec ORA (WaveTec Vision, Aliso Viejo, Calif.)—as well as the advanced implants and phaco machines we already have—enable us to confidently tell patients that they are more likely to end up with the results they are demanding we provide. Reference 1. Cionni, R. et al. Comparison of Effective Lens Position and Refractive Outcome: Femtosecond Laser vs. Manual Capsulotomy. Presented at the 2011 International Society of Refractive Surgery meeting (American Academy of Ophthalmology). Oct. 21-22, Orlando, Fla. Dr. Cionni is medical director, The Eye Institute of Utah, Salt Lake City. Contact information Cionni: rcionni@theeyeinstitute.com Lenstar is a registered trademark of Haag-Streit. Dublin, Calif.) to do. While they both provide good axial length readings, the LENSTAR biometer will take a little longer to produce those simply because it's taking so many more readings and providing more information. In my opinion, the LENSTAR biometer provides the most reliable keratometry readings, which include accurate axis and magnitude of corneal cylinder. In the past, we relied on a topographer to determine the axis and on manual keratometry read- ings for the magnitude. Now, we can rely on the LENSTAR instrument to give us not only the axial length, but also keratometry and lens thick- ness, and then input that data into the LenSx Laser (Alcon, Fort Worth, Texas). The lens thickness reading is also important in the newer genera- Alcon Sunday supplement_Chicago2012-12pages_Layout 1 4/20/12 4:51 PM Page 11

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