Cornea Society News

SUM 2014

Cornea Society International Organization Advancing the treatment of corneal disease

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T he 2014 Cornea Day program featured presentations on topics ranging from advances in cataract surgery for the corneal surgeon, to the benefits of using viscosurgical devices and staining materials for better visualization. Calculating nomograms with femto lasers With 50% of all patients presenting for cataract surgery having "at least 0.75 D of astigmatism," choosing how to cor- rect that astigmatism is becoming more of an issue, said Kendall Donaldson, MD, Miami. Studies have shown that for astigmatism levels of 2.25 D or higher, toric IOLs are preferred, but at lower levels there's not much statistical difference in outcomes between toric and limbal relaxing incisions (LRIs). "We know from the Nichamin nomograms that we need to treat with-the-rule astigmatism differently from against-the-rule," she said. Although there are no published nomograms when using the femtosecond laser, "if you're using the Donnenfeld or Nichamin nomograms, subtract about 33% from your manual nomograms," she said. Some tips for success when using the femtosecond laser: patient selec- tion, managing patient expectations, and "select and personalize your nomo- gram with continual outcome analysis." Dry eye and LASIK compatibility The etiology of dry eye is "not perfectly clear," and the neurotoxicity of the excimer laser results in a cyclical process of "inflammatory dessication of the ocular surface," said Elizabeth Yeu, MD, Norfolk, Va. Several factors increase the risk of dry eye complica- tions/complaints in the postop LASIK patient, including low Schirmer's scores, preop contact lens wear, and ocular allergies, among others. "An older age and female gender may confer a greater risk," she said. Race may also play a role, as chronic dry eye after 6 months is seen more fre- quently in Asian eyes than in Caucasian eyes, she added. Postop dry eye will peak between 1 week and 3 months after LASIK, and will be "considerably worse" if preop dry eye exists, she said. She suggests tear film break-up time be more than 8 seconds and preop dry eye be mild before considering LASIK in these eyes. In general, she suggested treating preop dry eye medically first, then pro- cedurally, which may include thermal pulsation or chalasis cauterization. "If dry eye does not resolve, these patients will be poor candidates for LASIK," he said. Include posterior corneal measurements Douglas D. Koch, MD, Houston, stressed to attendees here that "if you measure only the anterior cornea," there will be over- and undercorrection, depending on which IOL is chosen and whether astigmatism is with-the-rule (WTR) or against-the-rule (ATR). If the Cornea Day topics range from nomograms to glaucoma Drs. Donaldson and Koch speak at the 2014 Cornea Day. News A C o r n e a S o c i e t y p u b l i c a t i o n S u m m e r 2 0 1 4 V o l 1 0 , N o . 3 continued on page 3 by Michelle Dalton, contributing writer CorneaNews_Summer 2014-dl_CorneaNews 6/24/14 9:57 AM Page 1

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