They typically will think that you “caused” the problem, even though it was pre-existing.ĭr. He added that “macular OCT has saved me so many times in picking up ERMs or macular holes that it must be done on every patient.” The last thing you want is to do a perfect surgery and the patient is unhappy because they can’t see, he said. “The days of A-scans and manual Ks are over and are below the standard,” he said. Walter said biometry is the standard of care and absolutely needs to be done. He added that he thinks that all of these technologies are “absolutely necessary, unless you have a patient with low cylinder, a great ocular surface, and no history of LASIK then maybe you could skip the topography and just use the biometry to guide you,” he said. “Corneal topography is also important especially with prior LASIK and to rule out bad ocular surfaces or other cornea disorders,” he said. Walter will use macular OCT to look for any potential problems that might render the patient a non-candidate for a premium lens. “I only use the Barrett formulas, as they are the most accurate,” he added.ĭr. Walter said that he always uses the IOLMaster or LENSTAR (Haag-Streit) to get accurate measurements and calculations. This device will also offer objective data on dry eye.ĭr. Williamson will sometimes use the HD Analyzer preoperatively in less dense cataracts, which he said will give him an idea of the ocular scatter index when symptoms and complaints seem to outweigh the clinical exam. He also likes to get an OCT of the macula on every patient, regardless of what lens is being putting in.ĭr. “Everyone is going to get topography and tomography,” Dr. He also mentioned doing meibography on the Keratograph (Oculus) if the meibomian glands are a concern. He examines the ocular surface and may use point-of-care testing, such as the InflammaDry (Quidel) and TearLab Osmolarity Test (TearLab). He said the physician has to make sure they have all the testing in place to confirm it’s a pristine eye because these implants are very sensitive to any type of comorbidity or aberration. Williamson stressed the importance of having a healthy eye for advanced IOLs. She described it as a useful tool that moves everything from the EHR to the VERACITY system.ĭr. She added that VERACITY is helpful for post-refractive cases, as it has a built-in calculator for that. Nikpoor said she uses VERACITY (Carl Zeiss Meditec) for all IOL calculations to help with IOL selection and finds it particularly useful for toric lenses because she can toggle between different measurements, toric calculators, and other data. Nikpoor said measurements used for the IOL calculation-topography, aberrometry, and IOLMaster-are repeated so there are two sets.Īll of this information is consolidated into a grid with the astigmatism measurements.ĭr. She will add in more treatments as needed, including LipiFlow (Johnson & Johnson Vision) and/or pharmaceutical dry eye treatments.ĭr. Additionally, for cataract patients getting premium lenses, she performs a standard OSD optimization protocol that includes warm compresses, lid scrubs, and artificial tears. Nikpoor said, is used for all cataract patients, even those getting standard IOLs. “We don’t use it on everyone, but we’ll use it if someone is post-refractive or if we think they have OSD or early keratoconus,” Dr. She will also obtain a LipiScan (Johnson & Johnson Vision) on every patient and likes to use epithelial mapping. She noted that having a high-quality biometer is helpful for measuring posterior astigmatism she uses the IOLMaster 700 (Carl Zeiss Meditec). “Comparing this index with the iTrace Dysfunctional Lens Index helps me grade the impact of very early lens changes,” she said. She will also use the HD Analyzer (Keeler) on every patient, which she said helps by giving an objective assessment of the tear film. This includes a preoperative macular OCT, topography, RNFL analysis, and aberrometry.

Nikpoor said that every patient who comes into her office for a refractive lens exchange (RLE) or cataract evaluation gets the same testing. Source: Neda Nikpoor, MD Preoperative technologies and testingĭr. RLE in an RK patient with +5 D hyperopia placed Light Adjustable Lens (RxSight) OU Neda Nikpoor, MD, Keith Walter, MD, and Blake Williamson, MD, discussed some of the technologies that they use preoperatively, intraoperatively, and postoperatively to help achieve excellent outcomes. When it comes to premium lenses, patients have high expectations for great outcomes.

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