Highlights from Hawaiian Eye 2011: Cataract/IOL Advances

The Cataract/IOL symposium entitled "Advances in Techniques and Technology to Advance Patient Outcomes" featured a line-up of international surgeons who discussed a wide range of topics. Here are some of the highlights from the session:

Premium IOLs: There were a number of talks devoted to current and future IOL technology.

• Drs. Mark Packer and Frank Bucci Jr. reviewed their personal experiences with various premium IOLs for RLE and cataract surgery. The Tecnis multifocal lens was the preferred IOL in studies by both these surgeons.
• Dr. David Hardten addressed the importance of aggressively diagnosing dry eye and blepharitis and optimizing the ocular surface prior to surgery in order to achieve superior outcomes.
• Dr. Michael Knorz shared his experience with the Synchrony dual optic IOL, which is available outside the United States. The main limitations of the existing version of this lens are the larger incision size necessary for implantation (3.8 mm) and the time for refractive stabilization in the postoperative period (patients are initially myopic).
• Dr. John Hovanesian discussed current and future presbyopia correcting IOL designs. Some of the more interesting approaches include the FlexOptic lens, FluidVision lens, and NuLens. Additional talks dealt with unhappy postoperative patients.
• Dr. David Chang showed how the iTrace wavefront aberrometry system is helpful for determining the etiology (lens vs. cornea) of patient symptoms. He demonstrated how multifocal IOL tilt or decentration can cause significant complaints.
• Dr. Jeffrey Horn presented his experience with the Revital Vision system for neural vision training. In this pilot study, there was an improvement in visual acuity, contrast sensitivity, and reported quality of vision for up to 6 months after the training sessions.

Surgical instruments and techniques:

• Dr. Randall Olson presented preliminary data on a micro-camera that can be used as an aid in ophthalmic surgery. This 0.5 mm flexible fiber optic video camera can be inserted through an incision smaller than 1 mm and allows visualization of structures that cannot be seen directly. Surgical instruments attached at the tip of this device may include a scalpel, needle holder, tiers, scissors, irrigator, and cautery.
• Dr. Uday Devgan shared his pearls for facilitating IOL exchange and iris suturing. Once the existing IOL is moved from the capsular bag into the anterior chamber, he recommends inserting the new IOL underneath it to protect the posterior capsule when the old IOL is cut and explanted. He also suggests pulling the iris centrally prior to locking the McCannel suture knots to prevent an oval pupil when suturing a sulcus lens to the iris. Dr. Roger Steinert also discussed iris fixation of a sulcus IOL and prefers initiating the suture pass from the concave side of the haptic because this facilitates a small peripheral needle bite.
• Dr. Eric Donnenfeld showed how the ORange intraoperative aberrometer has improved his cataract surgical refractive outcomes not only in patients with astigmatism but also those who have had prior LASIK surgery. The device is able to capture the aphakic refraction and calculate the necessary IOL power at the time of surgery.
• Dr. Sonia Yoo reviewed various methods for managing small pupils and IFIS. These include pharmacologic and manual with various stretching devices, hooks, and rings to dilate and stabilize the iris.

Cataract and glaucoma:

• Dr. Richard Lindstrom showed significant data supporting the finding that cataract surgery alone can lower IOP in patients with glaucoma or ocular hypertension. A number of other surgeons then discussed various techniques and devices that can be used in the surgical treatment of glaucoma.

Visual function and distortions:

• Drs. Jack Holladay and Helen Wu discussed the etiology and treatment of negative and positive dysphotopsias, a common symptom of IOLs. Although inserting a piggyback lens or resorting to IOL exchange can improve the situation, these secondary procedures do not always resolve the dysphotopsia.
• Dr. John Wittpenn shared his observations on IOL glistenings. He explained their etiology and how they may affect vision in certain patients. The concern is whether this will be a clinically significant issue in the future since so many of these lenses are being implanted.

MRSA:

• Dr. James McCulley discussed the increasing prevalence of MRSA infections, particularly the community acquired type. He reviewed the characteristics, epidemiology, and strategies to combat this disturbing trend.