Uday Devgan MD Los Angeles You can download

Uday Devgan MD Los Angeles You can download my slides for free at www. Uday. Devgan. com 1

Uday Devgan MD disclosures • • • • • Abbott Medical Optics: consultant, research Accutome Inc: speaker Alcon Laboratories: stockholder Allergan: consultant, speaker, research funding Bausch & Lomb: consultant, research funding Gerson Lehman Group: consultant Haag-Streit: speaker Hoya Surgical Optics: consultant, speaker Inspire Pharma: stockholder (former), consultant Ista Pharma: consultant, speaker, stockholder i. Therapeutix: research funding, travel support Optos Inc: speaker Renaissance Surgical: stockholder Sirion Therapeutics: consultant Specialty Surgical: stockholder Staar Surgical: consultant (former) Zeiss / Carl Zeiss Meditec: speaker This presentation represents the speaker’s professional experience. 2

Astigmatism Must Be Addressed 3

Question #1 How close do I have to be for excellent visual results with the Crystalens? 1. plano +/- 0. 50 D < 0. 50 D cyl 2. plano +/- 1. 00 D < 1. 00 D cyl 3. my patients have such dense cataracts they are happy even if I leave them aphakic. 4

Confirmed with Surgi. Vision Data 5

Binocular: 20/20 dist, 20/18 int, 20/25 near if there is minimal cylinder 6

Perfect Plano Quick, where’s my camera? 7

1 D Residual Astigmatism (Far) 8

1 D Residual Astigmatism (Near) 9

Nailing +/- 0. 50 D for Both Sphere and Cylinder Is Important 10

Sphere 11

Effective Lens Position is Critical The A-constant assumes a proper posterior vault of the Crystalens 12

Incisions Must be 100% Sealed 13

Cylinder 14

The Difference Between Sad & Happy • +1. 00 – 2. 00 x 090 • SE = Plano • +0. 25 – 0. 50 x 090 • SE = Plano 15

Is the AO More Forgiving than the HD? -0. 50 cyl 0 +0. 50 cyl Crystalens HD Crystalens AO 16

Measure & Treat the Astigmatism 17

Question #2 How do you determine the amount of pre-op astigmatism that needs to be fixed? 1. 2. 3. 4. IOL Master / Lenstar corneal topography manual keratometry manifest refraction 18

Pre-Op Corneal Cylinder Ignore the refraction cylinder Look at the Corneal cylinder 19

Topography to Check Symmetry 20

Weed-out Inappropriate Patients 21

Address the Astigmatism • Topography • Effect of your incisions? • LRI: Limbal Relaxing Incisions 22

What’s the effect of your incision? 5 43. 7 5 2. 44 Pre-op K: 44. 50 x 030 43. 50 x 120 Most clear K incisions = Flattening of about 0. 50 D 23

LRIs can reduce/eliminate K cyl BEFORE AFTER 24 Thank you to Kevin Miller MD for this slide.

Factor in your Phaco Incision: Figure 1 © 2009 Uday Devgan MD 25

0 8 1 x 5 2. 44 0 9 x 5 7. 4 4 BEFORE SURGERY © 2009 Uday Devgan MD 26

0 8 1 x 0 0. 44 0 9 x 0 0. 5 4 AFTER PHACO INCISION (0. 5 D of flattening at 180) © 2009 Uday Devgan MD 27

0 8 1 x 0 5. 44 0 9 x 0 5. 4 4 WITH LRI DONE FOR 1 DIOPTER AT 90 © 2009 Uday Devgan MD 28

LRIs are placed in the peripheral clear cornea by tracing along the fixation ring. 29 © 2009 Uday Devgan MD

Post-Op Astigmatism 30

Question #3 What are the causes of post-op astigmatism? 1. 2. 3. irregular ocular surface residual corneal astigmatism IOL tilt or shift from capsular bag contraction / fibrosis 4. all of the above 31

Irregular Corneas (uncommon) 32

Residual Refraction (common) Not Enough Effect From Your LRI 33

Capsule Issues Causing IOL Shift 34

Small Rhexis / Phimosis Hyperopic Shift and Induced Cylinder 35

Posterior Capsule Fibrotic Bands Myopic Shift and Induced Cylinder 36

After YAG of Capsular Striae 37

Poor Rhexis = Poor Result • All 4 footplates must be at the capsular bag equator • One arm in the sulcus will cause IOL tilt 38

If you remember just ONE thing… 39

NAIL PLANO Sphere & Cylinder within 0. 50 D of plano 40