instrument insider
The Wallace LRI Set (Duckworth & Kent)
Reviewed by Kevin L. Waltz, O.D., M.D.

The Wallace LRI (limbal relaxing incision) set from Duckworth & Kent consists of three tough and reliable tools: a diamond knife, a modified Mendez marker and a 0.12-mm toothed colibri forceps. We've used three of the Wallace LRI sets in our ASC for 2 years without a single incident of breakage, and we've been very satisfied with patient outcomes. (We recently purchased an additional set to use at one of the local hospitals.)

Both the forceps and the marker (which has no moving parts) are made of titanium.

Everyone Benefits

Ironically, limbal relaxing incisions are probably the most underutilized procedure in ophthalmology. Yet the reasons for offering them to your patients are substantial:

• Limbal relaxing incisions significantly enhance the refractive outcome of cataract surgery. They can safely and predictably reduce the postoperative astigmatism of most patients to less than 1 diopter -- often less than 0.5 diopter. Most of us go to great effort and expense to obtain the best possible biometry for every patient, including using the best IOL calculation formulas available. When you work this hard to get the best outcome, it makes no sense to leave the patient with more than 1 diopter of astigmatism.
  Remember: Nothing increases your surgical volume like great word-of-mouth referrals.
• Your practice can benefit economically. Most third-party payers, including Medicare, don't cover this procedure. That means the patient pays you directly for the procedure at a mutually agreeable price.
• Limbal relaxing incisions are cost-effective. In our practice, the cost of one Wallace LRI set is recouped after performing only four LRI procedures. Put another way, a Wallace LRI set costs less than a quarter page advertisement in the local newspaper.

A Case in Point

Here's an example of the results we typically achieve using this LRI set:

A patient presented for cataract surgery with a manifest refraction of -6.75 + 3.75 x 090 OD and -7.00 + 4.00 x 090 OS; the cylinder was almost entirely located in the cornea. During the uneventful cataract procedure I made paired 80°-arc limbal relaxing incisions at the vertical meridian.

At the initial postoperative visit the patient was 20/25 without correction in both eyes. The patient and the family were thrilled with the results and have since referred several other family members to us for surgery.

The Wallace LRI diamond knife

The Wallace LRI 0.12-mm toothed colibri forceps

The Wallace LRI modified Mendez marker

Kevin L. Waltz, O.D., M.D., practices at Eye Surgeons of Indiana in Indianapolis. Dr. Waltz is also assistant professor at the Indiana University School of Optometry and medical director at TLC Indiana.