instrument insider
Terry/Schanzlin Astigmatome (Oasis Medical)

The second-generation Terry/Schanzlin Astigmatome can be used to significantly reduce regular astigmatism. The new model features the same superb metal blade technology as the previous version -- it delivers a clean, crisp cut -- but the new version incorporates a modified suction speculum to ensure fixation and prevent eccentric cuts.

The new model has an 8-mm optical zone and features a series of interchangeable cutting templates with pre-determined lengths of 30°, 45°, 60° and 90°, to ensure that cuts are accurate. The speculum attaches to a spring-loaded syringe via a thin, pliable tube.

I've used the Terry/Schanzlin Astigmatome for the past 2 months, and I've been pleased with the results. I use it three ways:

• to treat refractive astigmatism, allowing patients to switch from toric to spherical contact lenses, or to spectacle lenses with fewer optical aberrations
• to create limbal relaxing incisions for coexisting astigmatism during cataract surgery
• to correct surgically induced astigmatism from previous cataract surgery.

These procedures can be done in a doctor's office using a loop or operating microscope, and probably could be done at the slit lamp. (I perform the procedure in our ASC.)

Being able to offer this low-cost, high-benefit procedure has generated a whole new group of satisfied patients in our practice, as well as provided additional income to offset the current erosion of benefit reimbursement.

Edward D. Glinski, D.O., M.B.A., is medical director and surgeon at Heritage Eye Associates, Surgicenter in Oklahoma City. He's been performing RK since 1985.

Nevyas Capsulorhexis Forceps (Katena Products)

Recently, I had the opportunity to try the Nevyas capsulorhexis forceps with the cystotome-shaped tips from Katena. To my pleasant surprise, I was able to use these forceps both as a capsulorhexis forceps and as a bent needle cystotome because the tips are quite sharp.

I've been doing capsulorhexis with a bent needle cystotome since 1990, as I always have a more exacting feel with the needle. My basic technique is to puncture the capsule paracentrally, slide the needle slightly to the right, pull towards me, fold the flap over itself and then gently move the flap in the desired direction. Often, I make a relaxing puncture centrally with the needle to help keep the capsulorhexis from being too small.

Obviously, the needle is required for this part of the process. How-ever, when performing temporal clear cornea surgery, especially around the 3:30 to 4:00 o'clock position for the right eye and the corresponding 9:30 to

Stanley M. Rous, M.D., performs cataract and refractive surgery at the Fort Lauderdale Eye Institute in Sunrise, Fla.