M.D. Toolkit

Top Three Tools I Use Right Now

Here's a list of my favorite technology for producing excellent results in cataract surgery.

By Johnny Gayton, M.D.

Inevitably, most physicians will find that many of the instruments and technology they rely on in clinic and in surgery are invaluable, but when put upon, every doctor has his or her short list of favorites. My favorite ophthalmic tools include the Infiniti Vision System (Alcon, Fort Worth, Texas), the AcrySof Toric IOL (Alcon) and the Mastel (Rapid City, S.D.) marking system for improved accuracy in treating astigmatism.

Torsional Phaco

I have been an Infiniti user since its launch in 2003. In fact, our center purchased the first two machines that Alcon sold and we have been very pleased with the dependability and efficiency of operation that these machines offer. The torsional upgrade on the system allows side-to-side movement of the phaco needle, making cataract removal more efficient. For example, when working on a 4+ cataract, the torsional movement makes removal similar to a 3+ cataract with a standard system. Likewise, a 3+ cataract feels like a 2+ cataract. Additionally, the fluidics lend themselves to a very stable anterior chamber. I have not seen a corneal burn since switching to these machines. These features all increase my comfort using the system — I am able to safely perform more cataract procedures per day without feeling fatigued.

The Infiniti Vision System from Alcon.

Correcting Astigmatism

I have been attempting to correct astigmatism in conjunction with cataract surgery since opening my practice in 1983. Many of us have performed limbal relaxing incisions (LRIs), and will continue to do so, but I have been disappointed by inconsistent results with LRIs. When the AcrySof toric IOL was introduced, I became an enthusiastic early adopter.

In evaluating our results with an average preoperative astigmatism of just under 2 D, we achieved a postoperative astigmatism of 0.26 D. The lens is easily implanted and positioned. It also has minimal, if any, postoperative rotation. Overall, I have enjoyed improved outcomes and financial productivity with the use of the AcrySof Toric. It is an excellent way to get started with premium lenses, because one of the few contraindications for the lens is the absence of astigmatism. There is also a significant "wow" factor using this IOL, for the vast majority of patients quickly achieve excellent uncorrected visual acuity.

Eliminating "Garbage In, Garbage Out" Factor

A common saying in the computer world is "garbage in gives garbage out." For ophthalmologists who are treating astigmatism, marking the axis wrong is equivalent to "garbage in." The Mastel marking system offers a significant advance for marking patients, both for toric IOL implantation and LRIs. The system makes it easy to accurately mark the eye and the axis for IOL or LRI placement. After the preop marks are made with either a marking pen or, preferably the Bakewell marker with built-in level, the Gimbel/Mendez ring is placed on the eye; the Bores axis marker is then used to mark the axis. The system is easy to use and quite accurate, making "garbage out" far less likely.

The complete AK/LRI and toric family from Mastel.

There are, of course, many other things that I use and appreciate greatly in practice, but currently, my phaco system, toric IOL and astigmatism marking system are the ones that I cannot live without. OM