Spotlight ON TECHNOLOGY & TECHNIQUE

Intraoperative Refraction Tool Increases Patient Satisfaction

By Leslie Goldberg, Associate Editor

As the refractive capabilities of IOLs have increased in recent years, so too have patient expectations concerning postop visual acuity. Cataract surgeons are responding with a concerted effort to avoid saddling patients with residual refractive error (be it spherical or cylindrical) whenever possible. Many have even mastered the delicate art of correcting presbyopia with an intraocular lens.

How, then, to raise the bar on your refractive outcomes without committing to an inordinate amount of time-consuming enhancement procedures? By getting the refraction correct "on the table," experts say. As good as preop IOL power calculators may be, actual results can and do vary from those anticipated.

Intraoperative wavefront aberrometry — a wholly new concept that provides real-time refractions during surgery and allows a surgeons to make adjustments "on the fly" — has the potential to transform refractive cataract surgery, says WaveTec Vision, whose new ORange device features this cutting-edge technology.

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Eric Donnenfeld, M.D., of Ophthalmic Consultants of Long Island, has been using the ORange for over a year and says it has become an integral part of his surgical program. He says that the day 1 postop results determine the satisfaction level of his cataract patients. "No one has a cataract operation, comes back for an LRI 2 weeks later and then calls their friends to tell them what a wonderful procedure they've had," says Dr. Donnenfeld. "If you can get that better result on postop 1 day, reduce your enhancement needs and improve patient satisfaction, that's the key to growing your refractive cataract practice."

Attached to the operating microscope, the ORange captures refraction in two to five seconds, measuring sphere, cylinder and axis and displaying the results on a computer screen. The information provided can improve the accuracy of toric lens positioning or limbal relaxing incisions as the procedure dictates. It can also allow the surgeon to choose a different IOL than originally intended if the wavefront analysis suggests the need for a change. "We can fine-tune the process while still in surgery in order to get the optimum result for our patients the first time," says Dr. Donnenfeld.

Knowing the refraction of the eye after various steps in the procedure can help guide surgeon's decision making. "To be able to reliably improve astigmatic results and reduce astigmatism below a half a diopter on almost all cases gives patients better uncorrected visual acuity on the first postoperative day," Dr. Donnenfeld says. Using ORange to guide LRIs reduced residual cylinder at one month by 52% in a recent study; 69% of patients were within 0.5D vs. 46% of patients without ORange.

In addition, the ORange is capable of taking refractive measurements through a post-refractive cornea. It can confirm the refractive status of an eye immediately after IOL implantation, including phakic IOLs. "This is important because the refractive power of the cornea influences the IOL power and the effective lens position," says Dr. Donnenfeld.

Dr. Donnenfeld performs cataract surgery using the ORange to optimize his patient's visual outcome.

He says that while you can always go back and do additional refractive surgery, LRIs and excimer laser treatments to correct patients' residual refractive error, "the bottom line is you only get one chance to make that first good impression."

Patients who need additional enhancements, regardless of how much time is spent counseling them, are always a little disappointed, Dr. Donnenfeld mentions. "By reducing the number of enhancements, we increase patient satisfaction and patients are actually entering the office asking for the technology," he concludes. OM

For more information, visit www.wavetecvision.com.