Clinical Advantages of the OPD-Scan

When a high level of evaluative technology becomes routine, outcomes for cataract and LASIK surgeries improve.

BY JAMES J. SALZ, MD

Imaging and diagnostic technologies continually expand our understanding of ocular pathologies. In just a few minutes, we can get more information than ever before about the state of our patients’ eyes. The OPD Scan system (Marco) is just such a device, providing refraction, corneal topography, optical path difference and wavefront analysis in one brief sitting.

The data, including mapping and other analyses, help us diagnose patients and make treatment decisions, particularly for patients who are candidates for cataract surgery or laser vision correction. The visual nature of the reports also illustrates the situation for patients, which means their treatment makes sense to them and they know what to expect in terms of outcomes.

Clinical Advantages

The OPD helps me achieve the desired outcomes for both cataract and laser refractive surgeries. Before I choose an IOL or decide on limbal relaxing incisions, I need answers. Does the patient have astigmatism? Is it corneal or lenticular? Is it symmetrical or asymmetrical? What size is the pupil? Are there corneal aberrations?

The OPD answers these questions. For example, if a patient has astigmatism, I can plan to use a toric implant or limbal relaxing incisions with the femtosecond laser. Because the system arms me with all the relevant information, I’m very confident about my IOL choices, and outcomes are excellent. Patients pay a premium for a premium lens, and they are happy with their resulting vision. The technology helps me achieve that primary goal of surgery.

When it comes to laser refractive surgery, the OPD’s routine refraction helps me identify candidates. If a patient is a candidate and has an interest, we also collect data on the patient’s higher-order aberrations (spherical, coma, trefoil and tetrafoil). The device’s ability to measure pupil size is as important for these patients as it is for those undergoing cataract surgery who want multifocal IOLs. The instrument also has a printout that’s specifically for LASIK, so it’s convenient for my evaluation and for carrying into surgery.

Teaming with Patients

The OPD lets you educate patients graphically, bringing abstract or complex concepts firmly into their grasp. And when patients and surgeons are both on the same page, we can all work toward the same goals.

For example, it’s most impressive to show patients what their astigmatism looks like on the topographic map. Because they can visualize the astigmatism, they have an easier time understanding the decisions related to the problem. I explain the effect that the treatment will have, so they can see why we need to use a toric lens, or why we’ll use a multifocal lens and correct the astigmatism with limbal relaxing incisions.

The system also lets me show patients a map of the aberrations in their visual system. They see how much spherical aberration they have, and I explain what that means in terms of halos and glare, which helps us agree on an appropriate treatment.

After cataract surgery in which we’ve successfully corrected astigmatism, it’s nice to show patients the difference in the pre- and post-op topography. They can see how the aspheric lens has reduced spherical aberrations. With a toric lens, they can see how astigmatism is still present in the cornea, but the lens negates the total astigmatism. Patients understand and appreciate just how effective their surgery was.

Although much of this data was available before the OPD-Scan, it required us to move patients between four different instruments. The system makes it practical to routinely use this high level of testing.

James J. Salz, MD, is clinical professor of ophthalmology at the University of Southern California and President of Laser Vision Medical Group in Los Angeles.