THE ENGAGED PRACTICE

The Value of Versatility

For a combined cataract and refractive practice, the OPD-Scan performs many essential functions – quickly.

BY ERIN MURPHY, CONTRIBUTING EDITOR

In a practice where surgeons perform refractive and cataract surgeries, versatility is a necessity. Physicians at Laser Vision Medical and Seibel Vision Surgery, which share a facility in Los Angeles, have been using the OPD-Scan (Marco) for both types of surgery for several years.

“There are other instruments similar to the OPD-Scan, but very few can capture as much data at one time,” explains James J. Salz, MD, an internationally recognized refractive and cataract surgeon, as well as president of Laser Vision Medical and clinical professor of ophthalmology at the University of Southern California, Los Angeles. “We can’t identify aberrations in the optical system, measure the pupil and autorefract with a simple topographer. We can’t get simultaneous topography with an optical biometer. The OPD-Scan delivers a great deal of information in a few minutes — and that’s technician time, not physician time.”

One of Dr. Salz’s technicians, Gomer Ines, was an optometrist in his native Philippines before he began working in ophthalmology, where his experience now spans nearly 30 years. The OPD-Scan makes it easy to handle challenging cases,” says Mr. Ines. “With this system, we can obtain necessary measurements, even from patients with small pupils and we can more easily identify any ocular surface problems that should be treated before surgery.

The OPD-Scan answers this facility’s need for versatility. As part of its armamentarium of advanced technology, it helps surgeons and their staff elevate the standard of care and streamline their exam process through automation.

Support for IOL Choices

Surgeons have many goals for surgery, ranging from superior clinical outcomes to fast healing and patient satisfaction. Patients tend to focus on one specific goal: to see better.

Dr. Salz practices with another cataract surgeon, Barry S. Seibel, MD, of Seibel Vision Surgery, a pioneer of laser-assisted cataract surgery and clinical assistant professor of ophthalmology at the University of California, Los Angeles.

“Patients ultimately want great vision. The OPD-Scan enables us to assess the extent to which the cataract contributes to the vision problem, compared to other factors such as corneal irregularity or lenticular aberrations. We can see the optical path difference between the overall wavefront and corneal wavefront as well,” Dr. Seibel says. “By separating the cataract from the rest of the visual system, we can identify residual problems the patient may experience after cataract surgery.”

Once Dr. Seibel determines that a patient has aberrations based on data acquired from the OPD-Scan, he can see if they include any aspheric aberrations that can best be addressed by an IOL with positive, neutral or negative spherical aberration. He also uses the OPD-Scan to determine if a patient has undergone previous PRK or LASIK procedures. The sign and magnitude of spherical aberration typically indicates whether a hyperopic or myopic ablation was performed, which drives the choice of post-refractive IOL power calculation protocol.

“I had a patient with an unusual Salzmann’s nodular degeneration, which lead to irregular astigmatism that was very clear on the OPD-Scan. I knew that with her eyes in that condition, I wouldn’t be able to obtain good measurements for surgery and as a result, she wasn’t going to achieve good visual results,” Dr. Seibel says. “I was able to perform lamellar keratectomy and a new set of testing, followed by toric IOL implantation. In the end, she had sharp, clear vision because we were able to obtain a clear picture of her condition before surgery.

Pupillometry for LASIK and Cataracts

Drs. Salz and Seibel use their OPD-Scan to plan for cataract and refractive surgeries, because they say pupil measurement is an advantageous feature.

“In LASIK, there’s some controversy about whether pupil size impacts the quality of vision at night. I think patients with extremely large pupils are at risk,” Dr. Salz says. “We keep our OPD-Scan in a semi-dark area, which gives us a measurement of the mesopic pupil that’s within 0.5 mm of a dark room. That allows us to screen and select the right patients for LASIK and inform them about the likelihood of night vision problems.”

Some IOL choices are dependent on pupil size as well. Pupillometry results might determine whether the patient is a candidate for an apodized multifocal lens, according to Dr. Seibel. For example, the AcrySof Restor lens (Alcon) is diffractive only in the central 3.6 mm of the 6.0 mm optic, and the diffractive rings provide progressively less near vision as they progress from the center to the periphery of this diffractive zone. Therefore, a patient with a photopic pupil size of 1.5 mm will have stronger uncorrected near visual acuity than a patient with a pupil size closer to 3.0 mm. Patients with larger pupils may be better candidates for a full diffractive IOL design such as the Tecnis Multifocal (AMO). Also, a patient with a mesopic pupil significantly larger than 6.0 mm may be at increased risk for edge glare with the smaller 5.0 mm optic of a Crystalens (Baush + Lomb).

Fast, Accurate Refraction

Autorefraction gives many surgeons a good starting point. Used as part of a regular exam or a surgical workup, the OPD-Scan provides reliable results for Drs. Salz and Seibel.

“This machine is a game changer,” Mr. Ines says. “With the OPD-Scan, you’re not going to have many returned prescriptions. You see the difference. You have confidence when you dispense a prescription because you know it’s right.”

Mr. Ines frequently uses the OPD-Scan as part of the workup for cataract surgery. In that process, the OPD-Scan is one of three redundant tests performed to ensure accuracy.

“When we’re preparing for cataract surgery, we compare results from the OPD-Scan at the first visit, followed by the IOLMaster and Atlas 9000 (Carl Zeiss Meditec) at the second visit. If the comparison creates some uncertainty, the patient may need ocular surface treatment followed by a new set of tests. If the ocular surface is clear, we take another optical path difference measurement and use that refraction result,” he says.

“Although it’s not heavily emphasized, I get a very accurate automated refraction with the OPD-Scan,” Dr. Salz says. “Manual refraction has some subjective uncertainty and takes time, but the OPD-Scan gives you a starting point that’s very close to the final prescription in 2 seconds per eye. When you think about that and the total OPD-Scan time of about 2 minutes, we’re getting an accurate refraction and all the other measurements in a short time, which is great for patient flow through the office.”

Versatility is Key to Success

The OPD-Scan provides reliable refractions, along with pupillometry, topography, and wavefront and keratometry readings, all of which helps physicians at Laser Vision Medical and Seibel Vision Surgery save time while performing all the measurements necessary to guide decision-making and help ensure successful results after refractive and cataract surgeries. •

James J. Salz, MD is president of Laser Vision Medical and clinical professor of ophthalmology at the University of Southern California, Los Angeles.
Barry S. Seibel, MD, of Seibel Vision Surgery, is clinical assistant professor of ophthalmology at the University of California, Los Angeles.

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