this hour has 22 - csorn€¦ · for dsaek or dmek • do not use ... • look at spherical...

This Hour Has Rapid-Fire Trends of 2016 for Nurse’s OR

2016 CSORN Symposium

Kashif Baig MD, MBA, FRCSC University of Ottawa Eye Institute

June 18, 2016

22POINTS

Financial Disclosures

Financial  Interest/  Affilia0on Name  of  Company(s)

 Grant/Research  Support    Allergan,  Bausch  &  Lomb,  Merck,  Moria

 Employment/Honoraria/Consul0ng  Fees/Travel  Expenses  Alcon,  Allergan,  Bausch  &  Lomb,  Lab0cian

 Major  Stock  Shareholder      None

 Member:  Advisory  Panel,  Standing  CommiPee,  Board  of  Directors  Allergan,  Bausch  &  Lomb

 Other  Financial  or  Material  Interest      None

drbaig.ca

1Biometry

Zeiss IOL Master 700 Pentacam AXL Topcon Aladdin Movu Argos Nidek AL-Scan

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2Toric Calculators

Warren Hill, MD drbaig.ca

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3Imprimis

3 mL11 days

6 mL22 days

10 mL37 days

$50$90$130

-$85

-

-$85

-John Di Genova

Tel: 514-463-3643

PharmacyFax: 514-342-4996 drbaig.ca

4Recent MFIOLs

Presbyopia+

Cornea+

Inlays+

Small2aperture+ KAMRA%(AcuFocus)%

Corneal+Reshaping+ Raindrop%(ReVision%Op6cs)%

Refrac:ve+Op:c+Flexivue%(Presbia)%%

Icolens%(Neop6cs)%

Laser+

LASIK+Nidek%EC%5000,%Technolas%SupraCOR,%Alcon%Wavelight,%AMO%VISX,%Zeiss%MEL%

80,%Scwind%Amaris%PresbyMAX%

Femtosecond+ IntraCOR%

Heat+Conduc:ve+Keratoplasty++Op:2K+laser+thermal+

keratoplasty+

Lens+

Refrac:ve+ AMO%ReZoom%

Diffrac:ve+Alcon%ReSTOR,%AMO%Tecnis,%HumanOp6cs%Diffrac6va%

Trifocal:%Zeiss%AT%LISA%tri,%PhysIOL%FineVision%

Segmented+ Oculen6s%Mplus,%Lenstec%TFVSBL%

Accommoda:ng+

SingleVop6c:%B&L%Crystalens/Trulign,%Lenstec%Tetraflex,%HumanOp6cs%1CU%DualVop6c:%Visiogen%Synchrony%

Developing:%PowerVision%FluidVision,%NuLens%DynaCurve,%Elenza%Sapphire,%Oculen6s/Akkolens%Lumina%

EDOF+Diffrac6ve:%AMO%Symfony;%Small%Aperture:%AcuFocus%ICV8%

Adjustable%Spherical:%Calhoun%LAL;%Segmented:%Len6s%Comfort%

Polyfocality+ Medicem%WIOLVCF%

Sclera+ PresVIEWTM%(Refocus)%

LaserACE%(Ace%Vision)% drbaig.ca

5Capsulorhexis Aids

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6Piggyback IOLs

HumanOptics Add-On

Sphere  -­‐30  to  +6    |    Cylinder  +1  to  +30    |    Op7c  7mm    |  Overall  14mm    |    Silicone  op7c  with  PMMA  hap7cs    |    Surge  Canada

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Rayner SulcoFlex

Sphere  -­‐10  to  +10    |    Cylinder  +1  to  +6    |    Op7c  6.5mm    |  Overall  14mm    |    Hydrophilic  acrylic    |    iMed  Pharma

Aspheric

Toric

Multifocal

Toric Multifocal

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Sphere  -­‐10  to  +10    |    Cylinder  +1.5  to  +11    |    Op7c  6mm    |  Overall  13mm    |    Hydrophilic  acrylicdrbaig.ca

7MST Instruments

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8IOL Formulae

Extreme Axial Lengths• Myopia

• Holladay 1 with Wang-Koch AL adjustment AND/OR

• Barrett Universal II (no adjustment)

• RBF Method

• Hyperopia

• Olsen OR

• RBF Methoddrbaig.ca

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9Phakic IOLs

Artisan

Sphere  -­‐23.5  to  +12    |    Cylinder  +1  to  +7.5    |    Op7c  5/6mm    |  Overall  7.5/8.5mm    |    PMMA    |    Ophtec  (Clarion)

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Artiflex

Sphere  -­‐2  to  -­‐14.5    |    Cylinder  +1  to  +5    |    Op7c  6mm    |  Overall  8.5mm    |    Polysiloxane    |    Ophtec  (Clarion)

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Visian ICL

Sphere  -­‐18  to  +10    |    Cylinder  +1  to  +6    |  Overall  Diameter  12.1,  12.6,  13.2,  13.7  mm    |    Collamer    |    Staar

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10APX Pupil Device

11Capsular Tension Rings

2L 1G

19D

2C

10L 10C

6D

Capsular Rings

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14A

CTR Selection• <4 clock hours: CTR

• >4 clock hours or lens displaced: CTR + CTS; Cionni Ring (small rim)

• Contraindication: posterior capsule compromise

• Suture: GoreTex CV-8 > 9-0 Prolene > 10-prolene

• Toric IOLs in axial myopes: CTR or Henderson

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12Intraoperative Aberrometry

Alcon: ORA System with VerifEye

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Holos by Clarity

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13Xtreme D

Diopter  range  +45  to  +60  D    |    Incision  2.2mm    |    Op7c  6mm    |  Overall  diameter  12.1  12.6  9.8mm    |    Hydrophilic  acrylic    |    Zeiss drbaig.ca

Zeiss XTreme D

14Capsular Bag Stabilization

MST Iris Hook

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MST Capsule Retractor

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Capsular Bag Stabilization• Iris hooks: stress on rhexis edge

• Capsule hooks: support capsule at equator (decrease aspiration risk)

• CTS: coathanger iris hook

• CTR: “as late as you can, but as soon as you must”

• Cortex stripping: tangential toward area of weak zonules

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15Considerations for DMEK/DSAEK

For DSAEK or DMEK• Do not use hydrophilic IOLs - opacification

• Try to avoid CAI for IOP control

• For DSAEK: Aim -1.5 D; For DMEK: Aim -0.5 D

• Wait for YAG capsulotomydrbaig.ca

16Spherical Aberrations

Spherical Aberration Considerations• After myopic LASIK: induce +ve SA

• After hyperopic LASIK: induce -ve SA

• Non-centred ablation: coma

• European ancestry cornea SA: +0.27

• Lens SA

• Spherical: +0.180

• Alcon AcrySof IQ: -0.17

• AMO Tecnis: -0.27

• B&L LI61AO: 0.0drbaig.ca

17Toric IOL Apps

Axis Assistant

TorAxis

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18Signature Pro Analytics and Recording

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19IOL Power vs Thickness

Warren Hill, MD drbaig.ca

20Intraoperative Toric Alignment

Alcon

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Zeiss Callisto

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21IOLs Post Trauma

ODBefore BeforeAfter AfterOSSmall Iris Defects

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Aniridia Rings50C 50E 50F 96C

Partial Aniridia Rings96F 96G 94G

Aniridia Implants

67B 68 67G 67F 67L 94A

Partial Aniridia Implants

67 67A 94 67C 67D 68C 94C 67Edrbaig.ca

Iris Prosthetic System

Aniridia Lens

Artisan Iris Reconstruction Implant

Circular/Rota Disc Lens

Solutions for Iris Defects

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HumanOptics CustomFlex Artificial Iris

Pigmented  silicone  elastomer  with  (or  without)  polymer  fibre  meshwork drbaig.ca

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22MFIOL Screening

MFIOL Screening

• Overall higher order aberrations < 0.3

• Look at spherical aberration at 6mm zone

• Coma < 0.4

• Angle kappa < 0.5

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Cornea, Anterior Segment, and Refractive Surgery Team University of Ottawa Eye Institute

Attendings ! Kashif Baig MD MBA ! Bruce Jackson MD (retired) ! George Mintsioulis MD ! Setareh Ziai MD

Clinical Fellows ! Nima Noordeh MD (2015-2016) ! Esteban Santiago MD (2014-2016) ! Javiera Compan MD (2014-2015) ! Joshua Teichman MD (2013-14) ! Season Yeung MD (2013-14) ! Abdulmajeed Aljaethen MD (2012-13) ! Setareh Ziai MD (2011-12) ! Samer Abuswider MD (2009-11)

Research Fellows ! Yelin Yang MD (2015-2016) ! Ronan Conlon MD (2013-2015) ! Salina Teja MD (2012-13) ! Mustafa Kapasi MD (2011-12)

Technologists ! Sophie Boucher COMT ! Sabrina Taylor COMT ! Emily Wong COMT

Research ! Melanie Lalonde PhD ! Annelise Saunders LLB

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