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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
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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
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1Biometry
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Zeiss IOL Master 700 Pentacam AXL Topcon Aladdin Movu Argos Nidek AL-Scan
drbaig.ca
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2Toric Calculators
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Warren Hill, MD drbaig.ca
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drbaig.ca
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3Imprimis
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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
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4Recent MFIOLs
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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
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5Capsulorhexis Aids
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drbaig.ca
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drbaig.ca
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drbaig.ca
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6Piggyback IOLs
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HumanOptics Add-On
Sphere -‐30 to +6 | Cylinder +1 to +30 | Op7c 7mm | Overall 14mm | Silicone op7c with PMMA hap7cs | Surge Canada
drbaig.ca
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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
drbaig.ca
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Sphere -‐10 to +10 | Cylinder +1.5 to +11 | Op7c 6mm | Overall 13mm | Hydrophilic acrylicdrbaig.ca
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7MST Instruments
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drbaig.ca
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8IOL Formulae
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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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drbaig.ca
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drbaig.ca
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9Phakic IOLs
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Artisan
Sphere -‐23.5 to +12 | Cylinder +1 to +7.5 | Op7c 5/6mm | Overall 7.5/8.5mm | PMMA | Ophtec (Clarion)
drbaig.ca
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Artiflex
Sphere -‐2 to -‐14.5 | Cylinder +1 to +5 | Op7c 6mm | Overall 8.5mm | Polysiloxane | Ophtec (Clarion)
drbaig.ca
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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
drbaig.ca
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10APX Pupil Device
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11Capsular Tension Rings
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2L 1G
19D
2C
10L 10C
6D
Capsular Rings
drbaig.ca
14A
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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
drbaig.ca
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12Intraoperative Aberrometry
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Alcon: ORA System with VerifEye
drbaig.ca
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drbaig.ca
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Holos by Clarity
drbaig.ca
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13Xtreme D
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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
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14Capsular Bag Stabilization
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MST Iris Hook
drbaig.ca
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MST Capsule Retractor
drbaig.ca
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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
drbaig.ca
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15Considerations for DMEK/DSAEK
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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
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16Spherical Aberrations
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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
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17Toric IOL Apps
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Axis Assistant
TorAxis
drbaig.ca
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18Signature Pro Analytics and Recording
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drbaig.ca
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drbaig.ca
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19IOL Power vs Thickness
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Warren Hill, MD drbaig.ca
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20Intraoperative Toric Alignment
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Alcon
drbaig.ca
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Zeiss Callisto
drbaig.ca
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21IOLs Post Trauma
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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
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Iris Prosthetic System
Aniridia Lens
Artisan Iris Reconstruction Implant
Circular/Rota Disc Lens
Solutions for Iris Defects
drbaig.ca
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drbaig.ca
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drbaig.ca
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HumanOptics CustomFlex Artificial Iris
Pigmented silicone elastomer with (or without) polymer fibre meshwork drbaig.ca
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drbaig.ca
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drbaig.ca
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22MFIOL Screening
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MFIOL Screening
• Overall higher order aberrations < 0.3
• Look at spherical aberration at 6mm zone
• Coma < 0.4
• Angle kappa < 0.5
drbaig.ca
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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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