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Astigmatism Basics | Sept/Oct '18

Intraoperative Wavefront Aberrometry: Keys to Success

New evidence-based rules to conquer astigmatism at the time of cataract surgery.

Video 1 | Dr. Rao outlines the three groups of patients in whom he utilizes intraoperative wavefront aberrometry.

Post laser vision correction. Patients with a history of LASIK, PRK, or radial keratotomy.

Premium IOLs. Patients who opt for toric or multifocal IOLs and therefore benefit from the most accurate lens calculations possible.

Monovision. Patients aiming for monovision or engineer-type patients who want a specific near vision focal point.

Video 2 | Dr. Rao weighs in on some of the lessons he has learned over the past few years of using intraoperative wavefront aberrometry.

Intraoperative wavefront aberrometry readings are an adjunct. Intraoperative wavefront aberrometry can be a helpful adjunct to improve accuracy and surgeon confidence in the lens he or she is implanting, but the use of biometry is still required.

ORA does not use only its own measurements. The ORA System (Alcon) uses its own measurements and averages them into its final calculation for lens power while also using the biometry measurements that the surgeon has inputted to calculate the final lens power.

There can be no errors in transcription. When inputting data into the ORA website, care must be taken not to input any data incorrectly.

Type of OVD matters. It is important to have either a cohesive OVD or balanced salt solution in the eye when taking the ORA reading. Care should be taken not to have two different types of viscoelastic (some dispersive and some cohesive), as this can throw off the ORA scan and decrease accuracy. After removing the cataract, the dispersive OVD is removed from the anterior chamber, and a cohesive OVD is placed in the anterior chamber and in the capsular bag. Cohesive OVDs or balanced salt solution ensure the greatest accuracy, whereas use of dispersive OVDs during the ORA scan should be avoided.

Naveen K. Rao, MD
  • Lahey Hospital and Medical Center, Burlington, Massachusetts
  • Assistant Professor of Ophthalmology, Tufts University School of Medicine, Boston
  • Medical Director at Lions VisionGift East, Boston, Massachusetts
  • naveen.k.rao@lahey.org; Twitter @NaveenKRaoMD
  • Financial disclosure: None