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