Remarkable reduction of precipitates on intraocular lenses by oral macrolide antibiotics
In the course of clinical practice, we noted that patients who had taken oral clarithromycin to treat bronchitis showed considerable reduction of intraocular lens (IOL) precipitates and subjective improvement in visual function. Thus far, methods for cleaning IOLs are limited to surgical intervention (eg, scraping or IOL extraction). Regardless of attempts to surgically clean IOLs by scraping, precipitates immediately return; therefore, IOL extraction and reimplantation remains the sole approach for recovery of visual function. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Kazuichi Maruyama, Hirokazu Sakaguchi, Shizuka Koh, Kohji Nishida Tags: Correspondence Source Type: research

Controversies on the use of nonsteroidal antiinflammatory drugs and steroids in pseudophakic cystoid macular edema prophylaxis
Regarding the article by Laursen et  al.,1 we believe some discussion is required. Specifically, the authors reviewed the current available evidence on the prevention of macular edema in patients with diabetes having cataract surgery. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Andrzej Grzybowski, Piotr Kanclerz Tags: Letters Source Type: research

Reply
Our analysis included almost 900 patients across 6 random clinical trials. The main conclusion was that NSAIDs with or without topical steroids were superior to topical steroids alone in preventing PCME in patients with diabetes without macular edema before surgery. We previously found similar results for nondiabetic patients in a systematic review and meta-analysis1 performed before the conclusion of the PREMED study.2,3 (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Sophie Bryde Laursen, Jesper H øiberg Erichsen, Lars Morten Holm, Line Kessel Tags: Letters Source Type: research

New device for ciliary sulcus suture fixation of intraocular lens
Sugiura et  al.1 described a new device, the Ciliary Sulcus Pad Injector (Duckworth& Kent Ltd.), for ciliary sulcus suture fixation. They sought to show the superiority of this new instrument compared with preexisting techniques2,3 for ciliary sulcus suture fixation of an intraocular lens (IOL). In both ab interno fixation and ab externo fixation, the needle is blindly inserted in the ciliary sulcus, leading to a high risk for complications (eg, ciliary body bleeding). Sugiura et  al. developed the Ciliary Sulcus Pad Injector as a safer instrument for piercing the ciliary sulcus. (Source: Journal of Cataract ...
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Marco Nardi, Giuseppe Covello, Michele Figus, Chiara Posarelli Tags: Letters Source Type: research

Reply
The reference I used to make the Ciliary Sulcus Pad Injector was the needle injector produced by Rumex Co. I was not aware of the Trimarchi injector, which is very similar to the Rumex needle injector. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Takeshi Sugiura Tags: Letters Source Type: research

Smartphone-aided technique to quantify toric intraocular lens alignment
Toric intraocular lens (IOL) alignment along the desired axis is of paramount importance for accurate visual and refractive outcomes. Judicious preoperative planning and precise execution intraoperatively are the key factors that determine the IOL orientation postoperatively. After surgery, the position of the IOL with respect to the desired axis is usually confirmed on slitlamp examination; however, additional methods have been described. These methods include anterior segment optical coherence tomography, use of the editing function of Photoshop (Adobe), and use of a refractive power –corneal analyzer system. (Sour...
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Amar Pujari, Saumya Yadav, Ritika Mukhija, Jayanand Urkude, Namrata Sharma Tags: Correspondence Source Type: research

Handshake riveting flanged technique for Yamane method of intrascleral fixation of an intraocular lens
Yamane et  al.1 described the flanged double-needle technique for secured transscleral fixation of an intraocular lens (IOL). Effortless externalization of the trailing haptic is a concern, and various modifications have been described.2–5 The handshake technique to facilitate trailing haptic externalizati on has been described for a glued variant of the secondary IOL fixation method.6,7 Kusaka et al.8 described a riveting technique for iridodialysis repair in which the flanged and riveted ends of the suture hold the peripheral iris tissue in place. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Priya Narang, Amar Agarwal Tags: Correspondence Source Type: research

Partial-thickness scleral tethering suture for optimum fixation and centration of transscleral-sutured intraocular lens –capsule complex
We describe a surgical technique for fine-tuning the centration of a transscleral-sutured modified capsular tension ring (CTR) –intraocular lens–capsular bag complex using a partial-thickness scleral tethering suture placed posterior to the external episcleral portion of a transscleral suture loop. The technique can be used for adjusting the centration of any intraocular supporting or prosthetic device that is transscle rally sutured in a “hanging” technique, such as capsular tension segments, modified CTRs, capsular anchoring devices, or iris prostheses. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Bo Li, Michael E. Snyder Tags: Technique Source Type: research

Cataract surgery operating times: Relevance to surgical and visual outcomes
In a public health system, such as the United Kingdom's National Health Service (NHS), “time is money.” Thus, it was reassuring for our group that over the 5-year duration of the Nderitu and Ursell study,1 the increase in operating room efficiency and surgical techniques enabled a timesaving of 3 minutes per case. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Cheng F. Kong, Brendon W.H. Lee, Adarsh George, Melvin L.H. Ling, Neeranjali S. Jain, Ian C. Francis Tags: Letters Source Type: research

Reply
We concur that it is important to maintain high-quality cataract surgery. Indeed, we could not agree more that there should be an uncompromising focus on achieving the best possible visual outcomes for patients and on minimizing complications. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Paul Nderitu, Paul Ursell Tags: Letters Source Type: research

Refractive surprise after phacoemulsification in a post-laser in situ keratomileusis case
A 52-year-old woman presented with a history of cataract surgery performed 3 months prior. The patient presented with a refractive surprise of +2.00 −2.5 × 75. Her uncorrected distance visual acuity (UDVA) was 20/80 (Snellen) and the corrected distance visual acuity (CDVA) was 20/30. A detailed history revealed that the patient had undergone a laser in situ keratomileusis (LASIK) procedure approximately 20 years ago. Case sheets revealed that a +24 diopter (D) monofocal foldable intraocular lens (IOL) was implanted, and on clinical evaluation, it was found to be well placed in the capsular bag (Figure 1). (Sour...
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Marcony R. Santhiago, Priya Narang, Amar Agarwal Tags: Consultation Section: Refractive Source Type: research

December consultation #2
It is important to consider both corneal and intraocular approaches to resolve such a case. One treatment option is a LASIK procedure. It is possible, even 20 years after the initial refractive procedure, to lift the LASIK flap and apply a new treatment on the residual estromal bed. However, this approach is neither typical nor easy to execute in such cases because of the length of time elapsed since the first LASIK procedure, which puts the integrity of the previous flap at risk. There is also a greater possibility of epithelial growth in the interface because of the manipulation of a long-existing scar. (Source: Journal ...
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Jos é Beniz, Luiz Arthur F. Beniz Tags: Consultation Section: Refractive Source Type: research

December consultation #3
I have seen multiple cases like this over the years, and as much as I would have liked to apportion blame to the IOL surgery, each time it has come down to the cornea or tear film. The devices that most help to resolve these difficult cases are wavefront aberrometers, such as the iTrace (Tracey Technologies), OPD Scan III (Maraco), or KR-1W (Topcon), which separate the whole-eye wavefront from the corneal wavefront, and the HD Analyzer (Visiometrics S.L.), which separates the whole-eye ocular scatter index (OSI) from the tear film OSI. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Arthur Cummings Tags: Consultation Section: Refractive Source Type: research

December consultation #4
This is a classic hyperopic refractive surprise after cataract surgery in a patient who has undergone myopic laser vision correction in the past. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: A. John Kanellopoulos Tags: Consultation Section: Refractive Source Type: research

December consultation #5
New IOL calculation formulas have improved visual outcomes in patients undergoing cataract surgery with a history of previous LASIK. However, the preoperative examination is critical in understanding whether other factors may impact a patient ’s final visual outcome. Patient’s with a history of previous LASIK expect that, following cataract surgery, their vision will return to excellent UCVA and CDVA. The preoperative examination can help identify whether there are abnormalities in the corneal shape that may be contributing to a pati ent’s reduced CDVA. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: William Trattler Tags: Consultation Section: Refractive Source Type: research

December consultation #6
IOL calculations in eyes that have undergone prior corneal refractive surgery can pose several challenges to the refractive surgeon. Particularly in cases of prior myopic laser vision correction, as seen in this patient, hyperopic refractive surprises can arise after cataract surgery due to underestimations of the final IOL power. Alterations in the keratometric index (ratio between the anterior and posterior corneal surfaces), inaccurate extrapolation of central corneal curvature values from steeper paracentral corneal points by modern-day keratometers and topographers, and erroneous predictions of the effective lens posi...
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Nandini Venkateswaran, Terry Kim Tags: Consultation Section: Refractive Source Type: research

Editors' comment
IOL exchange or a piggyback IOL placement would be the first modality that comes to a surgeon ’s mind when handling a case as described. But this option is faced with the challenge that the patient may experience a refractive surprise again. Thus, we performed a pinhole pupilloplasty (PPP) to solve the refractive surprise rather than exchanging the IOL or placing a piggyback IOL (Video 1, available at https://jcrsjournal.org). The pinhole effect bars the peripheral rays arising due to corneal aberrations. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: Marcony R. Santiago, Priya Narang, Amar Agarwal Tags: Consultation Section: Refractive Source Type: research

Gratitude
As 2019 comes to an end, we simply want to say “thank you” to the many special people who make this venture of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons possible. Please browse our annual acknowledgement of reviewers in the back pages of this issue (pg. 1851) and join us in thanking them for their unselfish commitment to peer review. It is impossible to overstate the importance of the work they do to ensure both the quality and the relevance of work you see in print and online at JCRS. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Authors: William J. Dupps Tags: From the editor Source Type: research

Editorial Board
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Source Type: research

Masthead
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Source Type: research

Table of Contents
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Source Type: research

Visual Acuity Chart
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - December 1, 2019 Category: Opthalmology Source Type: research

Can we efficiently use structured rating scales to objectively assess global technical skill in cataract surgery?
The American Board of Ophthalmology has recently created the Ophthalmology Milestone Project to standardize assessment and documentation of trainees' competence.1 However, it does not include objective measures and standardized and scalable tools to assess technical skill or competency. Several structured rating scales have been developed to assess technical skill in cataract surgery.2 These scales can track surgeons' learning curves for both task-specific and global technical skills, identify deficiencies, and enable consistent feedback. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Kapil Mishra, Sidra Zafar, S. Swaroop Vedula, Shameema Sikder Tags: Correspondence Source Type: research

Highly myopic vitrectomized eye develops delayed subluxation of 3-piece PMMA intraocular lens after complicated cataract surgery
A 50-year-old male patient had suffered a tennis ball contusion in his right eye in his youth. At the age of 29 years, he developed retinal detachment, which was successfully repaired by vitrectomy and gas tamponade. At the age of 35, the patient underwent laser in situ keratomileusis (LASIK) in both eyes. Three years Later, the right eye underwent cataract surgery with a 3-piece poly(methyl methacrylate) (PMMA) intraocular lens (IOL) implantation. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Rupert Menapace Tags: Consultation section: Cataract Source Type: research

November consultation #2
This case represents a relative emergency because rubbing of the nasal haptic in the iridocorneal angle could lead to a severe endothelial loss. Preoperative workup should include an endothelial cell count (ECC) with specular microscopy, and the patient should be asked about the model and the power of the IOL placed in his right eye. If these data are not available, a pseudophakic biometry should be performed, taking into account the previous refractive corneal surgery. Considering the fact that the patient has a PMMA IOL, it can be supposed that this IOL was placed in the ciliary sulcus as a consequence of a temporal post...
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Pascal Rozot Tags: Consultation section: Cataract Source Type: research

November consultation #3
Figures 1 and 2 show a temporally dislocated 3-piece PMMA IOL and an incomplete capsule after a complicated phacoemulsification in a post-vitrectomy cataract eye with a PCR and a sulcus lens implantation with a malpositioned nasal haptic in front of the iris in a post-LASIK eye. It seems likely that horizontal subluxation of the IOL is the cause of the recent monocular diplopia and reduction in visual acuity. However, for the near future, I do not expect that the IOL would luxate entirely because of the pseudofixation by the prepupillary haptic. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Maurits V. Joosse Tags: Consultation section: Cataract Source Type: research

November consultation #4
Late IOL dislocation is becoming a more frequently occurring event after previously uncomplicated cataract surgery. Pseudoexfoliation, status post-vitrectomy, myopia, trauma, and uveitis are the most common causes, and these are at cumulative risk. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Gabor B. Scharioth Tags: Consultation section: Cataract Source Type: research

November consultation #5
This patient clearly has visual impairment attributable to (1) a significantly dislocated IOL, and (2) iris pigment defects probably because of mechanical contact between the poorly secured and anteriorly dislocated IOL. The goal is to reposition or exchange the IOL with a placement such that there is no contact with uveal tissue. This patient is young; therefore, any repair should be undertaken with the idea that it will be durable for 30 to 40 years. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Kenneth J. Rosenthal Tags: Consultation section: Cataract Source Type: research

November consultation #6
This 50-year-old male patient with a history of trauma, previous surgery, and LASIK has a subluxated 3-piece PMMA IOL in a highly myopic eye.1 (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Lars-Olof Hattenbach Tags: Consultation section: Cataract Source Type: research

November consultation #7
I think in this unfortunate case of trauma in an eye with a thin sclera and past refractive surgery, I would keep it simple and suture the existing IOL to the iris. The past vitrectomy is reassuring because it means we are less likely to encounter vitreous and have subsequent retinal re-detachment. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Thomas A. Oetting Tags: Consultation section: Cataract Source Type: research

Editor's comment
This is a case of an open-loop PMMA IOL decentered and tilted in a defective capsular bag with the nasal loop dislocated into the anterior chamber. Action is required because the IOL might luxate any time and the complete lack of vitreous support could potentially result in retinal damage by the sharp loop ends of a spinning-around IOL. Also, the patient has been reporting night diplopia. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Rupert Menapace Tags: Consultation section: Cataract Source Type: research

Magnetic inhibition of implantable cardioverter-defibrillators during LASIK procedures: Let us have a change of heart
Implantable cardioverter-defibrillators (ICDs) have been tremendously useful in decreasing complications and death in patients with heart failure or arrhythmia disorders. It has been suggested that for every 9 devices implanted, one death and three hospitalizations for major cardiovascular events can be prevented.1 Patients with ICDs pose a challenge for surgeons, however, because a shock delivered from the ICD could potentially produce substantial patient movement on the operating table, significantly increasing surgical risk. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Majid Moshirfar, Anisha N. Somani, Grant C. Hopping Tags: Correspondence Source Type: research

Impact of corneal guttata on cataract surgery results
Data from the Swedish Cataract Registry showed that patients with corneal guttae benefited from cataract surgery but had poorer visual acuity and self-reported visual function than patients without guttae.1 As corneal surgeons, we are concerned about the recommendation to wait at least 3  weeks after cataract surgery to decide on corneal transplantation. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Francis W. Price, Matthew T. Feng Tags: Letter Source Type: research

Reply
Drs. Price and Feng's analogy of the cornea resembling a windshield is useful. We agree on the importance of a holistic approach to the patient's visual problems and the involvement of corneal transplantation as a possible treatment early in the planning process before cataract surgery. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Andreas Viberg, Per Liv, Anders Behndig, Mats Lundstr öm, Berit Byström Tags: Letter Source Type: research

Prerequisites for pain assessment
Shetty et  al.1 evaluated the effect of a bandage contact lens soaked in ketorolac ophthalmic 0.45% solution on pain modulation in patients having transepithelial photorefractive keratectomy (PRK). The authors did not mention whether the patients in the treatment group and no treatment group were masked. It is known that when patients are aware of the allocation to an experimental intervention or to a comparator including a placebo, they experience, report, or record greater benefits than when they are unaware of the assignment. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Swati Agrawal, Ashi Khurana Tags: Letter Source Type: research

Reply
Drs. Agrawal and Khurana raise valid points. We would like to clarify that the patients were masked to which group they were assigned and were  not aware of whether they were receiving a ketorolac-soaked bandage contact lens or a plain lens. This is important because, as Drs. Agrawal and Khurana rightly point out, the placebo effect could play an important role in pain management. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Rohit Shetty, Sharon D'Souza Tags: Letter Source Type: research

Corneal crosslinking: Current protocols and clinical approach
Members of the ASCRS Cornea Clinical Committee performed a review of the current literature on the corneal crosslinking (CXL) procedure for treating corneal ectasia. The members explored the data on the techniques currently in use and under investigation, including their advantages, safety profiles, risks, and cost analyses, compared with data on corneal transplantation. They concluded that CXL limits the progression of keratoconus, thus reducing the need for transplantation. They also found that compared with permitting the disease to progress naturally, CXL techniques carry significant and long-term cost and safety benef...
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Kenneth A. Beckman, Preeya K. Gupta, Marjan Farid, John P. Berdahl, Elizabeth Yeu, Brandon Ayres, Clara C. Chan, Jos é A.P. Gomes, Edward J. Holland, Terry Kim, Christopher E. Starr, Francis S. Mah, the ASCRS Cornea Clinical Committee Tags: Review/Update Source Type: research

Phakic intraocular lenses: Lessons learned
Toast to the lessons not yet learned and to the trials that will teach them. —Brooke Fraser (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Authors: Sathish Srinivasan Tags: From the editor Source Type: research

Editorial Board
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Source Type: research

Masthead
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Source Type: research

Table of Contents
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Source Type: research

Visual Acuity Chart
(Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - November 1, 2019 Category: Opthalmology Source Type: research

Evaluating the relative value of intraoperative aberrometry versus current formulas for toric IOL sphere, cylinder, and orientation planning
To retrospectively review toric intraocular lens (IOL) outcomes and compare actual results to those expected from preoperative calculations and intraoperative aberrometry (IA) in normal eyes. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: Kerry D. Solomon, Helga P. Sandoval, Richard Potvin Tags: Article Source Type: research

Slitlamp protractor: Refinement of existing slitlamp toric scale
We describe a simple modification to the preexisting protractor scale on the slitlamp to facilitate toricity measurement at each degree. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: Amar Pujari, Jayanand Urkude, Rashmi Singh, Saumya Yadav, Ritika Mukhija, Namrata Sharma Tags: Correspondence Source Type: research

Measuring aberrations of multifocal and extended depth-of-focus intraocular lenses
Studies comparing the optical quality of intraocular lenses (IOLs) in  vivo are proliferating. This increase in popularity is largely driven by the availability of aberrometers in clinical and laboratory environments. However, the approach to interpreting aberrometry results in pseudophakic patients has been insufficient in many cases, especially when considering mul tifocal or extended depth-of-focus (EDOF) IOLs. In the majority of published studies that compared the optical quality between multiple IOLs and pupil sizes, the authors present the root mean square (RMS) as a fait accompli. (Source: Journal of Cataract a...
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: Antonio J. Del Águila-Carrasco, Eleni Papadatou, Phillip J. Buckhurst Tags: Correspondence Source Type: research

Phakic intraocular lens implantation for the correction of hyperopia
The prevalence of myopia is much higher than hyperopia. Hence, there are relatively few studies investigating phakic intraocular lens (pIOL) implantation for the correction of hyperopia. This review aimed to summarize the available relevant literature on the efficacy and safety of pIOL implantation for the correction of hyperopia and hyperopic astigmatism. At present, two types of pIOLs are used to correct hyperopia and hyperopic astigmatism: anterior chamber iris-fixated pIOLs and posterior chamber implantable collamer lenses. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: Abdulaziz A. Alshamrani, Saad S. Alharbi Tags: Review/Update Source Type: research

Diagnosis of keratoconus progression by Fourier-domain optical coherence tomography should be correlated with Scheimpflug tomography
In a recent article, Ouanezar et  al.1 studied 134 keratoconus cases to define a new anatomic criterion for progressive keratoconus based on corneal optical coherence tomography (OCT). The authors stated that corneal thickness was better evaluated by OCT than by scanning-slit corneal topography on the basis of an interobserver rep eatability comparison between the Orbscan IIz topographer (Bausch + Lomb Surgical, Inc.) and the RTVue Fourier-domain OCT device (Optovue, Inc.). In an earlier study, Meyer et al. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: Swati Agrawal, Ashi Khurana Tags: Letter Source Type: research

Posterior elevation as a risk factor for corneal ectasia after small-incision lenticule extraction
In a case report by Pazo et  al.,1 a patient developed unilateral corneal ectasia 15 months after small-incision lenticule extraction (SMILE). The authors stated that the preoperative topography of the affected eye was normal, with a maximum keratometry value of 44.9 diopters (D) and a minimum thickness of 582 μm. They rep orted no significant inferior–superior (I–S) asymmetry on the curvature maps and unremarkable anterior and posterior elevation maps. However, it seems as though the case was suspicious for subclinical keratoconus preoperatively. (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: George D. Kymionis, Michael A. Grentzelos, Nafsika Voulgari Tags: Letter Source Type: research

Reply
It is well known that preoperative abnormal topographic abnormality, low residual stromal bed thickness, thin corneas, young age, and high myopia are factors that might increase the risk for developing corneal ectasia after corneal refractive surgery.1 As outlined, this patient had thicker than average corneal thickness. The anterior elevation map showed an asymmetric bowtie pattern with an I –S index of 1.0 D, which is below the recognized 1.4 D cutoff, and there was no skewed radial axis. Furthermore, the patient was 23 years old and the treatment size was small; therefore, this patient was deemed a suitable c...
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: Richard N. McNeely, Jonathan E. Moore Tags: Letter Source Type: research

Avoiding the anterior one third of the cornea might not prevent ectasia after laser vision correction
In a case report, Pazo et  al.1 described a patient with unilateral ectasia after small-incision lenticular extraction (SMILE). However, we believe that the contralateral left eye also had signs of early ectasia (Figure 1). (Source: Journal of Cataract and Refractive Surgery)
Source: Journal of Cataract and Refractive Surgery - September 27, 2019 Category: Opthalmology Authors: Arturo S. Chayet, Julio C. Moreno, Susana Y áñez, Yunuen Bages, Pablo Adamek Tags: Letter Source Type: research