At the recent annual meeting of the American Society of Cataract and Refractive Surgery in Washington, D.C., renowned Australian ophthalmologist Professor Noel Alpins talked about his technique to measure astigmatism of the eye to prepare it for surgery in order to get the most accurate measurement possible. He explains how to avoid adverse outcomes by obtaining key information prior to surgery.
“There are so many different devices to measure astigmatism, and you get so many different numbers, so how do you actually choose the number that is the most accurate for this particular eye? The important criterion is that the value that you are choosing is as close to the refractive cylinder as possible,” he said.
In a presentation during the conference, Alpins demonstrated in a study he and his team conducted using the ocular residual astigmatism, ORA, a measurement of how far the corneal astigmatism is from the manifest refractive cylinder. They looked at three different tomographers that calculate total corneal astigmatism and compared this to the total corneal topographic astigmatism (CorT Total — which includes the posterior cornea) from each device. The CorT was reliable across all three devices because it looks at the entire cornea and not just one ring like the simulated keratometry (SimK).
“We’re going for accuracy, and that number (CorT Total) is what you use to base your surgery on,” said Prof. Alpins, clinical professor and medical director of NewVision Clinics in Melbourne, Australia. “So it’s very useful to have it as a standard to see how well they perform against the best measure, which is CorT total.”
Presentation wins Best Paper
Prof. Alpins’ presentation won the Best Paper Award at the conference, which he called “a nice surprise,” adding that he was just “the front man” and that “I really have to thank my co-authors Doctors Randleman and Nevyas-Wallace for all their input.”
Prof. Alpins pioneered small-incision cataract surgery in Victoria, Australia more than 30 years ago and has specialized in cataract and refractive surgery since founding NewVision Clinics in Melbourne, Australia in 1996. Prof. Alpins is best known for The Alpins Method, which he developed in 1993, to analyse and treat astigmatism, and can be used to refine surgical techniques and adjust laser nomograms for future LASIK procedures. The Alpins Method has been adopted by major ophthalmology journals, including the Journal of Cataract and Refractive Surgery, The Journal of Refractive Surgery and Ophthalmology as the basis for astigmatism reporting. In addition, the American National Standards Institute uses the Alpins Method to help manufacturers determine the effectiveness of refractive surgical lasers and has been called one of the more sophisticated approaches to analysing surgical results. The Alpins Method is also used in planning for cataract/intraocular lens surgeries.
Book Is a Comprehensive Guide
Prof. Alpins recently published a comprehensive guide to correcting astigmatism. In it, he covered pre-operative planning to post-operative analysis, using his method focusing on analysing the parameters of refractive and corneal astigmatism and using those results for future surgeries to help improve a patient’s vision. The publisher calls the surgical correction of astigmatism “the last frontier to optimizing visual outcomes for patients.”
In 24 chapters, Prof. Alpins covers astigmatism planning and outcomes analysis, mixed and irregular astigmatism, coupling and corneal topographic astigmatism (CorT).
“It encompasses 20 scientific papers, following it step-by-step in easy-to-read methods, and follows the rationale to how to treat astigmatism in a better way using my method (The Alpins Method),” Prof. Alpins says, adding the “reaction has been very gratifying”.
“Companies that are submitting their devices for evaluation have to use my method. The technique of Vector PlanningTM is gaining more popularity and studies have gotten better visual results with vector planning where the corneal shape is incorporated into the treatment plan as opposed to conventional methods using the refractive parameters alone,” he noted.
“I’ve gotten a lot of feedback from people who have purchased the book and find it very useful.”
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