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This activity is funded by an independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc.

This medical education is jointly provided by USF Health and touchIME.

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    Faculty & Disclosures
    Prof. Sumit Garg

    Gavin Herbert Eye Institute, University of California, Irvine, CA, USA

    Prof. Sumit (Sam) Garg is vice chair of clinical ophthalmology, as well as medical director and professor in cataract, refractive, external disease and corneal surgery at the Gavin Herbert Eye Institute at the University of California, Irvine, CA, USA. Prof. Garg participates in a multitude of  research projects, many of which he has presented at national and international meetings. In addition to his research activities, Prof. Garg has authored numerous peer-reviewed papers and book chapters. read more

    Prof. Garg previously served as chair of the American Society of Cataract and Refractive Surgery (ASCRS) Young Eye Surgeons clinical committee, is currently on the ASCRS Cornea clinical committee and is chief medical editor for EyeWorld. Additionally, he serves as special advisor to the National Keratoconus Foundation and co-chair of the ophthalmic advisory board for Beyond Blindness.

    He has been recognized in Best Doctors and Super Doctors “Rising Stars” yearly since 2013 and has received the Orange County Medical Association’s Physician of Excellence award since 2014. Additionally, he was chosen by Ocular Surgery News as a Premier 300 Refractive Cataract Surgeon.

    Prof. Garg is actively involved in resident and fellow teaching. In 2014, Prof. Garg published a textbook entitled, Ophthalmic Microsurgery: Principles, Techniques, and Applications, designed for the education of ophthalmology trainees. In 2022, Prof. Garg co-edited Steinert’s Cataract Surgery, and was the cataract section editor for Ophthalmology by Myron Yanoff and Jay S Duker

    Prof. Sumit Garg discloses: Consultancy fees from Aldeyra Therapeutics, Allergan, Avellino, Centricity Vision, CorneaGen, Dompé Farmaceutici, ForSight Robotics, Glaukos, Johnson & Johnson Vision, Kala Pharmaceuticals, LensGen, Novartis (relationship terminated), New World Medical, Oyster Point Pharma, Sight Sciences, Samara Pharmaceuticals, SpyGlass Pharma, Tarsus Pharmaceuticals, Trefoil Therapeutics, Verana Health, Visus Therapeutics, Zeiss Pharmaceuticals.
    Dr Karolinne Rocha

    Medical University of South Carolina, Charleston, SC, USA

    Dr Karolinne Maia Rocha is a diplomate of the American Board of Ophthalmology, a member of the American Ophthalmological Society and a subspecialist in cataract, cornea and refractive surgery. Dr Rocha is currently the director of the Cornea & Refractive Surgery division at the Medical University of South Carolina, Storm Eye Institute in Charleston, SC, USA. She serves as programme director for the Cornea & Refractive Surgery fellowship programme and associate programme director for the Storm Eye Institute residency programme. read more

    Dr Rocha has received awards and distinctions for excellence in ophthalmology, including the American Academy of Ophthalmology’s Senior Achievement Award in 2019, and the Pierre Gautier Jenkins teaching award in 2021. Dr Rocha is active in clinical research, having published over 300 scientific works, including peer-reviewed publications, book chapters, review articles and abstracts in society meetings. She published the first definitive textbook on “Femtosecond Lasers in Cornea and Lens Surgery” (Rocha & Waring, SLACK, 2020).

    Dr Rocha serves on the programme committee for the American Academy of Ophthalmology Refractive Surgery Basic and Clinical Science Course and the American Society of Cataract and Refractive Surgery Cornea clinical committee. She has served as a course instructor at the American Academy of Ophthalmology Laser Refractive Skills Transfer Course since 2009 and teaches courses on optics, presbyopia, corneal topography and complex cataract surgery.

    Dr Rocha is an associate editor for the Journal of Refractive Surgery and the Journal of Refractive Surgery Case Reports.

    Dr Karolinne Rocha discloses: Consultancy fees from Bausch & Lomb, Hoya Surgical Optics (cataract), Johnson & Johnson Vision, Rayner, Zeiss Pharmaceuticals.
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    What must we include in the preoperative assessment of patients prior to cataract surgery?
    How do we optimize biometry and IOL calculations for best outcomes in cataract patients?
    How do previous refractive surgeries and corneal pathologies impact calculations and lens selection?
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    A relaxed discussion between two faculty focussed on real world clinical issues. Useful tips below will show how to navigate the activity. Join the conversation. Close

    Optimizing IOL selection: Focus on IOL calculations in “difficult” eyes

    Faculty Podcast Featured
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    • Downloads including slides are available for this activity in the Toolkit
    Learning Objectives

    After watching this activity, participants should be better able to:

    • Describe the preoperative assessment of ocular health in patients scheduled for cataract surgery
    • Discuss biometry and IOL calculations to achieve optimum postoperative refractive outcomes in cataract patients
    • Recognize how previous refractive surgeries and corneal pathologies in cataract patients impact biometry, IOL calculations and lens selection
    Overview

    In this activity, experts in ophthalmology, Prof. Sumit Garg and Dr Karolinne Rocha, respond to questions from the ophthalmology community on intraocular lens (IOL) selection in cataract patients, focusing on the preoperative assessment of ocular health, optimizing IOL calculations and the impact of previous surgeries on lens selection.

    This activity is funded by an independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc., and is jointly provided by USF Health and touchIME. read more

    Target Audience

    Ophthalmologists, including cataract and refractive surgeons.

    Disclosures

    USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

    Faculty

    Prof. Sumit Garg discloses: Consultancy fees from Aldeyra Therapeutics, Allergan, Avellino, Centricity Vision, CorneaGen, Dompé Farmaceutici, ForSight Robotics, Glaukos, Johnson & Johnson Vision, Kala Pharmaceuticals, LensGen, Novartis (relationship terminated), New World Medical, Oyster Point Pharma, Sight Sciences, Samara Pharmaceuticals, SpyGlass Pharma, Tarsus Pharmaceuticals, Trefoil Therapeutics, Verana Health, Visus Therapeutics, Zeiss Pharmaceuticals.

    Dr Karolinne Rocha discloses: Consultancy fees from Bausch & Lomb, Hoya Surgical Optics (cataract), Johnson & Johnson Vision, Rayner, Zeiss Pharmaceuticals.

    Content Reviewer

    John Steven Jarstad, M.D., FAAO, FRSM-UK has no financial interests/relationships or affiliations in relation to this activity.

    Touch Medical Contributors

    Samantha Waite has no financial interests/relationships or affiliations in relation to this activity.

    Anne Nunn discloses: Employee or independent contractor relationship from Envision Pharma Group (relationship terminated).

    USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

    Requirements for Successful Completion

    In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

    If you have questions regarding credit please contact cpdsupport@usf.edu.

    Accreditations

    Physicians

    This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

    USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu).

    Advanced Practice Providers

    Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

    The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

    Date of original release: 11 September 2023. Date credits expire: 11 September 2024.

    If you have any questions regarding credit please contact cpdsupport@usf.edu.

    This activity is CE/CME accredited

    To obtain the CE/CME credit(s) from this activity, please complete this post-activity test.

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    Topics covered in this activity

    Cataract Surgery / Anterior Segment / Refractive Surgery
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    This Activity Is Funded By:

    An independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc. This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 11 September 2023. Date credits expire: 11 September 2024.

     

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    touchIN CONVERSATION
    Optimizing IOL selection: Focus on IOL calculations in “difficult” eyes
    0.75 CE/CME credit
    Question 1/5
    What is best practice when selecting the right IOL for cataract surgery?

    IOL, intraocular lens.

    With continuing advances in technologies and techniques in cataract surgery, patient expectations are high. While full preoperative evaluation including a full medical history, examination and testing is essential, it is also important to listen carefully to patients and address any concerns they may have prior to surgery. Results from this evaluation should be used to effectively counsel patients and achieve good results.

    Reference

    Israelsen P, Garg S. Ophthalmology Management. 2020;24:38–41.

    Question 2/5
    During a preoperative assessment for cataract surgery, your 64-year-old patient tells you they want spectacle independence following surgery. Upon examination, astigmatism measurements are inconsistent, suggesting presence of DED. How do you advise this patient during their preoperative consultation?

    DED, dry eye disease.

    Prevalence of DED in patients needing cataract surgery is 3.5–33.7%.1 In these patients, cataract surgery requires careful pre, intra and postoperative planning, but is associated with good visual outcomes, with no significant complications when managed effectively.2,3 Multifocal IOLs will give the best chance of spectacle independence, but increase the risk of the patient experiencing visual disturbances such as glare and halos compared with monovision IOLs.4

    Abbreviations

    DED, dry eye disease; IOL, intraocular lens.

    References

    1. Trattler WB. Clin Ophthalmol. 2017;11:1423–30.
    2. Naderi K, et al. Eur J Ophthalmol. 2020;30:840–55.
    3. Donthineni PR, et al. Front Med (Lausanne). 2020;7:575834.
    4. De Silva SR, et al. Cochrane Database Syst Rev. 2016;12:CD003169.
    Question 3/5
    You would like to use the Olsen formula for your patient with myopia. What preoperative measurements do you need to obtain?

    The Olsen formula is based on studying axial and paraxial ray tracings of light through the eye, including the specific optics of a particular IOL. It has a C constant, which relates the centre of the IOL to the preoperative anterior chamber depth and lens thickness. The C constant does not depend upon the axial length and corneal curvature.

    Abbreviation

    IOL, intraocular lens.

    Reference

    Xia T, et al. Asia Pac J Ophthalmol (Phila). 2020;9:186–93.

    Question 4/5
    A Wang-Koch adjustment can be applied to some third- and fourth-generation IOL formulae to optimize the calculation of AL in certain eyes. When would you consider using the Wang-Koch adjustment?

    AL, axial length; IOL, intraocular lens.

    Outliers in AL measurement may result in refractive surprises unless an adjustment is made to the IOL formula. Long eyes have been a challenge and often end up hyperopic with standard calculations. This may be due to an overestimation of the length of the posterior segment, thus selecting an IOL of insufficient power. Long eyes are likely to have a longer posterior segment that has a different index of refraction compared with the anterior chamber and cornea.1 The Wang-Koch formula for optimizing AL fully compensates for this problem and has shown improved outcomes in long eyes with AL >25.0 mm.1,2

    Abbreviations

    AL, axial length; IOL, intraocular lens.

    References

    1. Khandelwal SS, Koch DD. Ophthalmology Management. 2016;20:28–30.
    2. Wang L, et al. J Cataract Refract Surg. 2011;37:2018–27.
    Question 5/5
    Your 78-year-old patient, who underwent hyperopic LASIK surgery 18 years ago, now requires cataract surgery and IOL implantation. What IOL would you consider for this patient?

    EDOF, extended depth of focus; IOL, intraocular lens; LASIK, laser assisted in situ keratomileusis.

    Prior hyperopic LASIK tends to induce negative spherical aberration in the cornea; however, it is more common for the anterior corneal aberration value to be reduced to a near-zero value, making an aberration-neutral IOL more appropriate.1,2 A traditional monofocal IOL with positive spherical aberration helps to offset the negative spherical aberration that may occur after LASIK correction for large amounts of hyperopia.1

    Abbreviations

    IOL, intraocular lens; LASIK, laser assisted in situ keratomileusis.

    References

    1. Stonecipher KG, et al. Previous Hyperopic LASIK. Cataract & Refractive Surgery Today. 2019. Available at: https://crstodayeurope.com/articles/2019-may/previous-hyperopic-lasik/ (accessed 15 August 2023).
    2. Wang L, Koch DD. Ophthalmology. 2021;128:e121-31.
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    This Activity Is Funded By:

    An independent medical education grant from Alcon Vision, LLC and Johnson & Johnson Surgical Vision, Inc. This activity is jointly provided by USF Health and touchIME.

    The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

    USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

    USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

    Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

    This content is intended for healthcare professionals.

    Date of original release: 11 September 2023. Date credits expire: 11 September 2024.

     

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