—The 2013 ASCRS Clinical Survey Results on Astigmatism—covering 168 data points with more than 1,000 physicians responding—showed that 57% of physicians saw benefits associated with femtosecond laser arcuate incisions compared with conventional manual incisions, according to John A. Vukich, MD.
"The arcuate incisions stood out as the one area where there was some feeling that they would provide a clinical benefit," said Dr. Vukich, in private practice in Madison, WI.
Regarding multifocal IOLs, 45% indicated that up to 0.71 D of residual cylinder was acceptable after implantation before visual function was affected; 0.61 D of postoperative sphere was considered acceptable, with 35% claiming that 0.75 D was acceptable before vision was compromised.
Regarding the acceptance of presbyopia-correcting IOLs to treat substantial residual cylinder, 51% of respondents use laser vision correction. U.S. physicians were far more likely to use astigmatic keratotomy limbal-relaxing incisions compared with European physicians; while 16% of respondents prefer glasses or contacts.
Regarding toric IOLs, only about 25% of respondents use them, with only about 15% in the United States. Regarding the accuracy of centration of these IOLs, most respondents thought that an average of 7° of decentration had to be present before there was a visual problem, while 33% claimed that up to 10° off the intended axisbefore there was a problem. When using a toric IOL, the survey identified a 50/50 split on whether to flip the axis to aim for lower residual astigmatism levels or stay within the original axis.
There was no consensus regarding the diagnostics to use for power decisions or for axis decisions, he said.
"The survey found enthusiam for femtosecond laser incisions," Dr. Vukich summarized. "There were high levels of acceptable residual pseudophakic error after implantation of multifocal IOLs. There were high levels of acceptable rotational error in the intended axis for toric IOL patients. There was no consensus on flipping the axis or on the use of diagnostic devices. There was high confidence in laser vision correction."
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