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A new offset system (Torsion Error Detection, Nidek) for alignment control measures the distance between the line of sight and the visual axis as well as the difference between photopic and mesopic fixation images. The amount of translation needed to match these images can be an indicator of poor fixation. The offset system allows detection and definition of line of sight and visual axis positions.

The American Society of Cataract and Refractive Surgery's Refractive Surgery Survey reached the 10-year mark in 2006. The results show an increase in epi-LASIK, advanced surface ablation, and wavefront-guided procedures and continued surprises regarding some standard-of-care issues.

Mixing and matching multifocal IOLs appears to be a safe and effective approach, according to a study of two lenses from the same manufacturer (Tecnis and ReZoom, Advanced Medical Optics). The surgeon who conducted the research provides pearls for using this technique.

A new corneal template (OptiPoint, Refractec) for conductive keratoplasty ([CK]; ViewPoint CK, Refractec) was designed to address existing challenges of the procedure to make CK easier to learn and perform while improving the consistency of the results. Those benefits along with good refractive and vision outcomes have been achieved in clinical use.

A prospective, randomized, single-site, multi-surgeon study of two platforms for wavefront-guided LASIK for the treatment of myopia underlines the excellent performance of advanced laser technology and ablation algorithms.

Initial findings from a prospective randomized study comparing a conventional ablation (LADAR4000, Alcon Laboratories) and wavefront-optimized technique (Allegretto, WaveLight) for hyperopic LASIK favor the latter for better predictability and vision outcomes. The results are considered excellent for both, however. Initial results from clinical experience with wavefront-guided hyperopic LASIK (CustomCornea, Alcon Laboratories) are also presented.

Iris registration with compensation for cyclorotation and centroid pupil shift seems to be essential for further improvement of refractive outcome and patient satisfaction. Ignoring the pupil centroid shift can lead to sub-optimal results in wavefront-driven refractive surgery.

The unique, three-dimensional configuration of a dual accommodating IOL (Synchrony, Visiogen) mandates careful surgical technique to ensure optimal implantation and postoperative results. Based on experience in more than 100 eyes, Victor Bohorquez, MD, outlines some of the important considerations.

In eyes undergoing LASIK, use of one proprietary microkeratome (Zyoptix XP, Bausch & Lomb) yields a low rate of complications, good uncorrected visual acuity, and refractive precision in a review by two surgeons in the same practice.

A femtosecond laser (IntraLase, Advanced Medical Optics) and microkeratome (M2, Moria) differ when it comes to changes in the flap and stromal bed that develop between primary LASIK and enhancement procedures. A greater increase in flap thickness at the time of enhancement after myopic LASIK might be the result of epithelial hyperplasia, according to Ronald Krueger, MD, speaking at the annual meeting of the American Society of Cataract and Refractive Surgery.

A new excimer laser platform (Technolas 100, Bausch & Lomb) is equipped with eye-tracking technology for static and dynamic eye alignment and can be integrated with online optical coherence pachymetry (OCP). Clinical experience demonstrates the performance of OCP and the value of static and dynamic rotational eye-tracking for improving LASIK outcomes.

Tracking of dynamic rotational eye movements during LASIK is especially important for obtaining good ablation results, considering that 29% of eyes can rotate 5° or more when the patients shift from the sitting to the supine position.

When a prospective, randomized study was undertaken to investigate the outcomes of "mixing and matching" different multifocal IOLs in fellow eyes, results showed differences between the lenses in intermediate and near vision, and one-third of patients sought IOL exchange.

Various multifocal IOL technologies may afford better visual acuity results than implantation of a single multifocal IOL model bilaterally, but implanting an accommodating IOL (crystalens, eyeonics) and a multifocal implant in fellow eyes appears to have no advantage over bilateral implantation of the accommodating IOL, according to analyses presented by Guy M. Kezirian, MD.

Hyperopic LASIK ablation centration on the entrance pupil center versus on the corneal vertex was compared in a prospective randomized study. The results favored the corneal vertex centration technique because it induced a more prolate profile and was associated with less induction of coma-like aberrations.

No surgical procedures are without the risk of complications. The most frequently occurring complication after Descemet's stripping endothelial keratoplasty is detachment of the donor button. Attachment is easily achieved with rebubbling in a high percentage of cases. Optical coherence tomography is very useful to observe the interface and elucidate the cause of detachments.

When a prospective, randomized, observer- and subject-masked study compared an aspheric IOL and a spherical, single-piece IOL for functional performance after implantation in contralateral eyes, contrast sensitivity testing and night-driving performance results favored the aspheric IOL.

A series of prospective, randomized, masked studies was conducted to compare aqueous concentrations and prostaglandin E2 (PGE2) inhibition achieved in patients undergoing cataract surgery and treated preoperatively with different topical nonsteroidal anti-inflammatory drugs (NSAIDs). The results suggest the superiority of ketorolac 0.4% (Acular LS, Allergan) for preventing inflammation and cystoid macular edema after cataract surgery.

A new microincision cataract surgery system (Stellaris Vision Enhancement System, Bausch & Lomb) is a flexible system designed to support rapidly evolving trends in microincision surgery. A full range of ancillary instruments is provided and designed to reduce the learning curve for surgeons.

A comparison of dynamic IOP values during cataract extraction by phacoemulsification using high and low flow found that lower bottle heights result in lower fluctuations of IOP. An enhanced fluidics management system allows the use of a lower bottle height with concomitant use of high vacuum and aspiration flow rate, without compromising the stability of the anterior chamber.

A new phacoemulsification system (WhiteStar Signature with Fusion Fluidics, Advanced Medical Optics) combines existing phaco technology with a dual-pump fluidics system designed to enhance chamber stability. In addition, the technology offers a streamlined user interface and accessories that aim to enhance the efficiency of the operating room.

Cataract surgeons can reduce the rate of complication from intraoperative floppy iris syndrome (IFIS) by using certain techniques before and during surgery.

Results of a retrospective study show good visual acuity outcomes at near, intermediate, and distance, and high rates of satisfaction can be achieved using a strategy combining an accommodating IOL (crystalens, eyeonics) in one eye with the apodized diffractive multifocal IOL (AcrySof ReSTOR, Alcon Laboratories) in the other eye in patients undergoing cataract surgery or a clear lens exchange procedure.

Bimanual phacoemulsification wounds allow significantly greater ingress of fluid from the ocular surface compared with a microcoaxial incision. Even with the smallest of clear corneal incisions, wound integrity is critical. Surgeons should always look for incision distortion at the end of the case and should not hesitate to suture if necessary.

Robert H. Osher, MD, has designed a new phacoemulsification tip with a less angled tip configuration for use during microcoaxial techniques. It offers surgeons who prefer using a straight tip during phacoemulsification procedures the advantages of torsional ultrasound.

Bilateral implantation of the aberration-free aspheric IOL (SofPort AO, Bausch & Lomb) in a monovision approach can provides cataract surgery patients excellent binocular distance and near uncorrected visual acuity (UCVA) with high rates of spectacle independence and low rates of night-time vision complaints.

A refractive multifocal IOL (ReZoom, Advanced Medical Optics) is an effective method for diminishing dependence on glasses for refractive cataract surgery patients.

Use of an apodized diffractive IOL in patients needing cataract surgery after prior refractive surgery is considered to be contraindicated, but excellent outcomes can be achieved if optical results are near emmetropia. Success depends on control of surgically induced astigmatism, use of accurate formulae, careful patient selection, and enhancement as necessary.