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A new user's experience with an intraoperative wavefront aberrometer
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The visual acuity expectations of cataract patients have almost surpassed those of refractive patients. To achieve the best results for my patients, I have recently begun to use the Optiwave Refractive Analysis System from WaveTec Vision. My initial experience has been very positive and has brought the following observations:
Denise Visco
1. As in most instances in life, practice makes perfect. I use the ORA System for every patient. I encourage other new users to practice as much as possible in the beginning, which means to take measurements on aphakic patients and then again after the IOL is inserted, even if you are not performing a limbal relaxing incision or using a premium lens. This will give you the feel of what the post-IOL placement readings will be. Doing this for a couple of months will perfect your understanding of the information the aberrometer provides and allow you to use that information to get the best outcomes for your patients. In addition, it allows you to practice taking precise measurements, and it really is something that you get better with the more you do it.
2. An intraoperative aberrometer is a tool, and like any other, it requires the skill and expertise of the user. A hammer does not drive a nail without the skill of the carpenter handling it. As with any data, you will occasionally get outliers, which have to be weighed against all of the preoperative data. There are specific situations in which new surgeons should be cautious when receiving information from the intraoperative system. The answers will be correct, but the circumstances may be based on surgical factors and not the innate refraction. This could be true if it is a very small eye and the speculum is pressing on the eye, or if there is some incisional edema present. In most cases the cylinder measurement is more likely to be affected than the spherical one. However, the ophthalmologist always needs to take into account every aspect of the situation. That said, if the surgeon is ever to trust outlier data, it would be with a post-refractive patient. In these patients, the ORA System really excels.
3. Surgeons with previous refractive experience will find using the aberrometer very intuitive because it is similar to the scope on various lasers. I like to put my hand on the patient’s forehead and tilt or move it slightly at the same time that I am moving the microscope to line up the reticule in the center and focus on the axis. As one might expect, having patients minimally sedated for surgery also enables more effective fixation. Finally, I have found that if a patient is breathing heavily, it is easier if they rock in and out of focus. Rather than chasing them around, I get eight to 10 measurements when they rock into focus and before they rock out of focus. I then wait a few seconds until they rock in again and continue my measurements.