New intraoperative devices may help improve cataract surgery outcomes

SEATTLE – Two speakers here at the Optometric Council on Refractive Technology meeting discussed how the ORA System (WaveTec) and Holos Surgical Wavefront Aberrometer (Clarity Medical Systems) can provide sphere, cylinder and axis measurements during cataract surgery to help ensure optimal visual outcomes.

The ORA Aberrometer fits on a surgical microscope, Jim Owen, OD, said at this meeting, which took place just prior to the American Academy of Optometry annual meeting.

Jim Owen

Owen said a separate monitor, which takes up little space in the operating room, shows the surgeon the data.

“It enables you to take aberrometry measurements before the IOL is put in and after,” he said. “You can make adjustments right in the OR.”

Owen said clinicians may ask: Does it slow the process? What happens if you get a different number? How much do you believe in it?

“I compare it to when we first started using wavescans,” he said. “If you have a good technician and get a good image, that wavefront is really right. But it’s hard for us to get away from the refractions. It’s the same with surgeons. They’re accustomed to using the IOLMaster (Carl Zeiss Meditec), and it’s hard to get used to this.”

Co-presenter Bill Tullo, OD, added: “There’s some talent to aiming the device.”

Bill Tullo

He said another significant aspect to using the ORA System is getting all of the viscoelastic out of the eye.

“The other big issue is how much pressure is in the eye,” he continued. “You can see the power change 2 D or more depending on if the eye’s filled. It takes some talent to learn how to use it, but, once you learn, it can be incredibly helpful.

“One technique we’ve used is to continually recheck the IOP to be sure the eye isn’t filled and the wounds are sealed,” Tullo added. “Otherwise, you’ll have problems getting consistent readings.”

Patient fixation can also impede accurate readings, he said.

Some surgeons use it on all patients, Tullo added.

Owen also discussed the Holos IntraOp, which takes aberrometry measurements in real time during the procedure.

“There are only a handful of prototype devices out there,” he said; “it’s in its earliest development.”

Owen and Tullo showed an intraoperative video where the surgeon pressed on the eye, and the device indicated real-time pressure changes. Another video showed how spinning the IOL around changed the pressure readings in real time.

Questions remain, Owen said: Does it interrupt patient flow? Does it improve powers?

“If this is reproducible and predictable, this is great,” he said. “If there are consistencies and we can look at outcomes down the line, it will be incredibly valuable.”

Disclosures: Tullo and Owen have no relevant financial interests to disclose.