More than 2 million implantable collamer lenses (ICLs) have been implanted worldwide. With a central port to improve aqueous flow through the ICL, the latest iteration of this phakic intraocular lens (pIOL) has been shown to have stable outcomes with very low rates of adverse events. However, correct planning and ICL size selection continue to be important to achieve an optimal vault. Shallow or excessive vaults are not complications in and of themselves but may increase the risk of complications. Historically, surgeons have relied on measurements of anterior chamber depth (ACD) and manual, caliper-measured white-to-white (WTW) distance to select the ICL size. New diagnostic and imaging technologies such as optical coherence tomography (OCT) and ultrasound biomicroscopy (UBM) provide additional opportunities for visualization and measurement of the intraocular dimensions involved in phakic intraocular lens implantation, including sulcus-to-sulcus (STS) and angle-to-angle (ATA) diameters. This paper reviews various approaches to ICL planning and sizing that have been published in the peer-reviewed literature, all of which produce acceptable results for predicting vault and size selection. Surgeons may also want to identify a methodology for patient evaluation and ICL size selection that best aligns with their personal preferences, diagnostic technology, and familiarity with analytical optimization tools. Plain Language Summary: Phakic intraocular lenses (pIOLs) are one method for correcting nearsightedness, with or without astigmatism. This category of refractive surgery has been growing rapidly in the US and around the world. Implantation of the implantable collamer lens (ICL), one type of pIOL, is safe and effective, with stable outcomes and low adverse event rates. When complications do occur, they are typically associated with an inappropriate vault, or distance between the implant and the natural lens. Preoperative planning and accurate ICL sizing are required to achieve an optimal vault and varies, depending on the diagnostic technology available to the surgeon. This paper reviews the current approaches to ICL planning and sizing in order to provide guidance to surgeons implanting this pIOL.

The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a “de-prioritization” of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.

Peer reviewed article authored by (Cummings AB, Kelly GE). Read article or submit your manuscript for publishing.

To compare the intended versus the resultant thickness of laser in situ keratomileusis (LASIK) flaps created with a new femtosecond laser and to report the 3-month postoperative refractive outcomes. Wellington Eye Clinic, Dublin, Ireland. Retrospective consecutive case series. A consecutive series of eyes having LASIK flaps created using a Wavelight FS200 femtosecond laser were included in this analysis. Eyes with preoperative spherical equivalent (SE) myopic refractive errors up to -12.00 diopters (D), hyperopic refractive errors up to +5.50 D, and astigmatism up to 6.00 D received primary LASIK. Outcomes included postoperative flap thickness and 3-month postoperative refraction. Outcomes in 431 eyes of 258 patients having LASIK with femtosecond flap creation were assessed. With an intended flap thickness of 120 μm, the mean post-LASIK flap thickness was 120.23 μm ± 13.94 (SD). In 349 of 813 eyes, EX500 optical pachymetry measurements were compared with Scheimpflug pachymetry readings. The mean corneal thickness was 553.52 ± 29.81 μm with optical pachymetry and 553.39 ± 29.12 μm with the Pentacam rotating Scheimpflug camera. In 162 eyes, the flap thickness was measured with optical coherence tomography; the mean was 121.94 ± 10.52 μm. Achieved flap dimensions were as intended. This study provides evidence of the predictability and lower variability of LASIK flaps created using the femtosecond laser. Consecutive patients having LASIK had good, predictable, and stable outcomes at the 3-month mark.

Purpose: To explore the efficacy, safety, and predictability of topography-guided laser epithelial keratomileusis (LASEK) and LASIK treatments using the ALLEGRO Oculyzer (rotating Scheimpflug image-based) as compared to the ALLEGRO Topolyzer (Placido disk-based) platform (WaveLight AG). Methods: In this retrospective, non-comparative case series, 72 eyes were treated using Oculyzer data and 71 eyes were treated using Topolyzer data. Seventy-nine men and 64 women ranging in age from 21 to 63 years were included in the study. The 6-month postoperative uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) of patients were compared to the preoperative values. The data analysis was stratified based on the preoperative refractions, separating patients into three categories: myopes, hyperopes, and mixed astigmatics. Results: Of the preoperative myopes in the Oculyzer group, 76% remained the same, 5% lost 1 line, 14% gained 1 line, and 5% gained 2 lines of visual acuity at 6 months. In the Topolyzer group, 69% remained the same, 25% gained 1 line, and 6% gained 2 lines of BSCVA. Using the Oculzyer, 95% of myopes, 80% of hyperopes, and 60% of patients with mixed astigmatism were within ±0.50 diopters (D) of target refraction. Using the Topolyzer, 88% of myopes, 78% of hyperopes, and 50% of patients with mixed astigmatism were within ±0.50 D of target. The outcomes of the preoperative hyperopes and patients with mixed astigmatism are similarly reported. The difference in outcomes between the Oculyzer and Topolyzer cohorts in the myopes and patients with mixed astigmatism was not statistically significant. In the hyperopes, patients treated with the Oculyzer had superior UCVA to those treated with the Topolyzer platform. Conclusions: This case series demonstrates that the Oculyzer and Topolyzer are both effective tools in topography-guided corneal excimer laser surgery. In myopes and patients with mixed astigmatism, both systems were comparable in efficacy and safety. In the hyperopes, the resultant UCVA in the Oculyzer cohort was slightly superior.

Purpose: To compare the accuracy of pre-operative corneal measurements obtained with four devices, and the refractive outcomes of two optical biometers. Setting: Private practice. Design: Retrospective. Methods: Data taken from biometric measurements on 299 consecutive eyes prior to cataract surgery were retrospectively analyzed using the Argos SS-Optical Biometer and the Lenstar LS900 PCI optical biometer. As part of the standard cataract surgery pre-operative exam, patients also underwent placido disk topography and Scheimpflug tomography. Keratometry, anterior chamber depth, corneal diameter, pupil diameter, central corneal thickness and axial length were all measured. The comparable measurements were compared. Finally, for those eyes where cataract surgery was performed, the post-operative refractive results were compared to the predictive results of the two biometers. Results: The SS-OCT Argos was able to measure all eyes, while five eyes could not be measured with the Lenstar LS900 PCI. Axial length measurements were performed only with the Argos and Lenstar devices. The eyes that could not be measured by the Lenstar LS900 PCI included dense grade IV nuclear sclerosis and large posterior subcapsular cataracts. In the primary endpoints, there was strong correlation between the Argos and the Lenstar devices in eyes with an axial length between 20 and 30 mm. Conclusion: The predictive accuracies of the Argos Optical Biometer and Lenstar LS900 PCI are similar, except in medium and long eyes, in which the predictive accuracy of Argos SS-OCT biometry was higher. The Argos system was found easier to use by technicians when compared to the other biometry devices.