As more patients select premium intraocular lenses (IOLs) surgeons are increasingly challenged to hit precise refractive targets. Even small inaccuracies in preoperative measurements or minor surgical variations can result in less than optimal outcomes. However, surgeons currently have no way to measure success until weeks or months after a procedure.
A new device, the ORange™ Intraoperative Wavefront Aberrometer (WaveTec Vision™), that is scheduled to become commercially available in early 2009, will enable cataract surgeons to check a patient’s refraction during surgery. Surgeons will then be able to make adjustments during the initial surgery, as opposed to waiting for the patient to heal and then determining whether another surgery is necessary.
Attached to the operating microscope, the ORange aberrometer captures refraction in a few seconds. It then displays the sphere and cylinder result on a computer screen in the operating room, where the surgeon can easily view it during the procedure.
The ORange aberrometer can obtain refraction on aphakic eyes, as well as through a multifocal IOL, making it useful in several applications. In astigmatic patients, the device can be used to ensure proper alignment of a toric IOL, or it can be used to determine whether a limbal relaxing incision has corrected the necessary amount of cylinder. In addition, the device can confirm the refractive status of an eye immediately after IOL implantation, including phakic IOLs.
While the ORange is easy to incorporate into a surgical routine, a couple pearls will help maximize results with the device. Make sure the lid speculum does not compress the globe, as this could induce misleading intraoperative astigmatism readings. Additionally, when comparing the ORange intraoperative reading to subsequent readings taken days or weeks after surgery, be aware that some discrepancy may occur due to postoperative edema. However, the ORrange reading during surgery should match the final outcome once the edema has subsided.
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