December 2019


Best of ASCRS 2019: Refractive

by Liz Hillman EyeWorld Editorial Co-Director

John Hovanesian, MD


The Best of ASCRS 2019 is a general session at the ASCRS ASOA Annual Meeting where members of the EyeWorld Editorial Board select what they think were the best papers in different categories from the meeting. They choose from the papers that were awarded Best Paper of Session in each individual paper session throughout the meeting and explain why they made their selections. Here we recap what those papers were in the Refractive category and why John Hovanesian, MD, a member of the EyeWorld’s Editorial Board, thought they were noteworthy.

Clinical and patient reported outcomes of different combinations of diffractive and extended depth of focus IOLs

Jan Venter, MD, Stephen Hannan, OD

This was a retrospective study that included the following lens combinations: Symfony (Johnson & Johnson Vision)/Symfony (n=2,925, mini-monovision in most cases), Tecnis 2.75 (Johnson & Johnson Vision)/Tecnis 2.75 (n=3,362), Symfony/Tecnis 2.75 (n=1,250), and Symfony/Tecnis 3.25 (Johnson & Johnson Vision) (n=665).
Of those in the Sym/Sym group, 84.2% were able to see 6/6 or better; 87.7% in the 2.75/2.75 group saw 6/6 or better; and 86.1% in the Sym/2.75 group achieved uncorrected distance visual acuity as did 88.1% in the Sym/3.25 group. Uncorrected near vision was best in the 2.75 bilateral group and in the Sym/3.25 group at 91.6% and 93.4%, respectively.
Glare and halo were worse in the bilateral Sym/Sym group compared to the other combinations of higher add Tecnis lenses. The study concluded that the 2.75 bilateral seemed to be most preferred by patients and surgeons.

Intraop OCT vs. postop OCT for phakic IOL vault: a comparative study

Shady Awwad, MD, Julien Torbey, MD, Carl Jo Mehanna, MD, Maamoun Abdul Fattah, MD

Dr. Hovanesian said he thought this was interesting research because “we are on the verge of getting intraoperative OCT in the U.S., and I don’t think we realize all the benefits it could give us.”
Predicting the size of an ICL to put in the eye is currently done based on white-to-white diameter, Dr. Hovanesian said, which is not very accurate. This study performed intraoperative OCT and compared it to postoperative OCT ICL vault at different benchmarks out to 90 days postop on 42 eyes of 24 patients. There was a slight decrease in vault from postop day 1 over the course of 3 months.
Intraoperative measurement, Dr. Hovanesian said, may provide a better idea of what lens to use before implanting and may have many other benefits for routine cataract surgery.

Development, use, and results of novel analytic software to improve the accuracy of
topography-guided LASIK

Mark Lobanoff, MD

Topography-guided LASIK should, in theory, improve the accuracy of LASIK outcomes, but Dr. Hovanesian said the challenge is tolerances among differences between topographic measured astigmatism and subjective (manifest) astigmatism. The recommendation is there be less than 0.75 D difference between the two to use the Contoura topography-guided LASIK system (Alcon). Only about 10% of patients fit this criteria, Dr. Hovanesian said.
This research used a mathematical model that takes the surface topography and puts it together with other information in the hope of improving visual acuity with consistent results (Phorcides), Dr. Hovanesian said. The system factors in topography, cylinder, and a nomogram.
One-month postop results of patients treated with the information from the Phorcides nomogram showed 56% of patients achieved 20/15 or better, 93% of patients achieved 20/20 or better, and 99% 20/25 or better.
“The idea is that this software will allow us to take the engine of topographic-guided ablation and pair it with some math that allows better accuracy for treatment,” Dr. Hovanesian said.

Editors’ note: The session is available on demand at for those who attended the 2019 ASCRS ASOA Annual Meeting.

About the doctor

John Hovanesian, MD

Harvard Eye Associates
Laguna Hills, California

Relevant financial interests

: Alcon, Johnson & Johnson Vision, Carl Zeiss Meditec

Contact information


Best of ASCRS 2019: Refractive Best of ASCRS 2019: Refractive
Ophthalmology News - EyeWorld Magazine
283 110
220 138
True, 12