1) The document discusses a new technology called ORange that allows surgeons to measure refractive error during cataract surgery using wavefront aberrometry.
2) Surgeons reported that using ORange improved refractive outcomes by enabling real-time adjustments like limbal relaxing incisions. It also reduced the need for post-operative enhancements.
3) While ORange adds only a few minutes to surgical time on average, surgeons found that it increased patient satisfaction by providing better visual outcomes earlier in the recovery process.
Tien Measuring Situation Awareness Of Surgeons In Laparoscopic TrainingKalle
The study of surgeons’ eye movements is an innovative way of assessing skill and situation awareness, in that a comparison of eye movement strategies between expert surgeons and novices may show differences that can be used in training. Our preliminary study compared eye movements of 4 experts and
4 novices performing a simulated gall bladder removal task on a
dummy patient with an audible heartbeat and simulated vital signs displayed on a secondary monitor. We used a head-mounted Locarna PT-Mini eyetracker to record fixation locations during the operation. The results showed that novices concentrated so hard on the surgical
display that they were hardly able to look at the patient’s vital signs, even when heart rate audibly changed during the procedure. In comparison, experts glanced occasionally at the vitals monitor, thus being able to observe the patient condition.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
Tien Measuring Situation Awareness Of Surgeons In Laparoscopic TrainingKalle
The study of surgeons’ eye movements is an innovative way of assessing skill and situation awareness, in that a comparison of eye movement strategies between expert surgeons and novices may show differences that can be used in training. Our preliminary study compared eye movements of 4 experts and
4 novices performing a simulated gall bladder removal task on a
dummy patient with an audible heartbeat and simulated vital signs displayed on a secondary monitor. We used a head-mounted Locarna PT-Mini eyetracker to record fixation locations during the operation. The results showed that novices concentrated so hard on the surgical
display that they were hardly able to look at the patient’s vital signs, even when heart rate audibly changed during the procedure. In comparison, experts glanced occasionally at the vitals monitor, thus being able to observe the patient condition.
Purpose: To evaluate the corneal volume (CV) before and after Ferrara intrastromal corneal ring segments (ICRS) implantation and its influence in clinical outcomes in keratoconus patients.
PURPOSE: To evaluate the long-term safety and effica- cy of Ferrara intrastromal corneal ring segments (ICRS) (Ferrara Ring; AJL, Boecillo, Spain) in patients with kera- toconus.
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Doktor Vedat Kaya, Canan Aslı Utine, Sezen Harmancı Karakuş, Işılay Kavadarlı ve Ömer Faruk Yılmaz tarafından hazırlanmış olan bu makaleyi ilginize sunarız.
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
INNOVATION IN RETINAL IMAGING: OPPORTUNITIES & CHALLENGES - History of Intrao...Healthegy
Presentation by Duke University Medical Center at OIS@ASRS 2016.
Participant:
Cynthia A. Toth, MD - Duke University Medical Center
Powered by:
Healthegy
For more ophthalmology innovation
Visit us at www.ois.net
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
INNOVATION IN RETINAL IMAGING: OPPORTUNITIES & CHALLENGES - History of OCT-AHealthegy
Presentation from OIS@ASRS 2016.
Participant:
David Huang, MD, PhD - Peterson Professor of Ophthalmology and Professor of Biomedical Engineering at OHSU
Powered by:
Healthegy
For more ophthalmology innovation
Visit us at www.ois.net
Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
Presentation from OIS@ASCRS 2016
John Hendrick, President & CEO
Video Presentation:
https://www.youtube.com/watch?v=c2J1g7HYuek&index=24&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw
Comparative Study of Visual Outcome between Femtosecond Lasik with Excimer La...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Doktor Vedat Kaya, Canan Aslı Utine, Sezen Harmancı Karakuş, Işılay Kavadarlı ve Ömer Faruk Yılmaz tarafından hazırlanmış olan bu makaleyi ilginize sunarız.
Resultados preliminares do implante de um novo anel associado ao PRK para pre...Ferrara Ophthalmics
Dr. Sandro Coscarelli, Dr. Pablo Rodrigues, Dr. Guilherme Rocha e Dr. Leonardo Torquetti compilaram e compartilham seus resultados com o uso de Segmentos de Anel de Ferrara HM associado ao PRK para a correção da miopia de pacientes com corneas finas e contra indicados para as técnicas de Excimer Laser apenas.
INNOVATION IN RETINAL IMAGING: OPPORTUNITIES & CHALLENGES - History of Intrao...Healthegy
Presentation by Duke University Medical Center at OIS@ASRS 2016.
Participant:
Cynthia A. Toth, MD - Duke University Medical Center
Powered by:
Healthegy
For more ophthalmology innovation
Visit us at www.ois.net
A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure.
INNOVATION IN RETINAL IMAGING: OPPORTUNITIES & CHALLENGES - History of OCT-AHealthegy
Presentation from OIS@ASRS 2016.
Participant:
David Huang, MD, PhD - Peterson Professor of Ophthalmology and Professor of Biomedical Engineering at OHSU
Powered by:
Healthegy
For more ophthalmology innovation
Visit us at www.ois.net
Dr. Guilherme Rocha, Dr. Paulo Ferrara, Dr. Leonardo Torquetti, Dra. Luciene Barbosa analisam os resultados dos implantes de Anel de Ferrara de Arco longo no pós operatório de 6 meses
Presentation from OIS@ASCRS 2016
John Hendrick, President & CEO
Video Presentation:
https://www.youtube.com/watch?v=c2J1g7HYuek&index=24&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw
Background: Nowadays, ICRS are a step in the treatment of keratoconus. The purpose of this study was to evaluate the refractive effect and the tomographic and biomechanical parameters in keratoconus patients implanted with Ferrara ICRS, and their stability after 18 months.
Presentation from OIS@ASCRS 2016
Mark Packer, MD, Chief Medical Officer
Video Presentation:
https://www.youtube.com/watch?v=CWwqmEDJOhM&index=20&list=PL1dmdBNnPTZJBhQxPOp0vdNg3s3wtN2yw
Variability of Corneal Deformation Response in Normal, Keratoconic, and Post-...asclepiuspdfs
Purpose: The purpose of the study was to determine the repeatability of corneal biomechanical properties obtained with Corvis-ST in normal, keratoconic, and post-LASIK eyes and compare the results between groups. Material and Methods: A total of 30 eyes of 15 subjects in each of the normal, keratoconus, and post-LASIK groups underwent Corvis-ST measurements. The intra-observer intraclass correlation coefficient (ICC) and precision were calculated to evaluate the repeatability of measurements for each group. One-way ANOVA and post hoc test were used for comparison of precision between groups.
Augmented Reality : Future of Orthopedic SurgeryPayelBanerjee17
I just wanted people to be aware of all the recent advancements occurring in surgeries, and in medicine. so here I'm uploading it in public. kindly look into it. also, you can check out my
https://thatindiangirl1.blogspot.com (blog)
Head-to-Head Comparative Study of Two Optical Biometric Devices in Modern Cat...SM2 Strategic
Today's cataract surgeon has adopted non-contact optical
biometry as the standard of care in performing IOL calculations.
While modern formulae incorporate multiple variables as part
of their calculations, Axial Length and Keratometry readings
continue to be the inputs that are most influential in determining
IOL power. Some of the newer generation formulas such as
Holladay 2 and Olsen now incorporate more elements to help
increase accuracy.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Using real time feedback during cataract surgery to improve refractive outcomes (2)
1. Using Real-Time Feedback During Cataract
Surgery To Improve Refractive Outcomes
8 Shareef Mahdavi • SM2 Strategic • Pleasanton, CA 7
Wavefront aberrometry has become a common method outcomes for cataract surgery. Significant innovation
of determining refractive error in conjunction with corneal that is taking place in lens technology as well as lens
refractive surgery (e.g., LASIK). The technology has now placement creates a need to improve other aspects of
been adapted for use in cataract surgery, providing surgeons the surgical process, including how refractive error is
with a tool that allows them to measure refractive error during measured and handled.
surgery. WaveTec Vision (Aliso Viejo, CA) began commercial- ORange constitutes the first-ever ability to con-
izing ORange,® their intraoperative wavefront system, in early veniently perform wavefront-guided refractions on
2009. The company asked SM2 Strategic to conduct inter- patients during cataract surgery itself. The device is
views with a group of surgeons who have the most experi- mounted directly to the surgeon’s operating microscope
ence with the technology. and measurements are taken in the same co-axial line
The five surgeons collectively have treated over 800 eyes of sight used to visualize the eye and perform surgery.
using this intraoperative wavefront system, which is based on The device is connected to a separate workstation that
Talbot Moiré interferometry. The purpose of this paper is to is used to display refractive results for the surgeon.
better understand the way this technology has impacted how The software analyzes the data to give surgeons real-
surgeons approach their cases, especially with respect to the time information regarding sphere, cylinder and axis,
treatment of cylinder. Consequently, surgeons described how enabling them to make decisions regarding the need
this tool is being used to bring immediate improvement over to reduce residual and/or induced astigmatism while
previous visual outcome results and how this impacts patient still performing the procedure. The software provides
satisfaction. Equally important, analysis of the impact on both real-time wavefront-guided refraction readings follow-
time (surgical time per case) and money (incremental surgi- ing limbal relaxing incisions that allow physicians to
cal fee per cases) is shown to give further optimize the LRI's
surgeons evaluating the technology Table 1: Surgeons Interviewed for ORange and reduce remaining astig-
for their ASC or hospital a sense of SURGEON/LOCATION TOTAL CASES TO DATE matism. When using Toric
how it can be implemented. Finally, Eric Donnenfeld, MD 125 IOLs, the software similarly
qualitative comments by those Garden City, NY provides data to confirm axis
interviewed are included to give Stephen Lane, MD 66 placement or to rotate the
Minneapolis, MN
surgeons a sense of how this tech- IOL to optimize results.
Mark Packer, MD 77
nology fits in to the rapidly evolving Eugene, OR Interviews were conducted
field of cataract surgery. Dan Tran, MD 228 with five of the leading users
Newport Beach, CA (see Table 1), all of whom
Background Robert Weinstock, MD 314 are also adept cataract and
Largo, FL
For the past decade, the use LASIK surgeons. Early stud-
of wavefront aberrometry for laser vision correction ies performed by these surgeons and their colleagues
has steadily increased. First employed as a diagnostic showed that using ORange for cases where the patient
tool to allow comparison with manifest refraction, it presented with astigmatism did indeed lead to a
has emerged as the dominant method of refraction in reduction in post-operative cylinder when compared
LASIK, with wavefront data being used to program or to not using the intraoperative wavefront device.
“drive” the laser in the majority of cases performed This was due to the ability to perform LRI (planned
in the United States, according to data reported by and unplanned), take additional readings, and then
Market Scope. Results for customized approaches to perform another LRI if necessary. In these studies,
LASIK have improved over conventional approaches surgeons reported mean reduction in cylinder of 0.5
that utilized manifest refraction. Thus, it makes sense diopters that could be attributed to the surgical inter-
to consider whether or not a similar application of vention allowed by ORange. With more experience,
wavefront technology could be utilized to improve surgeons are finding that the real value of the technol-
2. ogy resides in the “outliers” that are prevented by using you use it; then it becomes a ‘must have’,” noted Dr.
ORange. “Outliers are very expensive,” noted Dr. Mark Eric Donnenfeld. The immediate feedback has made LRI
Packer. “There’s a huge cost not reflected in the expense viable once again as a treatment modality. “I didn’t do
of doing a LASIK enhancement; it’s the cost of a patient LRIs prior to ORange; it’s now part of my standard tool-
in tears who returns after surgery and says ‘I can’t see kit,” noted Dr. Stephen Lane, who now uses it routinely
well’ and tells people they had surgery with me and look in patients with astigmatism who are having conventional
what happened.” The ability of a technology to prevent monofocal implants.
this scenario — and positively impact patient referrals —
is of significant interest. Impact on Enhancements
A direct by-product of increased intraoperative inter-
Impact on Surgical Approach vention is the corresponding reduction in the need for
post-operative enhancement. Across the board, the sur-
Patient Selection geons reported a significant decrease in the number of
Surgeons report that ORange is used with four types patients needing enhancement in the 1 to 3 month post-
of cataract patients: operative period. Within this group, two surgeons pub-
1. Corneal astigmatism that requires correction lished studies with relevant data: Dr. Packer performed a
2. Refractive cataract cases involving either toric or retrospective study to determine the impact of wavefront-
presbyopia-correcting IOLs guided LRIs at time of surgery on the rate of future post-
3. Prior corneal refractive surgery (e.g., LASIK or RK) operative laser enhancement. In the first group of patients
4. High myopia (n=37 eyes) that were not measured with ORange, 6/37
Additionally, Dr. Dan Tran indicated that he will use (16%) went on to have LASIK enhancement. In a sec-
ORange to help “referee” any discrepancies in his pre-op ond group of patients (n=30 eyes) with similar pre- and
numbers or calculations. While the overall mix of cases post-operative characteristics that were measured with
varies among these surgeons, they are all performing ORange, only one (3%) of the eyes went on to have
“premium” cataract surgery that comprises the refractive LASIK enhancement, as 8/30 (27%) eyes received LRI
IOLs as well as conventional monofocal IOLs. The need during the primary procedure based on ORange findings.
for astigmatic correction typically occurs in about one of Dr. Packer contends that the results achieved in the study
every three cases, some of which is not recognized during demonstrate the potential for cataract surgeons to reduce
pre-op examination, according to these surgeons. the burden on their patients and themselves by eliminat-
ing the need for additional procedures.
Surgical Intervention In a study focused specifically on 48 post-LASIK
The availability of intraoperative wavefront refrac- patients that subsequently required cataract surgery, Dr.
tions has created a new paradigm for the cataract Tran discovered that the ORange refractive readings pro-
surgeon. Prior to ORange, the desire for a LASIK-like vided significantly greater predictability of final refraction
outcome was dependent on the excimer laser to fine- vs. intended than a historical control group as reported
tune results in accordance with patient expectations, a by Warren Hill, MD et al. In essence, the corneal distor-
process that typically occurs several weeks to months tion created by prior refractive surgery made data from
following the primary procedure. As an alternative to ORange more reliable than that obtained from other
laser, LRI has also been used an enhancement tool. But available diagnostics (Pentacam, IOL Master, Manifest
the results, according to Dr. Robert Weinstock, were “hit Refraction). Additionally, Dr. Tran concluded that the
or miss” and didn’t account for wound-induced cylinder. need for enhancement based on study data dropped from
“We employed a ‘wait and see’ philosophy for the first 23% of eyes to 6%, a nearly four-fold decrease.
few weeks and then performed either LRI or excimer.”
This variability in LRI outcomes limited its use and kept Impact on Patient Satisfaction
surgeons from aggressively treating pre-existing or resid- The ability of ORange to increase overall patient sat-
ual astigmatism. isfaction is also evident among the surgeons who were
What’s changed is the ability to fine-tune the LRI interviewed. “I am better able to nail the result and
during the primary cataract procedure; real-time refrac- reduce the need for the patient to come back for more
tive data is being used to affect a real-time change in the surgery,” exclaimed Dr. Donnenfeld. “These two go
refractive outcome. “This seems like a ‘nice to have’ until hand-in-hand in creating happier patients.” The value
3. Figure 1: Impact of ORange on Surgical Enhancement Plans for LRI had them cancelled
based on intraoperative read-
149 Consecutive Cases
ings. The balance of surgical
2% Toric Axis Change from Preop Plan
changes made are shown in
Figure 1. The impact on surgi-
18% Unplanned LRI cal protocols are mirrored by
the impact on Dr. Weinstock
38%
Changed himself, who was initially
Surgical
62%
No Change
Plans 1% Lens Implant Changed from Preop Plan resistant to the study concept
of Surgical
Plan 10% LRI Axis Change from Surgical Plan but then became excited after
seeing what transpired: “This
5% Did not Perform Planned LRI
is a great feeling of accom-
2% Unplanned LRI Enhancement
plishment that sends me into
the next operating room on a
proposition for the patient is clear to Dr. Weinstock: more positive note because I know I’m going to get better
“We are seeing many more 20/40 or better patients on results than I did previously.”
Day One post-op, which means more smiling faces and
excitement.” Added Dr. Tran, “ORange allows me to Impact on Surgical Time
create immediate patient satisfaction that I wasn’t get- One important factor is the impact on total time to
ting before. I now have patients who are happier in perform a cataract procedure. Once the learning curve
their first 3 months, many of whom will never need that for the technology has been achieved, surgeons are esti-
enhancement.”All of the surgeons voiced the ability to mating it takes an extra 2-3 minutes per case to incor-
enhance the “wow” response by patients as moving in porate ORange. A Company-initiated time and motion
the direction of LASIK outcomes. “Historically, patients study (See Figure 2) confirmed the surgeons’ subjective
had to wait weeks and months to see well after cataract impressions about the additional time required. A single
surgery,” said Dr. Donnenfeld. “ORange increases the measurement took 21 seconds on average to perform.
chances that we can make the Day One post-op experi- When additional measurements as well as surgical inter-
ence much better. This is a critical moment that I believe vention (i.e., for LRI) was factored in, the total impact
is when patients are most excited and most likely to tell was to add 2-4 minutes of surgical time per case. This
their friends about what happened.” He added, “I never time can be further sub-divided into that required to
want to hear a patient say on day one, ‘I thought I’d see measure the eye (average of 45 seconds, taking into
better than this.’” While direct measurement of patient account multiple measurements), with the balance of
satisfaction is difficult to obtain, Dr. Lane’s metric is put the time devoted to the surgeon thinking and then act-
this way: “fewer patients are coming back wanting me to ing upon the data at hand. “This technology causes
do more. That’s really good.” me to think on my feet more quickly,” exclaimed Dr.
Weinstock.
Consecutive Case Study
Early results from a study to assess the impact of this Figure 2: Impact on Surgical Time
technology on all cataract cases is showing the potential Surgeons Donnenfeld, Lane, Packer, Tran, Weinstock
of ORange to improve overall outcomes by changing # Of Cataract Cases Measured 45
the way surgeons approach their cases. ORange was Average Time Per Cataract Procedure 12 minutes (range: 6 to 25 minutes)
used to measure eyes on 156 consecutive cataract cases # Of ORange Measurements in Procedure # Cases
One Reading: 18
performed by Dr. Weinstock that included monofocal, Two Readings: 13
toric and presbyopia-correcting IOLs. Successful images Three Readings: 8
Four Readings: 4
were obtained on 96% of cases or 149 eyes. Of those, 56
TOTAL 45
eyes (56/149 = 38%) had their surgical plan changed as Average Time for Each ORange Measurement 21 seconds
a result of the ORange readings. The majority of these Average Time for All ORange Measurements 45 seconds
(26/149 = 18%) underwent LRI not previously planned ORange as a % of Total Surgical Time 7%
but indicated by the intraoperative readings. The inverse Typical Increase in Surgical Time – 2-4 minutes
Including Intervention
was also true, as 8 eyes (8/149 =5%) originally scheduled