Clinical Scorecard: Democratizing Precision in Cataract Surgery

At a Glance

Key Highlights

• Manual LRIs are effective but have variable outcomes and require significant surgical training.
• Femtosecond laser-assisted cataract surgery (FLACS) offers consistent LRIs but is costly and may not justify expense for all patients.
• ArcDUO is a single-use, sterile ophthalmic knife designed to provide controlled-depth arcuate incisions with laser-like precision at lower cost and ease of use.

Guideline-Based Recommendations

Diagnosis

• Assess extent of corneal astigmatism using biometry, corneal topography/tomography.
• Evaluate corneal thickness (central >500 microns, peripheral >600 microns at 9 mm).
• Consider lenticular astigmatism and expected postoperative corneal astigmatism.

Management

• Use Donnenfeld nomogram for LRI arc length determination.
• Select appropriate treatment diameter (9 mm or 10 mm) and arc length (15°, 30°, 45°, 60°) with ArcDUO.
• Perform LRIs perioperatively or postoperatively depending on residual astigmatism.
• Consider complete correction aiming for plano vision especially in patients with multifocal IOLs.

Monitoring & Follow-up

• Evaluate postoperative astigmatism at day 1, week 1, and month 1.
• Monitor best-corrected visual acuity (BCVA) to assess visual outcomes.
• Observe for potential overcorrection and regression; incisions can be reopened if necessary.

Risks

• Potential for overcorrection and regression of astigmatism during corneal healing.
• No adverse events or corneal perforations reported in initial ArcDUO cases.
• Limitations include small sample size and variable follow-up data.

Patient & Prescribing Data

Patients with regular corneal astigmatism <1.5 D undergoing cataract surgery with monofocal or multifocal IOLs

ArcDUO use resulted in mean postoperative astigmatism near zero and BCVA averaging 20/22 at one week and one month, with high patient satisfaction and no reported adverse events.

Clinical Best Practices

• Ensure good centration and suction of the ArcDUO docking ring for optimal incision alignment.
• Use ArcDUO for both perioperative and postoperative correction of corneal astigmatism.
• Aim for complete astigmatism correction in patients with high visual demands or multifocal lenses.
• Apply the Donnenfeld nomogram consistently to guide incision arc length.
• Recognize the short learning curve and simplicity of ArcDUO compared to manual LRIs.

References

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