Sponsored by Nidek

Better Preoperative Testing,Better Surgical Outcomes
Fast, easy, accurate imaging and analysis with the AL-Scan Optical Biometerand CEM-530 Specular Microscope.
Two surgeons share how the AL-Scan Optical Biometer andCEM-530 Specular Microscope help them optimize the outcomes ofcataract and refractive surgeries with fast collection of key data.

AL-Scan Optical Biometer
By Farrell “Toby” Tyson, MD
In the 2 years I have been using the state-ofthe-art AL-Scan Optical Biometer (Nidek), it has
become the biometer of choice for both my technicians and me. All of our biometers offer highly
accurate axial length and the good average keratometry weneed for IOL calculation formulas, while next-generation
devices also take into account anterior chamber depth andwhite-to-white distance.
Our AL-Scan offers all of the metrics. In a 10-second testwith the AL-Scan, we obtain six measurements for cataract surgery: axial length, corneal curvature radius, anteriorchamber depth, central corneal thickness, white-to-white
distance, and pupil size. That is with half the test time of ourIOLMaster (Zeiss) and a quarter of the time required for ourLenstar (Haag-Streit). Obtaining calculations two to fourtimes as fast as other biometers is beneficial in a busy clinic.

In a 10-second test with the AL-Scan,
we obtain six measurements forcataract surgery: axial length, corneal
curvature radius, anterior chamber
depth, central corneal thickness,
white-to-white distance, and pupil size.
Any of the technicians in my practice can operate theAL-Scan because it is so easy to use and checks the accuracyof test results. Anyone who can operate an autorefractor canoperate the AL-Scan. It automatically tracks movement of theeye in three dimensions, and then captures images and data

Because acquisition is accomplishedquickly, the system requires lesstechnician time. The time we gain
allows us to see more patients or extend
the duration of in-office examinations.
automatically when the eye is aligned. Technicians simplypush a button, and the system takes tests automatically at
the right time. I trust the AL-Scan results obtained by all of
my technicians.
With the AL-Scan, technicians do not have to tell patientsto stay perfectly still, staring straight ahead without blinking
for a long time (an especially difficult task for elderly patientswith cataracts). The fast, easy test instills confidence in ourpatients. Technicians can obtain quality data in a single reading and move on, rather than dragging out the process withrepeated readings that make patients wonder why the process is taking so long or if the technician is testing correctly.
In addition, the AL-Scan’s flexibility allows surgeons to customize testing. For example, the keratometer uses two separate rings of data points, so I can choose the radius I prefer. A
central reading of 2.5 mm mimics the IOLMaster, but a larger
radius offers results similar to a manual keratometer. Anterior
segment imaging includes sectional lens images, pupil images,
and double mire rings projected onto the cornea. The system
also reduces noise for cataract measurements and aids intoric IOL alignment.
From a business perspective, the AL-Scan is very cost effective. Because acquisition is accomplished quickly, the system
requires less technician time. The time we gain allows us tosee more patients or extend the duration of in-office examinations. It makes us more productive and boosts our ability to
fully optimize cataract surgery. We can give patients the exemplary outcomes we always strive to achieve, helping ensurethat patients are happier and require fewer enhancements.

OCTOBER 2017 INSERT TO CATARACT & REFRACTIVE SURGERY TODAY 1

CEM-530 Specular Microscope
By Daniel S. Durrie, MD
Knowing the status of the endothelial cells before
performing surgery on the eye is important. I
image and analyze the endothelial cells for all
new surgical patients, as well as anyone who has
not had the analysis for 2 years or more. With many years ofexperience taking endothelial photographs and participatingin the development of specular microscopes, I knew immediately that the CEM-530 Specular Microscope (Nidek) wasexceptional. Because the technology is so easy to use, I am
able to use it for all of my patients. Now, after just a few years
with the CEM-530, I find it virtually indispensable.
The CEM-530’s imaging and analysis provide key information about the endothelial cell layer and corneal thickness. The system has excellent conventional central andperipheral specular microscopy, as well as paracentral images
captured at eight points, yielding clear, highly detailed images
for evaluation. We can look at any variation in size and shapeof the endothelial cells and detect signs of stress on the endothelium. If there is little or no mycotic activity, cells have atendency to die off, and surrounding cells get larger. When I
see enlarged cells, I know there is stress, and I can show thisevidence to my patients.
The cell images correspond to the software’s analysis,
which helps me visualize the endothelial cells in trace, photo,area, and apex modes. It notes if the cell count is normal(2,500-3,000 cells/mm2) and displays histograms for variation in both shape and size. Users can even select an area offocus for the analysis. The CEM-530 performs and displays theentire analysis in just a few seconds.
Some of these features are available in technologies wehave used in the past, but it has been difficult to get picturesand manually count cells. The CEM-530 is extremely easy touse. It automatically focuses, aligns, and measures the eye.
When we got it, my technicians did back flips. We easily teachnew technicians to use this technology, so no special technician is needed for the examination.
The CEM-530’s accurate central pachymetry stands out aswell. Other technologies can have weaker results on patientswith prior surgery, but we do not have that problem withthis device.
Ultimately, information from the CEM-530 helps guidesurgery and optimize postoperative outcomes. In fact, I will
not do refractive surgery without axial length, topographic
analysis, and an understanding of the health of the patient’s
endothelium. The CEM-530 helps me identify patients whohave lower cell counts or early guttata lesions that may be an
early sign of Fuch’s dystrophy. The cell count is essential aswell. If the endothelial cell count is 1,200 versus 2,500, I canadjust my technique and inflammation control to improve

2 INSERT TO CATARACT & REFRACTIVE SURGERY TODAY OCTOBER 2017

The CEM-530 helps me identify
patients who have lower cell counts orearly guttata lesions that may be an early
sign of Fuch’s dystrophy. The cell countis essential as well. If the endothelial cellcount is 1,200 versus 2,500, I can adjust
my technique and inflammation control
to improve outcomes.
outcomes. Surprisingly, the CEM-530 has also revealed a lot ofcontact lens-related damage in my 20 to 40-year-old patients,
which makes me steer them toward LASIK to get them out ofcontact lenses.
I tell colleagues that when they go to the next conference,
they should look at the CEM-530’s capabilities and ease ofuse. Once they see how easy it is to use, they realize that they
can have more endothelial evaluation in a very fast, affordable way and avoid surprises after surgery. They do not wantto overlook guttata or endothelial dystrophy that cannot beseen in a screening slit-lamp evaluation.
In my own self-contained practice, the CEM-530 also has
become part of our long-term documentation of vision andhealth of the eyes. Once people come to us for surgery, we
continue to take care of them. Refractive surgery patients
return for evaluation every 2 years. This approach to using
the CEM-530 may not be for everyone. Because our practicedoes not take insurance or Medicare, we can perform thetests we want without a code or known diagnosis. There is amovement now within the insurance and Medicare world forphysicians to perform unbilled tests that enhance outcomes.
In situations like these, it is good to know that the CEM-530
is not an expensive test and it has no film or prolonged costs.
Quality analysis of the endothelial cells is also cost effective
in helping us avoid what we dread most: patients who areunhappy with their surgical outcomes. nFarrell “Toby” Tyson, MDm edical director of Cape Coral Eye Center, Floridat ysonfc@hotmail.com
n f inancial disclosure: consultant for Nideknn

Daniel S. Durrie, MD
founder of Durrie Vision in Overland Park, Kansas, and a professor of clinical ophthalmology and director of refractive surgery at
the University of Kansasn d durrie@durrievision.com
n f inancial interest: none acknowledgedn