Never make an incision like this!

This is a resident case where the incision has terrible construction. The primary mistake is gliding the keratome along the … More

Double Phaco Incisions to fix Astigmatism

double phaco incisions for treatment of astigmatism

Incisional Techniques for Astigmatism

Cataract surgery can be our most powerful refractive surgery procedure, correcting high degrees of myopia, hyperopia, and even astigmatism (with … More

choosing refractive targets

Plano is not always the goal It would seem logical that emmetropia is the ideal refractive state of the eye. … More

Cataract surgery & decentered LASIK flap

We frequently have patients with a history of prior LASIK who are now undergoing cataract surgery. We have explained in … More

Quiz: Why are there two main incisions?

Cataract Quiz: Why are there two phaco incisions in this eye? This is a routine cataract surgery and the case … More

Paired Incisions to fix Astigmatism

This is an easy technique that can be so helpful to all cataract surgeons. By using paired phaco incisions, we … More

Review: Cataract surgery after prior RK

This patient was very myopic and desired surgical correction many years before the advent of the excimer laser. As such, … More

Review: Why LRIs should be done at the end

Limbal relaxing incisions (LRIs) are useful for treating mild to moderate degrees of corneal astigmatism at the time of cataract … More

Toric IOL technique with a small pupil

The toric IOL is a great option to address astigmatism at the time of cataract surgery. For the toric IOL … More

Toric IOL Alignment Dilemma

In this picture, all of these lines are at the 120 degree meridian, so how do you choose where to … More

Cataract Quiz: Where should you make the incision?

Our phaco incisions will induce an astigmatic change in the cornea and we can use that to help achieve a … More

Complete Case: Flomax & Toric IOL

Many of our CataractCoach.com readers have been asking for complete cases, shown from start to finish. There is a lot … More

Cataract Surgery with Pterygium Present

For a patient with both a pterygium and a visually significant cataract, the best option is usually to do the … More

Toric IOL planning in a small eye (+29.5 D)

Our main phaco incision will induce astigmatism and multiple variables affect the degree of this change. Larger incisions have more … More

Simplified Technique for LRIs

Limbal relaxing incisions (LRIs) are a great option to treat pre-existing corneal astigmatism at the time of cataract surgery. They … More

Can we use a Toric IOL in Keratoconus?

Toric IOLs have the ability to neutralize corneal astigmatism at the time of cataract surgery to improve vision for our … More

Choosing Toric IOL Steps

For toric IOLs, we need to select the best spherical power as well as the ideal toric step. What is … More

How to do Limbal Relaxing Incisions

Just about any incision in the cornea will induce some astigmatic change. We have shown how to place the phaco … More

Sit temporal but operate using WTR incisions

With-the-rule (WTR) astigmatism is where the steep axis is at or near the 90 degree axis. Placing incisions on the … More

Paired Phaco Incisions to Treat Astigmatism

Cataract surgery is our most powerful refractive procedure based on the spherical power that we can correct. Anything from –30 … More

Toric IOL with intra-operative aberrometer use

Guest Expert John Hovanesian MD implanting a Toric IOL with aberrometer guidance Dr. Hovanesian is a well-known and much respected … More

Review: Temporal vs Superior Phaco Incisions

Some surgeons prefer to make a superior phaco incision while others prefer a temporal approach. Is there a substantial difference … More

Solving a tough case of Hexagonal Keratotomy

Featuring guest surgeon: Arun Gulani MD from Jacksonville, Florida, USA This complex case involved a patient who underwent hexagonal keratotomy … More

For a Dense Cataract should we fix the astigmatism?

This patient has a dense, white cataract with a pre-op vision of just Counting Fingers at 1 meter (CF at … More

Review: 3 Rules for Making Phaco Incisions

Over the last two decades, cataract surgery has evolved from scleral incisions to corneal incisions, from retrobulbar anesthesia to topical … More

Review: Phaco Incision paired with LRI for Astigmatism Correction

We know that the phaco incision will cause some degree of corneal flattening and this has the ability to alter … More

Left-Handed versus Right-Handed with Phaco Incisions

It can be helpful to place our phaco incisions on the steep axis of cornea astigmatism in order to provide … More

Never make your phaco incision like this!

In this anonymous video we have a phaco incision that is very poorly made. The placement is too far from … More

Quiz: Should you implant a Toric IOL in this eye?

The patient is 70 years old and the corneal scar of the left eye is about 80% depth within the … More

This is why I do LRIs at the end of the case

Limbal relaxing incisions (LRIs) are useful for treating mild to moderate degrees of corneal astigmatism at the time of cataract … More

Match the Phaco Incision to the Limbal Relaxing Incision

We know that the phaco incision will cause some degree of corneal flattening and this has the ability to alter … More

Complete Toric IOL Case: from Marking to Alignment

Toric IOLs allow us to surgically treat corneal astigmatism at the time of cataract surgery thereby providing our patients with … More

Shifting the Phaco Incision to treat Astigmatism

Our phaco incisions always have some degree of astigmatic effect by causing relaxation of the corneal curvature at that axis. … More

One-Chop Technique for Phaco Surgery

For a cataract with moderate nuclear density, splitting the nucleus into two halves can be sufficient for removal with phacoemulsification. … More

The Patient Refuses Refractive Correction!

This 75 year old patient needs cataract surgery because her best corrected vision is 20/50 and it is becoming increasingly … More

Some Simple Ophthalmology Mathematics

Ophthalmology has a large degree of math, particularly when it comes to refractive surgery. Our most commonly performed and most … More

Surgically Treating Residual Astigmatism

Which do you choose: Limbal Relaxing Incision (LRI) or Laser Vision Correction (LVC) for treatment of residual astigmatism after cataract … More

Basics of Limbal Relaxing Incisions (LRIs)

Every incision that is made in the cornea has an effect on its shape and therefore the astigmatism. For a … More

Temporal vs Superior Phaco Incisions

[Click link below for full video] Some surgeons prefer to make a superior phaco incision while others prefer a temporal … More

Cataract Surgery in Keratoconus

Patients with keratoconus, like all patients, eventually develop cataracts. However, cataract surgery in these keratocomic eyes is not the same … More

Choosing Refractive Targets to maximize Depth of Field

From this photo it is obvious that the aperture size of a camera makes a large difference in the depth … More

Complex Cataract: multiple challenging issues

This patient had a large rhegmatogenous retinal detachment repaired a few years ago with a successful pars plana vitrectomy. The … More

Another Corneal Laceration with Traumatic Cataract

Another patient presented to our resident ophthalmology clinic with a 1 day history of doing construction work on a roof … More

Femto Laser Incisions: Good or Bad?

The femtosecond laser is a powerful tool for ophthalmic surgery. While its use in creating corneal refractive surgery is widely … More

Alignment and Centration of Toric Multi-Focal IOLs

[From CataractCoach.com] New technology has given us the ability to address corneal astigmatism and presbyopia with a toric multi-focal IOL. … More

Plano may not be best refractive outcome for every patient

Some patients may benefit from a small degree of residual hyperopia, myopia or astigmatism. There is a pride that we … More

Phaco Incisions can improve or worsen Astigmatism

Astigmatic Effect from Phaco Incision Placement Many patients desire a refractive correction at the same time as cataract surgery. … More

3 Rules for making Phaco Incisions

A well-constructed corneal/limbal phaco incision will improve your cataract surgery technique and provide better results for your patient. (scroll down … More

On-Axis Paired Incisions for Astigmatism

Don’t have a toric IOL? Try this technique to help address astigmatism at the time of cataract surgery.

Phaco Flip and Chop Technique

The phaco flip technique is when the nucleus is prolapsed out of the capsular bag and then emulsified at the … More