How important is ORA technology?

[desm0nd]

27 years old, had Lasik on both eyes 3 years ago. I will be getting the Symfony lense(located in Canada)

I have two surgeons that I can choose from. Surgeon A uses ORA technology and Surgeon B doesn't. They both require pentacam, OPD Corneal Topography, Endothelial Cell Analysis, IOL Master testing. Surgeon A is $500/eye more than Surgeon B. Surgeon A has 40 years experience, surgeon B has 23 years experience, both with cataracts. I like both surgeons after meeting with them.

Is it worth it for me to spend the extra $500/eye on surgeon A because he has the ORA technology on top of the other testing? Am I just as fine going with surgeon B due to having the pentacam, OPD Corneal Topography, Endothelial Cell Analysis, IOL Master testing? I want to ensure that I have the best possible chance to get the lense power correct.

[JohnHaganMD]

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[SoftwareDeveloper]

Here are some links that are a bit older, 2013, 2014. I figured I'd post them since I mentioned them, but of course the technology improves over time so any of the con arguments might potentially be outdated:

http://bmctoday.net/crstodayeurope/2014/09/article.asp?f=pointcounterpoint-does-intraoperative
"POINT/COUNTERPOINT: DOES INTRAOPERATIVE ABERROMETRY MATTER?
Point: For those who consider themselves refractive cataract surgeons, this technology helps to nail the target refraction.
By Stephen G. Slade, MD; and Jonathan H. Talamo, MD
Counterpoint: Intraoperative aberrometry is not yet the best answer to guide the surgical refractive plan in cataract surgery. "

http://bmctoday.net/crstodayeurope/2013/03/article.asp?f=pointcounterpoint-is-intraoperative-aberrometry-worth-the-investment
"Point/Counterpoint: Is Intraoperative Aberrometry Worth the Investment?
Surgeons weigh in on the value of this technology in cataract surgery."

[JohnHaganMD]

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[desm0nd]

Thanks for these links!

[SoftwareDeveloper]

I hadn't researched ORA technology in the past few months, but in  articles before that although some surgeons were sold on it, others still had their doubts about it for the typical patient (partly I think since the eye without a lens isn't the same as an eye with a lens, and they weren't sure there was enough data collected from eyes in that state to be sure the formulas were as good as the usual formulas based on lots of data). However I do recall that there seemed to be indications there might be demonstrable benefit for eyes that had already had  lasik for determining IOL power, as well as perhaps other cases like dense cataracts that interfered with preop measurements. I hadn't hunted for any recent articles with pro/con views, but these that are mostly in favor of the technology mention the issue of post-refractive surgery eyes:

http://www.reviewofophthalmology.com/content/t/imaging_and_diagnostic_instruments/c/55633/
http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=110652

I don't recall if you've mentioned if you are getting a toric lens, because there is also added benefit in that case. If you do a search you can likely find pro and con articles on the technology.

[SoftwareDeveloper]

I'll add re: lasik enhancement, I don't know if you meant generically laser enhancement since some surgeons seem to suggest PRK is a better post-cataract surgery choice for a minor tweak, but not all agree so I suspect it isn't a big deal. I hadn't researched the issue in detail, I'd want to check on  what the risks are that even a small tweak might cut down on best corrected visual acuity (especially if you'd had prior laser surgery) due to increases in irregularities in the cornea causing optical aberrations.

[JohnHaganMD]

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[desm0nd]

Edit to add: Both surgeons offer a Lasik enhancement if needed.

[JohnHaganMD]

This question has been asked and discussed in just the last 2 weeks. Use the search feature and archives to locate the discussions, you can also scan to question topics for the last couple of weeks. One poster Software Developer has writtten extensive on his/her experience with the Symphony lens.

The short summary is the extra technology is not absolutely necessary and because there are more procedures and steps may actually increase the complication rate.

JCH MD

[desm0nd]

Hi John, I am not asking about the Symfony lens. I am curious if the ORA technology is necessary considering the other tests I am having done.

[JohnHaganMD]

I was referring to the ORA technology. Not necessary, adds expense and may actually increase complication rate.