1st Edition

Practical Astigmatism Planning and Analysis

By Noel Alpins Copyright 2017

    The surgical correction of astigmatism is the last frontier to optimizing visual outcomes for patients. Practical Astigmatism: Planning and Analysis is a comprehensive guide to correcting astigmatism from pre-operative planning to post-operative analysis. This provides readers with unique insight to what actually happened surgically: did the astigmatism over or under correct? Was it on-axis or off-axis? With this book, ophthalmologists will be able to analyze previous procedures with the appropriate nomograms and more often achieve targeted outcomes.

    Dr. Noel Alpins has developed the Alpins Method of astigmatism to provide accurate planning and analysis of astigmatism procedures. His method focuses on analyzing refractive and corneal astigmatism parameters and using the results in future surgery to improve visual outcomes. The importance of the ocular residual astigmatism (ORA) is detailed when planning astigmatism surgery.

    Practical Astigmatism features vector planning for refractive laser surgery as well as planning and analysis applied to cataract and limbal relaxing incisions, , in addition to demonstrating graphical analysis of astigmatism using high quality vector and fan diagrams, as used in scientific journals. In addition, hemidivisional analysis of the irregular cornea, corneal coupling in incisional and excimer laser surgery for mixed astigmatism and toric IOL planning with total corneal power using corneal topographic astigmatism (CorT total) are addressed as well.

    Some Questions Answered Inside:

    • What is the difference between regular and irregular astigmatism?
    • How do I diagnose each, and how does this affect my surgical technique?
    • Can I incorporate corneal astigmatism when performing excimer laser surgery?
    • Why are my LRIs undercorrecting the astigmatism?
    • Is it safe to perform excimer laser on keratoconous patients?
    • Which corneal astigmatism measure do I choose and what do I do following a refractive surprise?
    Practical Astigmatism: Planning and Analysis will help ophthalmologists, optometrists, and technicians alike address each patient’s unique circumstances and act as your in-depth guide to correcting astigmatism.
    “For more than three decades I have been listening to, arguing with, and admiring the work of Dr. Noel Alpins in the field of astigmatism.  Despite his remote location on the small island of Australia, his knowledge of astigmatism is at the peak of Mt. Everest.  There are few others who have devoted their careers to understanding and managing astigmatism for which the world of ophthalmology is truly grateful.”  - Robert H. Osher, MD

    “Noel is an original thinker who took on and conquered the complexities of astigmatism analysis, publishing the seminal papers on the way. His work has formed the cornerstone from which our current understanding and management of astigmatism has been built. He is someone from whom we have all learnt a great deal and this book is a testament to this.” - Dan Z Reinstein, MD MA(Cantab) FRCSC DABO FRCOphth FEBO



    About the AuthorPreface

    Foreword by Spencer P. Thornton, MD, FACS

    Foreword by Dan Z. Reinstein, MD, MA(Cantab), FRCSC, DABO, FRCOphth, FEBOIntroduction

    Chapter 1 Astigmatism in the Population

    Chapter 2 History of Vectorial Analysis of Astigmatism

    Chapter 3 A Dilemma: The Conflict Between Incisional and Laser Ablative Approaches

    Chapter 4 The Genesis: A Method to the Madness

    Chapter 5 The Nonzero Target and Why It Meets Ongoing Resistance

    Chapter 6 The Basics of the Alpins Method

    Chapter 7 The Astigmatic Indices: Useful Measures That Make It All Worthwhile

    Chapter 8 The Flattening, Steepening, and Rotation of Astigmatism

    Chapter 9 Ocular Residual Astigmatism: When Zero Is Not the Target

    Chapter 10 For Cataract Patients With Astigmatism: Toric Intraocular Lenses

    Chapter 11 Analysis and Management of Refractive Surprises After Toric Intraocular Lens Implantation

    Chapter 12 Corneal Topographic Astigmatism: A Measure of Anterior and Total Corneal Power

    Chapter 13 Vector Planning Approach: Optimizing Both Corneal and Refractive Astigmatism

    Chapter 14 Corneal Astigmatism: Less Is More

    Chapter 15 Not Everyone Has Regular Astigmatism: The Hemidivisional Solution

    Chapter 16 Topographic Disparity: Quantifying Corneal Irregularity

    Chapter 17 The Perfect Treatment: Reduction and Regularization

    Chapter 18 Polar Displays Versus Double-Angle Vector Diagrams

    Chapter 19 Clinical Application of the Alpins Method for Clinical Studies

    Chapter 20 Regulatory Adoption

    Chapter 21 Coupling Concepts

    Chapter 22 Mixed Astigmatism

    Chapter 23 How to Perform Your Own Corneal and Refractive Vector Analyses

    Chapter 24 Software: ASSORT, iASSORT, Web Calculators, VECTrAK Appendix Astigmatic Terms and ConceptsFinancial Disclosures



    Dr. Alpins pioneered small-incision cataract surgery in Victoria, Australia, in 1987 and then became a founder and current member of the Excimer Laser & Research Group. He has specialized in cataract and refractive surgery since founding NewVision Clinics in Melbourne, Australia, in 1996. He speaks widely on surgical techniques at national and international meetings and has been a keynote speaker and chair on many occasions.

    Dr. Alpins serves on the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) program committee, and has served as chair for the invited speakers subcommittee since 2008. In 2010, he was the invited Council Lecturer at the RANZCO annual scientific meeting in Adelaide, South Australia, which was established to honor Fellows engaged in original work.

    In addition to his many writings and lectures, he continues to investigate the vector analytic approach to astigmatism analysis that he pioneered (the Alpins Method). He is involved in ongoing clinical research in this area. He is also an international council member of the International Society of Refractive Surgery (ISRS) of the American Academy of Ophthalmology (AAO).

    Dr. Alpins is on the editorial board of a number of publications, including the Journal of Cataract & Refractive Surgery (official journal of the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons), the Journal of Refractive Surgery (a publication of the International Society of Refractive Surgery affiliated with the American Academy of Ophthalmology), Ocular Surgery News, EuroTimes, and others. He has contributed over 150 articles in peer-reviewed journals and ophthalmic periodicals as well as more than 20 book chapters. In 2015, he received the Certificate for Outstanding Contribution in Reviewing, awarded by Elsevier.

    Dr. Alpins received the 2012 ISRS/AAO Lans Distinguished Award in Chicago, and in 2014 he received the ISRS Lifetime Achievement Award. Dr. Alpins is on the international advisory board for refractive surgery in China.

    In January 2017, Dr. Alpins was awarded Member in the General Division of the Order of Australia for “significant service to ophthalmology, particularly to the development of innovative refractive surgery techniques, and to professional associations.” The Order of Australia was established in 1975 by letters patent of Elizabeth II, Queen of Australia, and countersigned by Prime Minister Gough Whitlam. Around 500 prominent Australians receive the award annually. Dr. Alpins is also regularly appointed as an ambassador for the state of Victoria in the government’s annual Australia Day.

    Dr. Alpins is the 2017 RANZCO “Norman McAlister Gregg Lecturer” for 2017. The Gregg Lecture was established in 1958 by the Council of the Ophthalmological Society of Australia in recognition of the outstanding contribution made to ophthalmology by Sir Norman Gregg.
    Dr. Alpins and his wife, Sylvia, have three daughters: Fiona, Vanessa, and Martine. When Dr. Alpins is not practicing ophthalmology, he enjoys playing golf, skiing, going to live entertainment, and spending time with Sylvia, his daughters, and grandchildren.

    His training is summarized below:
    Medical degree (MB, BS): University of Melbourne, 1970
    Diploma of Ophthalmology: University of Melbourne, 1977
    Residency: Alfred Hospital, Australia, 1971-1972
    Fellowships and certifications: Ophthalmology Registrar, Royal Victoria Eye & Ear Hospital, Australia, 1974-77; Fellow, RANZCO, 1978; Fellow, Royal Australasian College of Surgeons, 1978; Fellow, American College of Surgeons, 1985; Fellow, Royal College of Ophthalmologists (UK), 1989; Fellow, American Board of Eye Surgery, 2005; Honorary Senior Lecturer, Melbourne University Department of Ophthalmology, 2013.

    Memberships: International Intra-Ocular Implant Club; American Society of Cataract and Refractive Surgery; European Society of Cataract and Refractive Surgeons; International Society of Refractive Surgery; American Academy of Ophthalmology; and the Australian Medical Association.