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What is ORA, and how can it give me a great RLE result?

By Joel Hunter, MD | 10/6/17 7:00 AM
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I got to be around for the early days of ORA. One of the benefits of getting to do a fellowship year with Dr. Durrie was the chance to see and develop new technologies before they made it to market. A fellowship is an optional year of extra training after completing the training of residency. A lot of doctors choose not to do a fellowship since they’ve just finished a decade of training and they already are more than prepared to begin their medical practice. The opportunity to spend a year with Dr. Durrie, however, was all I wanted from the first year of residency. And it was because of opportunities like this.

What is ORA?

That’s the same question I had 10 years ago! Except back then—for reasons I’ll never fully understand—it was called Orange. They said it was because it could be used in the OR for a range of features. I know, I don’t get how that makes the name Orange a good idea either. Maybe they thought, “It worked for Apple,” and forgot the universal law that you can’t compare the two.

Once a giant company (in this case, Alcon) bought the tech and gave it to marketing people for branding, it became ORA. The three letters stand for Operating Room Aberrometry. I haven’t found any marketing materials to confirm it specifically, but that has to be right. That’s what it is. Wavefront aberrometry that’s able to be performed intra-operatively instead of pre-operatively.

What is aberrometry?

It measures the specific way your eye is bad at focusing light. Traditional testing for this is usually done by using lenses to figure out what works to make your vision clearer. “Better one, or better two” testing at the optometrist’s office does that. Aberrometry works in a completely different way. A grid of invisible laser light dots is sent into your eye and then the pattern made by that grid as it bounces off the retina is measured. The differences in how the grid looks before and after it went through your eye’s lenses can be measured to determine all the tiny optical aberrations found in your eye. Aberration metrics are measured by aberrometry.

What is different with ORA?

Well, aberrometry has been around a surprisingly long time, considering how hi-tech it is. The ability to do that type of measurement in the middle of surgery, however, that’s new and exciting. Aberrometry has always had this flaw in that it can only measure the total aberrations created by your eye—both the cornea and the lens inside the eye. But after either cataract surgery or RLE, that old lens won’t be there anymore. You’re measuring something that won’t be part of the final result. But now the measurement of change in that grid pattern of laser light can be measured during surgery after the old lens is already removed.

The measurement of your eye’s aberrations when there is no lens in there gives an unbelievably accurate determination of what new intra-ocular lens (IOL) should be chosen to correct your vision. No “better one, better two” test, no worries about what optics your old lens used to contribute, just a pure, unfiltered, objective measurement of the exact optics we need to correct. The IOL is then chosen after this measurement. Even after using the technology for a few years now, it still just amazes me.

Part of the amazement is how far it has come. I remember the painstaking hours of sitting in a dark room getting measurements for ORA, which was at that time Orange. It seemed at that time to be one of those great ideas that would get lost in some impossibility of the logistics of implementation. Or it seemed if it surmounted those difficulties, no one would buy a super expensive wavefront aberrometer inexplicably named Orange. But here we are. Moving from a dimly lit lab to being in the spotlight as a key piece of OR technology, ORA has grown up and made a huge difference in RLE.

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