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Centration important when using toric IOLs for astigmatism
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Toric IOLs are an effective and predictable treatment for astigmatism but require keen preoperative measurement and assessment, a surgeon said at the OSN New York annual meeting.
 Kerry D. Solomon |
"I think toric IOLs work very well and are very predictable in all instances," Kerry D. Solomon, MD, said. "But it's not a panacea of IOLs ... toric lenses are technique dependent."
Patient selection and accurate centration are critical to refractive outcomes, Dr. Solomon said. Accurate keratometry values and corneal topography mapping are also essential factors.
Corneal marking at the slit lamp is effective for ensuring proper centration of the toric IOL, Dr. Solomon said. The bubble should be centered between the 3, 6 and 9 o'clock marks, with the axis of astigmatism centered accurately.
"You want to mark the patient sitting up because there is a small degree of cyclotorsion when patients go from sitting up to lying down," he said.
Even a slight discrepancy in lens location can significantly diminish refractive outcomes.
"It's very straightforward," Dr. Solomon said. "But, again, everything has to fit. You've got to make sure if you are off by a few degrees you're not going to create irregular astigmatism, but what you will create is you'll lose some of the effect of the lens itself."
For patients with less than 2 D of astigmatism, a limbal relaxing incision can be supplemented with a toric IOL, Dr. Solomon said.
"I also use LRIs for presbyopia-correcting intraocular lenses," he said. "I think there's a place for all of us."