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Mastering IOL technology for improved outcomes
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Leading experts gathered to share insights and information on merging technology and technique to improve patient outcomes at a session on new advancements in IOL technology held on Wednesday at the Alcon-sponsored event, "Ophthalmology Management Trends," preceding the 25th APAO Congress.
"The important thing about ophthalmology is that it is rapidly changing," said moderator Charith Fonseka, MD, a renowned ophthalmic surgeon and a Consultant Ophthalmologist at the Eye Hospital, Colombo. "We have new technology...but we also need insights on how to apply this technology, and we also need to share each other's experience."
Pairing OZil technology with AcrySof IOLs to meet patient expectations
As cataract surgery evolves and patient expectations increase, surgeons are expected to produce clear corneas on postoperative day 1 and deliver optimal visual results, said Abhay Vasavada, MD, Director at the Iladevi Cataract and IOL Research Centre, Raghudeep Eye Clinic.
 Abhay Vasavada |
"Today we have come to a stage-we are not worried about posterior capsular bag rupture or any serious complications that require removing the lens," Dr. Vasavada said. "We must realize now that cataract surgery is evolving to higher expectations."
The predictability of technique using the OZil torsional technology paired with the AcrySof IOL have enabled surgeons to produce predictable outcomes and meet patient expectations, Dr. Vasavada said.
"Effective lens position in terms of axial and posterior AP position, rotational stability, decentration and anterior posterior capsular opacification response are major IOL considerations and that is where the single-piece AcrySof platform is found very useful and predictable, an example of using asphericity at its best," Dr. Vasavada said.
Calculating astigmatism correction
The new generation of toric IOLs features a wide range of cylindrical values that offer more precision when correcting astigmatism, and determining the appropriate calculations is necessary to achieve optimal visual results, said Warren Hill, MD, an internationally recognized expert in the field of IOL power calculations.
 Warren Hill |
According to Dr. Hill, the fundamental three-part process includes calculating spherical power of the lens, measuring the power difference between meridians corresponding to the correction at the plane of the capsular bag, and determining the steep axis. "You can use whatever method you would normally use to calculate the spherical power of the lens, but do not use automated keratometry for determining power differences between meridians because you may lose control over the process," Dr. Hill said.
He recommended using a manual keratometer to determine the power difference between principle meridians.
"Measure the horizontal meridian and determine the axis and power, then rotate that 90 degrees and measure the meridian vertically," said Dr. Hill. "That will give you the power difference between meridians."
Dr. Hill also suggested that surgeons use topography to confirm regular astigmatism and set the steep axis. For calculating the steep meridian, he recommended that surgeons use their average surgically induced astigmatism or a value of 0.5 diopters. Dr. Hill also emphasized accurate placement of reference marks that can be achieved by having the patient sit upright and look at a distance target to avoid cyclorotation.