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Toric IOLs may become conventional treatment for astigmatism

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OTTAWA — Toric IOLs have the potential to replace relaxing incisions as the conventional way to correct existing astigmatism during cataract surgery, predicted a surgeon speaking here.

Douglas Koch, MD, said he envisioned that the future standard for astigmatism treatment during cataract surgery will include toric IOLs used in conjunction with incisional surgery and laser modifications where necessary. He spoke on the topic here at the annual Sally Letson Symposium on Cataract Surgery and Refractive IOLs.

“As toric IOLs improve, particularly with the new Alcon platform, the SA60, we will find a very good way of correcting astigmatism using IOLs rather than using corneal incisions,” Dr. Koch said. “We will be doing astigmatic corrections with IOLs, supplementing with incisions for those patients who, for one reason or another, can’t be corrected fully or appropriately by an IOL. Overall, it will mean better accuracy and better patient results, such as improved visual acuity and less need for glasses.”

The current standard cataract incision has so little astigmatic effect, Dr. Koch said, that it is a challenge to minimize existing astigmatism through incision placement alone. A standard bevelled 3.2-mm corneal incision will result in a 0.3 to 0.4 D with-the-rule shift, Dr. Koch said. If the incision is 2.8 mm, it results in less than a 0.25 D shift.

“We try to minimize the astigmatism with peripheral corneal relaxing incisions,” Dr. Koch said.

Some toric IOLs currently in use have resulted in reoperation rates as high as 10%, Dr. Koch said.

“We would like to reduce that reoperation rate to a much lower figure before the lens is widely used,” he said. “The other source of inaccuracy is lack of alignment. There is no reason to think we can’t align those new IOL designs as well as we align the incisions.”