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Surgeon says toric IOLs preferred over limbal relaxing incisions
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CHICAGO — One surgeon here made the case for using toric lenses over limbal relaxing incisions.
John A. Hovanesian, MD, FACS, and Louis D. “Skip” Nichamin, MD, debated the merits of limbal relaxing incisions vs. toric IOLs for patients undergoing cataract surgery at Refractive Surgery Subspecialty Day preceding the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology.
“Though some surgeons get precise and stable results with limbal relaxing incisions, at least half of surgeons using presbyopia-correcting IOLs are not performing them, even for patients with more than 1 D of corneal astigmatism,” Hovanesian said. “That statistic speaks volumes about surgeons’ lack of comfort with LRIs.”
The preoperative corneal astigmatism range for LRIs is 0.75 D to 2 D, while the range for toric IOLs is 0.75 D to 4 D.
Hovanesian also shared data about the relative precision and visual acuity outcomes of these procedures.
In a study published in 2010, uncorrected visual acuity was 20/30 with LRIs and 20/25 with toric IOLs at 3 months postop; the percentage better than 20/32 was 60% and 75%, respectively, while the percentage of patients who needed distance spectacles was 45% for LRIs and 15% for toric IOLs.
“Most important is what Charlie Kelman said: ‘While doctors debate, patients decide,’” Hovanesian said. “In the U.S., the only portion of the premium lens market that is growing is toric IOLs.”
Disclosure: Hovanesian is a consultant, receives lecture fees and is an equity owner in Abbott Medical Optics and Bausch + Lomb. He receives patents/royalties from Abbott Medical Optics.