Speaker suggests best method to address irregular astigmatism

NEW YORK — The best method to treat irregular astigmatism around cataract surgery may be determined by looking at the corneal topography in the pupil zone, according to a speaker here.

“Look at the central cornea. If the central cornea is relatively symmetric, then a toric IOL can be reasonable,” Uday Devgan, MD, said at OSN New York 2013.

According to Devgan, if the pupil zone is treatable before cataract surgery, it should be fixed first. Do not attempt to fix the astigmatism if it is very irregular, centrally asymmetric or unstable, he said. If the central corneal zone looks reasonable, then the toric IOL should be fine.

The topography in the pupil zone — considered along with along with the patient’s history — can show when it is best to treat, Devgan said. Patients who have used rigid gas permeable contact lenses to fix their astigmatism will not do well with a toric lens, he said.

If there is any doubt in the topography reading because of a patient’s inability to fixate, repeating the test is advisable, he said.

Disclosure: Devgan is a consultant for Aaren Scientific, Alcon, B + L, Gerson Lehman Group, LensGen, Omeros, Optimedica. He is a stockholder for LensGen and Specialty Surgical and receives royalties from Accutome Inc.