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BLOG: ReSTOR toric approval a major breakthrough

ByJohn A. Hovanesian, MD, FACS

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Last week the FDA announced approval of the AcrySof IQ ReSTOR +3.0 D multifocal toric IOL in the U.S. with available toric powers ranging from about 0.6 D to about 2.0 D in the corneal plane (SND1T2-SND1T5 lenses, respectively). This approval is a major breakthrough for patients. As I have blogged before, patients with more than about 1D of corneal astigmatism were previously not well suited to multifocal implants which were available only in spherical powers. We have performed several studies in patient satisfaction using the MDbackline follow-up care system and shown that achieving “top box” satisfaction absolutely requires astigmatism to 0.5 D or less. That’s difficult to reach with a limbal relaxing incision in patients with higher cylinder but very achievable with a toric lens.

Naturally, the next question is when will we see approval of a lower add multifocal toric, the ReSTOR 2.5 or for that matter toric Tecnis multifocals from Abbott Medical Optics? Inside sources at both companies tell me that this is close on the FDA’s radar and may even be available in 2017. These expanded approvals will be absolutely necessary to offer our patients what they want near, intermediate, and distance vision. For me, this is best achieved with a low add multifocal in the dominant eye and a higher add, usually +2.75 or +3.0 in the non-dominant eye.

It’s worth noting that Crystalens is also an excellent presbyopia correcting lens, and the Trulign toric version of this lens has been available for a couple of years. Many surgeons find the Crystalens family of products particularly helpful for patients with higher cylinder or comorbidities like mild maculopathy, moderate to severe dry eye, or mildly irregular corneas, where a multifocal lens might not be a safe choice. For surgeons, more options are always better, and this week’s approval of the ReSTOR toric makes it easier to match lenses with patients with the confidence to correct astigmatism accurately.

Disclosures: Hovanesian consults with AMO, Alcon and Bausch and Lomb.