Optimize toric lens outcomes by addressing dry eye disease, astigmatism
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Dry eye disease should be addressed, the cornea should be optimized and astigmatism should be determined before cataract surgery to ensure the best outcomes when implanting a toric lens, according to a speaker.
“You first need to determine the astigmatism. There are a variety of diagnostic methods you can use, and you want to choose more than one. Be consistent, compare your readings, and if there is corneal pathology or ocular surface disease, you want to treat that first and then repeat the readings,” Audrey Talley Rostov, MD, said at the virtual OSN New York meeting.
Ocular surface disease, such as anterior basement membrane dystrophy, pterygia, Salzmann’s nodular degeneration or dry eye disease, needs to be addressed before cataract surgery. Dry eye treatment, for example, can change keratometry readings and IOL calculations, so measurements should be repeated after treatment completion, she said.
Patients with regular astigmatism, such as preexisting astigmatism or astigmatism after a cornea transplant, are typically good candidates for toric lenses. However, patients with irregular astigmatism due to keratoconus or a corneal scar may not be good candidates.
“Astigmatism can either be with the rule or against the rule. You want to undercorrect with-the-rule astigmatism and either fully or overcorrect against-the-rule astigmatism. Also, remember that posterior corneal astigmatism plays a role,” she said.
Make sure to mark the axis, either preoperatively, intraoperatively or both. Manual marking is acceptable but may result in bleeding of the marks and cyclorotation, so it may not be as accurate.
“Choose the way you’re going to mark the axis and then align your IOL. If your IOL does rotate, then wait 2 to 3 weeks, rotate the IOL and use a suture for your wound,” Talley Rostov said.
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Talley Rostov A. Optimizing outcomes with toric lenses. Presented at: OSN New York and OSN New York Retina; Oct. 17-18, 2020 (virtual meeting).
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