Consider toric IOL use to eliminate residual astigmatism
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Toric IOLs are an invaluable tool in the cataract surgeon’s armamentarium, not difficult to use and beneficial for the practice and patients, according to one presenter.
At Real World Ophthalmology, Ben LaHood, MD, gave pearls on how to use toric IOLs successfully, based on his research and experience.
“First of all, change your mindset, and check in every eye if a toric IOL would be better. Calculate every IOL for a toric version. Then, see if residual astigmatism is improved,” he said, noting that “there is no lower limit to astigmatism needing a toric IOL.”
“Bear in mind that residual astigmatism is not your friend. You may hear that myopic astigmatism gives some additional depth of focus, but we have more elegant solutions for presbyopia,” he said.
With multifocal IOLs, eliminating astigmatism is especially important, and it is worth considering toric versions.
LaHood recommended quality, consistent biometry for accurate alignment and calculation of toric lenses.
“There is no need for fancy devices. I rely on IOLMaster 700 (Carl Zeiss Meditec) and an autokeratometer,” he said.
Topography is not needed and has never changed his toric plans. Posterior corneal astigmatism should not be a concern because it is managed by most calculators, such as the Barrett Universal formula.
Contrary to what is often taught, a few degrees of misalignment do not affect the final outcomes.
“We are told that 1° leads to 3% loss of astigmatic treatment, but this is an optical principle, and the eye is far more robust,” he said.
By taking some extra moments during the operation, the risk of late rotation can be minimized.
“Remove the viscoelastic from behind, gently tap the IOL against the [posterior chamber] to maximize surface contact, and minimize [anterior chamber] flattening,” he said.
“Finally, if you need to realign a toric IOL, do not try to reposition the IOL back to its original intended position because you are dealing with a different eye from what you started with,” he said. “For help, use some handy resources, like toricpro.com, Barrett Rx or astigmatismfix.com.”
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LaHood B. Hit me with your best toric IOL pearls. Presented at: Real World Ophthalmology; April 2, 2022 (virtual meeting).
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