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BLOG: Astigmatism correction essential to 20/happy cataract outcomes
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We know that today’s cataract surgery is truly refractive cataract surgery. As such, patients expect refractive type outcomes after the procedure.
Therefore, more than ever before, it is crucial that astigmatism is managed at the time of cataract surgery to provide patients with the best possible uncorrected visual acuity.
Surgeons can correct corneal astigmatism by implanting toric IOLs, creating laser arcuate incisions or performing limbal-relaxing incisions. Get to know the postoperative outcomes of the surgeons with whom you refer and have confidence that they implant astigmatism-correcting lens options and are also proficient at performing limbal-relaxing incisions. To be able to manage even low levels of cylinder at the time of cataract surgery is a must for today’s cataract surgeons.
According to Market Scope, toric IOLs have accounted for only 6% to 8% of cataract procedures since 2010, even though approximately 52% to 70% of cataract patients have enough astigmatism to qualify for these lenses. Although surgeons have been slow to fully embrace toric technology, the hesitation may be changing with the introduction of new lenses that can correct both presbyopia and astigmatism.
The Trulign Toric is Bausch + Lomb’s toric version of the Crystalens. It is a silicone implant with a 5-mm optic and flexible, rectangular hinged haptics with polyamide loops. The FDA approval trial found that 96% of implants rotated no more than 5 degrees between the day of surgery and 3 to 6 months postoperatively. Investigators say the polyamide loops are integral to the rotational stability of the lens. The Trulign provides excellent distance and intermediate correction.
More recently, the FDA approved the Tecnis Symfony lens in standard monofocal and toric models. The toric version of this extended-depth-of-focus (EDOF) implant provides a full range of continuous, high-quality vision after cataract surgery, while at the same time correcting presbyopia and astigmatism. The Symfony also represents the first presbyopia-correcting non-accommodating toric lens. Rather than splitting light to two different focal points as a multifocal IOL does, EDOF IOLs provide a wider range of quality vision, over approximately 1.5 to 2.0 D of defocus.
Residual refractive error and dry eye disease are the most common causes of patients’ unhappiness after cataract surgery. Correcting astigmatism at the time of cataract surgery will provide patients better visual quality, and these happy patients will tell their friends.
References:
FDA. FDA Summary of Safety and Effectiveness Data: Trulign. http://www.accessdata.fda.gov/cdrh_docs/pdf3/P030002S027b.pdf. Accessed March 10, 2018.
FDA. FDA approves first intraocular lens with extended range of vision for cataract patients. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm511446.htm. Posted July 15, 2016. Accessed March 10, 2018.
FDA. PMA. Tecnis Symfony. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMA/pma.cfm?id=P980040S065. Posted July 25, 2016. Accessed March 20, 2018.
Lachman M. State of the premium channel market. https://ois.net/what-happened-at-spotlight-on-the-premium-channel-at-oisascrs/. Posted June 4, 2016. Accessed March 10, 2018.