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EW Boston 2014 3 correction of corneal astigmatism by either arcuate incisions or a toric IOL, having this kind of information instantly available at the time of surgery is a quantum leap forward in the execution of a surgical plan. Planning for the procedure Once the preoperative measure- ments have been captured and auto- matically transferred to the planning software, the user now has access to multiple IOL power calculation for- mulas, including Holladay 2. There is also a toric calculator and a way to plan for arcuate incisions. Here, the surgical plan is thoughtfully and completely developed well in advance of the procedure. The best part about surgical planning using the VERION Image Guided System is that it does not take additional time compared to what many surgeons and their staff members are already doing. Guidance during surgery In the operating room, information is transferred to the digital marker from the planning software for each patient so that every aspect of the surgical plan can be carried out with precision. The digital marker image automatically rotates and aligns with cyclorotation. There is no need to mark the eye, as all aspects of the surgical plan are automatically registered. This is especially useful for toric intraocular lenses, where the incision location and the align- ment of the toric intraocular lens significantly impact the refractive outcome. In fact, the VERION Image Guided System is a great addition for those who frequently use toric IOLs as it helps surgeons optimize their process of measurement, calculation, digital marking, and placement. Process philosophy Years ago, the automaker Toyota embarked on a plan to improve the quality of its automobiles. Rather than checking each car for defects as it came off the assembly line, they instead worked to limit variability by building quality into each step of the manufacturing process itself —in other words, removing aspects that could induce variability. Eye surgery can be thought of in much the same way. Rather than just looking at outcomes over a range of surgeries, the better ap- proach is to work to optimize each aspect of the process so that the final product is the sum of these op- timized steps. Once again, cataract surgery refractive outcomes repre- sent the summation of a multi-part process. The VERION Image Guided System allows the surgeon to incorporate a new process to do better than what most surgeons are currently doing with best-in-class diagnostics and planning. Each step can be validated before moving on to the next. Toric planning For example, cataract patients with low amounts of corneal astigmatism can be challenging. It is a well- known fact that low amounts of astigmatism are more common than higher amounts—the patients who we most frequently remember. In fact, a little more than 60% of eyes have 1 D of corneal astigmatism or less. Measuring low amounts of astigmatism may be difficult be- cause the orientation of the steep meridian is often more difficult to determine with precision, and the power difference between the steep and the flat meridians may be less obvious. Additionally, there is more variation from one piece of equip- ment to the next. Physicians and their staff often try to make up for this by taking averages, or perhaps relying on one piece of equipment for some patients and something else for others. Such an approach induces variability. With the orientation and the power difference between the steep and flat meridians unambiguously displayed, the planning software will next develop a surgical plan that displays the location of the incision and the orientation of the toric IOL without the surgeon placing a mark on the cornea. The AcrySof IQ Toric (Alcon) is an excellent IOL to use with the VERION Image Guided System's new astigmatism management capa- bilities for planning and execution. An almost immediate interaction of the AcrySof IOL material with the posterior capsule provides excep- tional long-term rotational stability. This is a critical feature with toric IOLs, to have confidence it will remain at the axis you've preopera- tively planned for and placed at during surgery. The VERION Image Guided System is designed with accuracy as its purpose, reducing errors in measurement, translation, and execution. It represents an intuitive process by which the creation of a consistent plan helps reduce poten- tial sources of error, intended to re- duce variability and improve quality for refractive outcomes. Because of the unique capability of the refer- ence unit to accurately and graphi- cally represent corneal astigmatism and the planning software to gener- ate the necessary calculations and intraoperative landmarks, it is a great compliment to the toric IOL and can help surgeons improve outcomes for all other types of intraocular lenses. Dr. Hill is in private practice in Mesa, Ariz. He can be contacted at hill@doctor-hill.com. continued from page 1 An AcrySof Toric IOL is aligned to the pre-planned orientation of 80 degrees using the VERION Digital Marker. The overlay is projected live into the surgeon's oculars as well as viewable on the Digital Marker's monitor screen. Treating astigmatism with AcrySof IQ Toric IOLs by Stephen V. Scoper, MD W hy do we treat astigmatism at the time of cataract surgery? I believe it is all about giving my patients the best possible quality of vision. My first objective when seeing a patient for a cataract evaluation is managing the astigmatism. We have learned from Warren Hill, MD, that 52.5% of all patients undergoing cataract surgery have 0.75 D or more of corneal astigmatism. These patients have the opportunity to have clear, crisp distance vision with reduced dependency on glasses. Having my staff provide LENSTAR LS 900 Biometer measurements and topography before I see the patient allows me to make a specific IOL recommendation at this initial encounter. With confidence, I am able to recommend the AcrySof IQ Toric IOL because of the proven predictabil- ity and rotational stability. The acrylic AcrySof material binds extremely well to the capsule. Having the broadest range of cylinder correction (0.75 D to >4.0 D) allows me to treat the majority of cataract patients with astigmatism. Attention to detail assures the best possible results. Understanding the role of surgically induced astigmatism and the surgeon constants in selecting the IOL power is critical to improving outcomes. Topography confirms the correct axis of the cylinder. Considering that posterior corneal astigmatism may add 0.5 D of ATR cylinder influences my final calculation. In my hands, marking the cornea at the YAG laser slit lamp is a more accurate technique before taking the patient to the OR. The new VERION Image Guided System is designed to obviate this need for pre-marking the patient before surgery as well as marking the patient on the operating table. This new technology will help me deliver results to my patients that they now expect—and deserve.

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