Eyeworld Supplements

Supplement to EyeWorld Daily News, Saturday, April 18, 2015 Supported by an educational grant from Abbott Medical Optics Optimizing outcomes with toric IOLs Dr. Donnenfeld: In the ASCRS Clinical Survey of more than 1,500 ophthalmologists, 33% of respon- dents believed 0.75 D or more cylinder had no significant impact on visual quality in postoperative cataract patients. What level of astigmatism do you believe has a significant impact on vision quality? Dr. Vukich: If we were prescribing glasses it would be unlikely that we would ignore 0.75 D of astigmatism. The same standard holds true for our cataract patients, who are seeking a refractive outcome. Patients have become increasingly savvy about the ability to have uncorrected distance acuity after cataract surgery. Dr. Hovanesian: In our study of about 200 patients, approximate- ly 80% of patients with 0.5 D of astigmatism or less were extremely satisfied after cataract surgery (Figure 1). When you correct to less than 0.5 D of astigmatism, patients are more likely to recommend the procedure to their friends. Dr. Donnenfeld: Our goal is to ex- ceed patient expectations. Even 0.5 D of cylinder is sometimes an issue, and our goal should be to maximize every patient's visual potential. How do you choose between treatment options, such as on-axis incisions, limbal relaxing incisions (LRIs), laser vision correction, and toric IOLs for a patient with 1.25 D of cylinder? Dr. Mah: You need to determine whether the patient has corneal astigmatism versus lenticular astig- matism and whether it's against- the-rule or with-the-rule. Douglas Koch, MD, recently highlighted the existence of posterior corneal astigmatism. First, we perform keratometry and make sure there is corneal astig- matism. Then we perform topogra- phy to make sure the astigmatism is regular and can be corrected with a corneal incision or toric IOL. Next, we perform a posterior corneal measurement with the Pentacam (Oculus, Arlington, Wash.). If the 1.25 D of astigmatism is with-the- rule, we may use on-axis incisions rather than a toric IOL. Dr. Kontos: We perform topography on all our cataract surgery patients, then discuss our goals regarding Eric Donnenfeld, MD, is in practice at Ophthalmic Consultants of Long Island, New York; clinical professor of ophthalmology, New York University; and a trustee at Dartmouth Medical School. Mark Kontos, MD, is a senior partner at Empire Eye Physicians, Spokane, Wash. Sumit "Sam" Garg, MD, is interim chair and medical director, Department of Ophthalmology, Gavin Herbert Eye Institute at the University of California, Irvine; and a member of the ASCRS Young Eye Surgeons Clinical Committee. Francis Mah, MD, is director of the cornea service, and co-director of the refractive surgery service, Scripps Clinic, La Jolla, Calif.; a member of the ASCRS Cornea Clinical Committee, Food and Drug Administration Committee, and Infectious Disease Task Force. John Hovanesian, MD, is clinical faculty at University of California, Los Angeles, Jules Stein Eye Institute; in private practice at Harvard Eye Associates; and a member of the ASCRS Cornea Clinical Committee. John Vukich, MD, is in private practice, Madison, Wis.; and chair of the ASCRS Refractive Surgery Clinical Committee. Figure 1. Patient satisfaction after cataract surgery. Data in press, John Hovanesian, MD, 2014. During Hawaiian Eye 2015, held from January 17–23, a distinguished panel shared insights on achieving optimal outcomes with toric intraocular lenses (IOLs). Members discussed treatment options for astigmatism, the significance of toric IOLs, tips for success, intraoperative alignment and locking, error avoidance, and postoperative management when using toric IOLs. digital.eyeworld.org The news magazine of the American Society of Cataract & Refractive Surgery

• Cover