This is a supplement to EyeWorld Magazine.
Issue link: https://supplements.eyeworld.org/i/569828
Modernizing cataract surgery: Navigating success with toric multifocal IOLs Supplement to EyeWorld September 2015 Supported by an educational grant from Abbott Medical Optics by Francis Mah, MD Success with toric and multifocal IOLs The 2014 ASCRS Clinical Survey demonstrated educational gaps regarding toric and multifocal intraocular lenses T he ASCRS Clinical Survey revealed important information regarding members' use of toric and multifocal intraocular lenses (IOLs). 1 This annual survey is conducted to examine the most compelling and con- troversial issues facing ASCRS members. It included 267 data points from 134 questions on key clinical opinions and practice patterns. It surveyed more than 1,500 unique respon- dents. Toric IOLs After implanting a toric intraocular lens (IOL), 33% of respondents believe 10 degrees of postoperative rotational error or more does not significantly affect visual acuity or quality (Figure 1). When members were asked, "How are you aligning the preoperative axis assessed with your diagnostic tools with your intraop- erative axis where you are placing the toric IOL during surgery?" 37% of respondents are not using any instrumentation to guide their alignment marks. Of these, 6% use anatomic landmarks without preoperative marking, and 31% use ink marking at the slit lamp with- out additional instruments. I found this very surprising. They were correcting astigmatism, however, they were not using any instrumen- tation to guide the alignment of toric IOLs. The survey results demonstrated little consensus on how to manage 1.25 D of astigmatism (Figure 2). Nearly 54% chose toric IOLs. continued on page 3 Figure 1. The 2014 ASCRS Clinical Survey asked, "After implanting a toric IOL, how many degrees of postoperative rotational error is acceptable before visual quality and visual acuity are significantly affected? 33% of respondents believe >10 degrees of error does not significantly affect visual quality/acuity 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Less than 5 5 6 to 9 10 Great than 10 Depends U.S. Non-U.S. Overall Supplement to EyeWorld September 2015 Figure 2. The survey asked, "What is your most common procedure to manage astigmatism in a cataract patient with the following levels of cylinder?" Little consensus on how to manage a 1.25 D patient On axis incision 0.75 D 1.25 D 2 D 3 D 42.1% 12.0% 0.9% 0.5% Manual LRI or AK 13.2% 17.1% 3.5% 1.1% Femtosecond laser LRI or AK 7.9% 8.3% 1.6% 1.1% Toric IOL 5.9% 53.9% 89.7% 91.6% Postop laser vision correction 0.9% 1.6% 2.7% 3.6% Glasses or contact lenses 7.1% 5.3% 1.5% 1.8% No special correction needed 22.9% 1.9% 0.1% 0.2% Little consensus on how to manage a 1.25 D patient