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Astigmatism management for today's patient: Technologies and techniques that take your practice to the next level Elizabeth Yeu, MD, is in private practice in Norfolk, Va. She can be reached at eyeulin@gmail. com. Are you treating low cylinder during cataract surgery? Find out why you should By Elizabeth Yeu, MD T o ensure that patients achieve their best possible visual outcome, astigmatism should be addressed at the time of cataract surgery. This includes low cylin- der, which is anything less than 1.25 D to 1.50 D. Low cylinder definitely needs to be treated, because patients can experience a decrease in the quality of their uncorrected vi- sion within the low cylinder realm of anything above 0.5 D. Previously, we were only able to treat these patients using corneal relaxing incisions, which were not ideal. As we know, the more peripheral the incision, the weaker the effect. Toric IOLs are a better choice for addressing astigmatism at the time of cataract surgery because they can provide a greater level of accuracy. Having had 8 years of experi- ence with them, I can say with certainty that some of my happiest patients are the ones who have had their higher levels of astigmatism corrected. Conversely, some of the unhappiest patients that I've counseled have been those with lower levels of astigmatism that was not corrected at the time of surgery. Not correcting these low levels of astigmatism can lead to a compromise in quality of vision and a dissatisfied postoperative patient. Also, the more advanced toric online calculators and diagnostic tools are providing better insight into the total corneal power. This further increases our accuracy with utilizing the toric technology, which then leads to better outcomes. In my hands, 94% of my patients have less than 0.5 D of residual refractive astigmatism after toric IOL implantation. These are my happiest post-cataract surgery patients. Toric IOLs are my preferred method for treating astigma- tism, even low cylinder. For anyone who has total corneal astigmatism of 0.75 D against the rule or 1.0 D with the rule, my go-to is a toric lens implant because it provides a consistent, accurate outcome that has a longevity in effect. Relaxing incisions can reduce upwards of 1.0 D of astigmatism and can result in less than 0.5 D of residual refractive astigmatism, but regression is common. The outcome with toric lens implants is much longer lasting. I have used all of the different toric lens technologies, but I achieve the most predictable outcomes with the Alcon toric lens. I believe that the lens material provides greater stability and less rotation, and I also think that the quali- ty of the actual lens provides a predictable outcome. For these reasons, it is my go-to toric lens. Successful toric IOL surgery comes down to three steps: accuracy of preoperative measurements of the corneal astigmatism, proper steep meridian identification during This supplement was produced by EyeWorld and sponsored by Alcon. The doctors featured in this supplement are consultants for Alcon and received compensation from Alcon for their contributions to this supplement. Copyright © 2017 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or the publisher, and in no way imply endorsement by EyeWorld or ASCRS. Johnny Gayton, MD, is the founder of Eyesight Associates of Middle Georgia and adjunct pro- fessor of ophthalmology at Mercer Medical School. He can be reached at jlgayton9@gmail.com. John Berdahl, MD, is a partner at Vance Thompson Vision. He can be reached at john.berdahl@ vancethompsonvision.com.

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