Eyeworld Supplements

3 cataract surgery, and tech- nique to ensure stability of the IOL's position. It is im- portant to be as accurate as possible because, for every degree that the lens is off, the patient loses 3.3% of astigmatism correction. As an example, if the toric IOL is off by just 10°, it causes a 33% loss in desired astig- matic correction and, po- tentially, an unhappy post- operative patient. There are several ways to measure the axis of astig- matism. I identify the total corneal astigmatism with the Cassini, which accurate- ly determines the astig- matic contribution of the posterior cornea. Then, the LenStar biometry provides extremely accurate anterior K values as it measures the corneal curvature at the 1.8 and 2.3 mm zones, and I verify these values with a placido-disk topography device. We have the Atlas and the Nidek OPD, but I commonly will use the OPD because it also offers angle kappa information. Additionally, there are sev- eral methods for marking the axis of astigmatism, and they vary in accuracy. The standard of care for mark- ing the axis has been ink, but ink pens are not ideal because of the precision required for both measuring and marking the target axis. Marking at the slit lamp as well as incorporating various astigmatic gauges and mark- ers to identify the reference axes and the steep meridian can increase accuracy. Other methods include imaging or fingerprinting, limbal registration, and wavefront intraoperative aberrometry. I have had experience with the VERION system. While it takes time to initially get comfortable incorporating the VERION into the prac- tice, once it is incorporated, I do believe this technology will continue to improve and make my toric surgery efficient, because the refer- ence landmarks have al- ready been identified. Intra- operatively, you no longer have to ink mark the steep meridian on the cornea be- yond image registration of the eye, as the VERION proj- ects this into the cornea. Preoperatively, the VERION requires an extra image capture for the surgical planning. Intraoperatively, this does help to increase efficiency and accuracy with toric IOL surgery. Some surgeons believe that low levels of astigmatism do not need to be treated during cataract surgery. However, if we are of a refractive mindset, and we are setting expectations, we must be mindful of the effects of residual astig- matism on final outcomes. Interestingly, patients who have some with-the-rule residual astigmatism, even upwards of 0.5 D, can still achieve acceptable quality of vision. Unfortunately, against-the-rule astigma- tism is not nearly as forgiv- ing. If we are not planning to correct astigmatism with- in the appropriate ranges (0.5 D or more against the rule or 1.0 D or more with the rule), we are setting ourselves (and our patients) up for likely disappointment if we are trying to provide patients with the highest quality of vision, particular- ly without spectacle cor- rection. I recommend that we spend extra chair time explaining to our patients that they will most likely require glasses if their cylin- der is not addressed during surgery. n Please see additional Important Product Information about the products in this supplement on page 7 " Some of my happiest patients are the ones who have had their higher levels of astigmatism corrected. " —Elizabeth Yeu Warning/Precaution: Careful preoperative evaluation and sound clinical judgment should be used by the surgeon to decide the risk/benefit ratio before implanting a lens in a patient with any of the conditions described in the Directions for Use labeling. Toric IOLs should not be implanted if the posterior capsule is ruptured, if the zonules are damaged, or if a primary posterior capsulotomy is planned. Rotation can reduce astigmatic correction; if necessary lens reposi- tioning should occur as early as possible prior to lens encapsulation. All viscoelastics should be removed from both the anterior and pos- terior sides of the lens; residual viscoelastics may allow the lens to rotate. Caution: Federal (USA) law restricts this device to the sale by or on the order of a physician. Indications: The AcrySof IQ Toric posterior chamber intraocular lenses are intended for primary implantation in the capsular bag of the eye for visual correction of aphakia and pre-existing corneal astigmatism secondary to removal of a cataractous lens in adult patients with or without presbyopia, who desire improved un- corrected distance vision, reduction of residual refractive cylinder and increased spectacle independence for distance vision. AcrySof IQ Toric Astigmatism Intraocular Lenses Important Product Information Optical theory suggests that, high astigmatic patients (i.e. > 2.5 D) may experience spatial distortions. Possible toric IOL related factors may include residual cylindrical error or axis misalignments. Prior to surgery, for products for which a Patient Information Brochures (PIB) is available, physicians should provide prospective patients with a copy of the Patient Information Brochure informing them of possible risks and benefits associated with the AcrySof IQ Toric Astimatism IOLs. Studies have shown that color vision discrimi- nation is not adversely affected in individuals with the AcrySof Natural IOL and normal color vision. The effect on vision of the AcrySof Natural IOL in subjects with hereditary color vision defects and acquired color vision defects secondary to ocular disease (e.g., glaucoma, diabetic retinopathy, chronic uveitis, and other retinal or optic nerve diseases) has not been studied. Do not resterilize; do not store over 45° C; use only sterile irrigating solutions such as BSS or BSS PLUS Sterile Intraocular Irrigat- ing Solutions. Attention: Reference the Directions for Use labeling for a complete listing of indications, warnings and precautions.

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