EyeWorld Asia-Pacific September 2015 Issue

September 2015 26 EWAP FEATURE Aligning the stars with TRULIGN by Maxine Lipner EyeWorld Senior Contributing Writer Correcting astigmatism and more I n cataract patients with pre- existing corneal astigmatism, the TRULIGN toric lens (Bausch + Lomb, Bridgewater, NJ) can correct for this, while also offering enhanced vision in the intermediate range in particular, as well as functional near acuity with excellent distance vision, according to Jay Pepose, MD, PhD, medical director of Pepose Vision Institute, and professor of clinical ophthalmology, Washington University School of Medicine, St. Louis. “The intermediate vision is almost double that seen in the studies with standard toric lenses,” Dr. Pepose said. “So patients are going to get much better intermediate vision, which is important for using a cell phone, for a computer, and for seeing the dashboard of a car.” Building on the Crystalens platform This lens has the distinction of being the first toric presbyopia- correcting IOL in the U.S. The TRULIGN uses a Crystalens (Bausch + Lomb) platform but also has a toric component on the posterior surface of the lens to correct for astigmatism, Dr. Pepose explained. It includes a hinged optic haptic junction that was originally thought to play a key role in providing improved vision across the natural range of focus. “There have been multiple mechanisms of action studied, which have shown enhanced range of vision,” Dr. Pepose said. “These include axial translational movement of the lens and theoretical deformation of the lens (accommodative arching) creating central depth of field.” Dr. Pepose views the TRULIGN lens as best suited for patients who have preexisting corneal astigmatism and are also interested in a greater depth of field. This is especially true for those who would like to avoid the photic phenomenon (nighttime glare or halos) that sometimes occur with multifocal lenses, he noted. Studying the lens In a recent prospective, randomized study published in the February 2015 issue of the Journal of Cataract & Refractive Surgery, investigators evaluated the safety and efficacy of the lens. Patients were stratified based on their corneal astigmatism. The TRULIGN comes in 3 different powers of toricity at the IOL plane, 1.25 D, 2 D, and 2.75 D, Dr. Pepose said. During the study, 229 patients were placed in one of 4 groups: high, intermediate, and low astigmatism groups or a low astigmatism control group. Those in the low astigmatism control group received a Crystalens, Dr. Pepose said. “For the high toric [patient], we didn’t have a control because that would not be ethical— we would still have high corneal astigmatism (left) untreated,” he said. Of these patients, 74 received the low-powered toric lens while 68 received the non-toric Crystalens, he said. “There was no attempt to reduce the astigmatism in the control group other than the primary corneal incision for Schematic of the TRULIGN lens Source: Jay Pepose, MD, PhD