EyeWorld Asia-Pacific September 2015 Issue

7 September 2015 EWAP FEATURE How to get started with toric IOLs by Vanessa Caceres EyeWorld Contributing Writer AT A GLANCE • Offering toric IOLs enhances your practice and gives patients with astigmatism additional options to become spectacle- free. • Although toric IOLs do not have a steep learning curve, they do require the use of multiple pieces of equipment to assess astigmatism and determine the ideal IOL for patients. • Surgeons and staff both need to explain astigmatism and toric IOLs to patients in an easy-to- understand way. • The cost for toric IOLs should cover any possible need for enhancements. A to Z on technical accuracy and administrative acumen with torics I ncorporating toric IOLs into your practice requires a commitment to precision, an investment in some of the right equipment, and a desire to educate both staff and patients on what toric IOLs can offer. “To increase the number of patients that have their goals met with cataract surgery, correcting astigmatism is a big part of meeting the expectations,” said David R. Hardten, MD , Minnesota Eye Consultants, Minnetonka, Minn. “By learning to do this effectively, your practice is in a much better position.” If you are interested in adding torics, the learning curve is not that steep. “It shouldn’t be much of a challenge for cataract surgeons,” said Gary Wortz, MD , Commonwealth Eye Surgery, Lexington, Ky. “In reality, placing a toric lens follows all of the same well-known principles as correcting astigmatism in a phoropter. Instead of spinning the dial, you are rotating the lens.” Offering toric IOLs is part of the big picture of astigmatism management for patients, said George O. Waring IV, MD , FACS, assistant professor of ophthalmology, director of refractive surgery, Storm Eye Institute, Medical University of South Carolina, Charleston, and adjunct assistant professor of bioengineering, Clemson University, Clemson, SC. “We feel that all patients should be given the opportunity to see the best they can with and without spectacles. The key is approaching every patient as though they have the opportunity to reduce their dependence on spectacles for at least something, if not everything,” he said. Although astigmatic keratotomy and limbal relaxing incisions are other ways to treat astigmatism in cataract patients, the surgeons interviewed for this article find that toric IOLs help to treat higher degrees of astigmatism, avoid associated dry eye, and lead to more predictable outcomes. There are some tools of the trade to learn when adding toric IOLs. Getting started with toric IOLs First, equip your practice with numerous ways to measure astigmatism. “You need two or three ways to measure it,” said Rosa Braga-Mele, MD , professor of ophthalmology, University of Toronto. Dr. Braga-Mele suggests the use of manual keratometry and biometry with the use of an IOLMaster (Carl Zeiss Meditec, Jena, Germany) or LENSTAR LS-900 (Haag-Streit, Köniz, Switzerland) as well as corneal topography. Corneal topography is particularly important for astigmatism management, Dr. Waring said. You also need to get comfortable with the variety of online calculators to help calculate the right IOL for patients. One more recent consideration that surgeons interviewed for this article mentioned is posterior corneal astigmatism, brought to the forefront by Douglas D. Koch, MD , Houston. Although there are various calculators available, the Barrett Toric IOL calculator on the ASCRS website allows for the consideration of posterior corneal astigmatism, Dr. Braga-Mele said (www.ascrs.org/ barrett-toric-calculator). Surgeons who cannot invest in pricey equipment for toric IOL insertion shouldn’t be deterred, Dr. Wortz said. “There’s a lot of technology out there that provides incremental gains. If a simple IOLMaster is all you have and you base calculations off of that, you’d probably get very close to what someone with duplicative and more expensive technology would get for patients with normal corneas,” he said. One exception is with intraoperative aberrometry, which Dr. Wortz described as a game- changer for the field. Additionally, Toric lens with slight rotation from asymmetric capsule contraction Source: David R. Hardten, MD continued on page 8