EyeWorld Asia-Pacific June 2018 issue

June 2018 28 EWAP FEATURE Using toric IOLs to correct astigmatism by Ellen Stodola EyeWorld Senior Staff Writer AT A GLANCE • There are various toric platforms available to help correct astigmatism, and for patients with higher astigmatism than can be addressed by the torics, a combination with LRIs or other techniques may be used. • Surgeons may want to use caution in patients with irregular astigmatism, as they may not be the best candidates for toric IOLs. Available toric IOLs and specifics for implanting them T oric IOLs can be a good option to correct astigmatism in a va- riety of patients, with several different lenses available. Michael Greenwood, MD , Fargo, North Dakota, Russell Swan, MD , Bozeman, Montana, Edward Holland, MD , Cincinnati, and Lawrence Woodard, MD , At- lanta, discussed current toric IOLs, how to correct for higher astig- matism, and other approaches to using torics. Current IOLs to correct astigmatism in the U.S. Dr. Greenwood said there are a number of toric IOL options avail- able to help correct astigmatism. Alcon (Fort Worth, Texas) has the AcrySof toric IOL that can correct up to 4 D of astigmatism at the spectacle plane; Johnson & John- son Vision (Santa Ana, California) has the Tecnis toric lens that can also correct up to 4 D; and Bausch + Lomb (Bridgewater, New Jersey) has its Trulign platform, which is similar to the Crystalens with the pseudoaccommodating platform but also a toricity of about 2 D at the spectacle plane. Additionally, Dr. Greenwood said Alcon makes multifocal toric IOLs, and Johnson & Johnson Vision has the Symfony toric. “We have access to all of them at our center,” he said, adding that he uses whichever is best for each individual patient. In a patient who will get a monofocal toric, Dr. Greenwood leans toward the Alcon platform because he said there are a couple of studies that show rota- tional stability is a little better. “All of the options are good,” he added. If a patient is looking for more independence from glasses, Dr. Greenwood said multifocal or extended depth of focus IOLs are good options. “I talk to patients and see what kinds of activities they do where they want freedom from glasses.” The Alcon multifocal toric, he said, allows you to get a little more plus power compared to the Symfony, which is a little bet- ter at intermediate. Dr. Woodard also mentioned the AcrySof and Tecnis families of IOLs. “We also have the STAAR Surgical [Monrovia, California] toric family of IOLs available, which is an older one and not used as commonly now,” he said, add- ing that it can correct up to 3 D of astigmatism in the corneal plane. “I think the nice part is we have continuing emergence of more and more toric IOL plat- forms,” Dr. Swan said. The one he thinks is most widely used is the AcrySof toric platform. Most recently, there has been a move to extended depth of focus, particularly the Symfony toric. The first toric IOL introduced was from STAAR, Dr. Holland said, and it was a single-piece plate toric IOL. “It was a breakthrough because it was the first time an IOL could be used to address astigma- tism,” he said. However, this first toric didn’t have rotational stability. He thinks that the AcrySof lenses have the best rotational stability. High corneal astigmatism Dr. Holland said there may be patients with a higher degree of astigmatism than toric IOLs can correct. If you plan on augmenting a toric IOL with incisional kera- totomy, it’s important to ensure that the astigmatism is regular astigmatism. He has used limbal relaxing incisions (LRIs) or femto arcuate incisions in these cases of high astigmatism. However, in cases of high astigmatism that is asymmet- ric, such as forme fruste keratoco- nus, incisional keratotomy should never be used. This is because of the unpredictable nature of the tissue response. “In these eyes, I would consider a toric IOL if the asymmetry is mild, but I would avoid corneal incisions of any kind,” he said. If you have a patient who has more than can be corrected by a AcrySof Toric IOL Source: Alcon