EyeWorld Asia-Pacific March 2019 Issue

38 March 2019 EWAP CATARACT / IOL said. “If you are going to rotate the lens and you do it before 5–6 weeks, you might want to put a CTR in because otherwise there is going to be a good chance of that lens rotating again.” When rotating a patient at day 1 postop, Dr. Safran said he doesn’t use software, sticking with rotating them back to where the original operative plan had intended. If you wait 5–6 weeks before rotating, however, he recommended the Barrett Rx formula or astigmatismfix.com. He pointed out that fibrosis should be considered, even if rotation is occurring at the 1-month mark. Freeing up the haptics and recognizing the common points of adhesion that are specific to the IOL is important, he said, but noted that there won’t be any fibrosis if rotation occurs within 1–2 days postop. Dr. Safran said he will always reposition off-axis lenses vs. correcting residual astigmatism with a laser, provided the patient has not had a YAG laser posterior capsulotomy. If he finds the wrong toric power altogether was used, he will exchange the lens. “To me, to change the cornea to compensate for a rotated lens is not the right way to fix it because you’re compensating in a way that I don’t think is going to provide as good of a refractive outcome as to fix the problem directly,” he said. EWAP Reference 1. Ma JJ, Tseng SS. Simple method for accurate alignment in toric phakic and aphakic intraocular lens implantation. J Cataract Refract Surg . 2008;34:1631–6. Editors’ note: Dr. Safran and Baartman have no financial interests related to their comments. Contact information Baartman: brandon.baartman@ vancethompsonvision.com Safran: safran12@comcast.net in to rotate a toric lens, he said he is more likely to rely on the axis proposed by astigmatismfix.com vs. intraoperative aberrometry, which he used when placing the lens primarily. In terms of knowing when to correct a rotated toric, that depends on your threshold, Dr. Safran said. “If you’re using a low power toric and it’s rotated 5 or 10 degrees, that might only be a 10th of a diopter,” he said. “If it’s a higher power toric, that could become a significant amount.” Dr. Safran said he refracts his patients at postop day 1 and again at 1 week postop. If the toric lens is not where he wants it to be and it’s causing enough residual astigmatism to be considered significant, he will take a 30-gauge needle, go in through the limbus, and rotate it appropriately just at the slit lamp. “Most doctors don’t do slit lamp rotation like I do; they’re not comfortable with it. So I tell those doctors if you have a rotated toric in a high myope, wait about 5–6 weeks to fix it so the capsular bag can contract a little. If you fix them right away, there’s a greater chance they’ll reoccur and you’re back to where you started. … If you place a CTR you also reduce the risk of the lens rotating again,” Dr. Safran ...all patients getting premium implants, including torics, should be made aware of the potential for residual astigmatism and the possibility of a fine tune in the future... – Brandon Baartman, MD Toric IOL - from page 37