EyeWorld Asia-Pacific December 2021 Issue

EWAP DECEMBER 2021 17 crease in the use of toric IOL for managing astigmatism. If cost were not an issue, 52% of patients with clinically astigmatism would receive a toric IOL. Dr. Kim explained that a patient who has regular corneal astigmatism and is interested in spectacle independence will be a good candidate for toric IOL implantation. However, there are other factors to consid- er when deciding whether a patient is a good candi- date. Those with posterior capsular dehiscence, poor pupillary dilation, and prior vitreoretinal procedures may not achieve desired results with toric IOLs due to lack of IOL stability, a basic require- ment for perfect toric IOL performance. Additionally, “successful toric IOL implan- tation is mainly determined by accurate preoperative analysis of astigmatism and well-performed IOL align- ment,” says Dr. Kim. For preoperative analysis of astigmatism, optical biom- etry is the most preferred method to measure power and to select the axis. To analyze the pattern of astig- matism and to confirm the axis, a topographic exam is frequently added, explained Dr. Kim. Reference marking is an- other factor that may pre- dict successful toric IOL implantation. Manual ref- erence marking with ink is still a commonly used tech- nique. However, from the ESCRS 2019 survey results, surgeons are increasing- ly preferring digital image registration over manual ink marking with either axial instruments or a slit lamp. For intraoperative align- ment, image-guided systems may greatly improve the evaluation step during toric IOL implantation. Surgeons must consider patient fac- tors, intraoperative factors, and IOL factors that may affect toric IOL rotation. Dr. Kim explained that patient factors could include a long axial length, thick lens, or an asymmetric capsular bag shape. During operation, surgeons should pay atten- tion to a large continuous curvilinear capsulorrhexis size, hyperinflation, and poor watertight sealing. Even IOL factors such as its material or shape may con- tribute to toric IOL rotation. Dr. Kim’s take home mes- sage from her presentation was that patients with reg- ular astigmatism are rec- ommended to receive toric IOL implantation, which can provide an expected residu- al astigmatism of under 0.5 diopter with good long-term stability. Though there may be a steep learning curve for implanting toric IOLs because of increased time for preoperative analysis and greater surgical skill, Dr. Kim believes that there are many resources for enhancing sur- gical skill of toric IOLs. She strongly recommends sur- geons to “learn everything from A to Z about toric IOLs before starting your first case and to continue updat- ing your knowledge.” The New EDOF Kid on the Block Michael Lawless, MD, Australia With access for nearly two years to the Acrysof ® IQ Viv- ity ® IOL and the AcrySof™ IQ Vivity™ Toric Extended Vision IOL, Dr. Lawless dis- cussed his experience with the IOLs in his practice as well as insight from his par- ticipation in the Vivity Reg- istry Study. Vivity Registry Study is a multicenter, ambi- spective, non-comparative, open-label study (including countries from Europe, Aus- tralia, and New Zealand) that looked at 129 patients with a bilateral implant of either the Acrysof® IQ Vivity ® IOL or the Vivity™ IOL. The study’s primary endpoint was photopic binocular uncor- rected visual acuity at dis- tance while also observing visual disturbance as a safety endpoint. The results of the Registry Study showed that mean photopic binocular uncor- rected distance visual acu- ity (UCDVA) at least three months after AcrySof IQ Vivity ® IOL implantation was 0.009 logMAR, which corresponds to 20/20 vision (Snellen). In terms of safety outcomes, more than 88% of subjects had no visual distur- bances of halos, glare, and starbursts at least 3 months after IQ Vivity AcrySof IQ Vivity ® IOL implantation. “This is where the AcrySof IQ Vivity ® IOL shines,” says Dr. Lawless. Other con- clusions from the registry showed that most subjects did not need to wear glasses for distance and intermedi- ate tasks, and most subjects reported no difficulty with their everyday life activities. Dr. Lawless presented a case in which a 63-year-old male patient presented with cortical cataract, corrected distance visual acuity of 6/9 in each eye, slightly dis- turbed tear film, yet normal topography. The patient achieved plano in the left eye with an implanted Clare- on ® monofocal IOL and -0.75 diopter in the right eye with an implanted Vivity ® IOL. The patient reported a 10 out of 10 on a scale of overall quality of vision 3 months after surgery. Look- ing at uncorrected vision post surgery, the patient’s left eye was 6/4.5 (binocular distance), N10 (binocular intermediate), and N12 (bin- ocular near). “That’s how a monofocal lens works,” said Dr. Lawless. With an uncor- rected right eye of 6/7.5 (binocular distance) and N5 for both binocular interme- diate and near, Dr. Lawless explained that “the patient was getting more from [the implantations] without the disadvantage of true mono- vision.” Until recently, in Dr. Law- less’s view, a traditional monofocal lens gave great distance vision but poor near and intermediate vi- sion. On the other hand, a Copyright 2021 APACRS. All rights reserved. The views expressed here do not necessarily reflect those of the editor, editorial board, or publisher, and in no way imply endorsement by EyeWorld, Asia-Pacific or APACRS. © Alcon 2021 ASIA-ACP-2100004 Exp Date 30 June 2022 Successful toric IOL implantation is mainly determined by accurate preoperative analysis of astigmatism and well-performed IOL alignment.