One other very important factor that may influence the rotational stability of toric IOLs is the anterior capsule coverage and whether the continuous curvilinear capsulorhexis (CCC) edge completely or partially covers the optic. Prof. Oshika found that at 6 months after surgery, the degree of misalignment significantly differs between eyes with complete coverage compared to eyes with partial coverage of the anterior capsule. With the latest version of toric IOLs, the TECNIS® Toric II IOL, there is an improved frosted haptic which exerts more friction within the capsule. Prof. Oshika was able to show that the TECNIS® Toric II IOL unfolded much faster than the TECNIS® Toric IOL due to less adhesion of the optic and haptics. With the faster release of the haptic and increased friction, Prof. Oshika found improved rotational stability with the TECNIS® Toric II lens. Finally, Prof. Oshika investigated the appropriate timing of repositioning surgery and final misalignment of IOLs in a study. He found that, when performed just after primary cataract surgery, some IOLs rotated back to the same position. “It is better to wait one week after cataract surgery before performing repositioning surgery,” said Prof. Oshika. Innovations in Cataract Surgery efficient than manual marking, but the improvement in accuracy did not show to be significant: there was no significant difference between manual and digital marking in terms of toric IOL misalignment at 1 week and 1 month after surgery. When using the manual marking method, Prof. Oshika stated that surgeons “need to pay attention. Sometimes the mark may be vertically deviated.” Lateral and asymmetrical deviation may also occur. Another consideration is axis misalignment of toric IOLs. “Sometimes, the lens rotates or deviates significantly, and reposition surgery is required to correct the axis,” said Prof. Oshika. In a graph that Prof. Oshika showed, axis rotation occurs mainly in the early postoperative period. The largest rotation occurs at the end of surgery within one hour. Afterward, axis rotation remains stable. Thus, the most critical period of the stability of the toric lens is within 1 hour of surgery. One tip Prof. Oshika provided to reduce misalignment is to wait until the complete unfolding of the lens. “Some lenses are very slow to open,” he said. Surgeons should instruct patients to not walk around but to stay at rest for at least 1 hour after surgery. Although there is no data to support this tip, Dr. Oshika believes it may help with stabilizing the toric lens. Laboratory & Clinical Evaluation of Multifocal IOLs: Extended Intermediate Functions Professor Chul Young Choi, South Korea Recently, Prof. Choi has studied the “physical” and “optical” characteristics of multifocal IOLs. In his presentation, Prof. Choi began with a discussion on surface imaging of different IOL types. In his study, different IOLs may look clear and calm at a low magnification. However, when one views the IOLs at a higher magnification (20,000 times), the IOL appears more wavy and rough except for one IOL: the TECNIS Symfony™ IOL. This specific IOL shows a smoother and more regular pattern. The difference in surface roughness, then, can be attributed to differences in optical scattering on the varied angulated diffractive steps of certain IOLs. To avoid additional surface scattering, surgeons should choose IOLs with a regular straight pattern and with a minimum surface roughness scale. On the topic of optical bench testing, Prof. Choi compared three different IOLs (TECNIS Synergy™ IOL, ZEISS AT LISA tri, and Alcon PanOptix®) at both 2 mm and 3 mm pupil sizes and at 546 nm wavelength. From this study, the modulation transfer function (MTF) curve of the TECNIS Synergy™ IOL showed a wide reading distance ranging from 33 cm to 27 cm while the other two IOLs Copyright 2022 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. All other trademarks are the intellectual property of their respective owners. © Johnson & Johnson Surgical Vision, Inc. 2022 PP2022MLT6001 “For a continuous range of vision with better near visual acuity, we need to individualize and optimize using a ‘combined’ implantation strategy.” Prof. Chula Young Choi, South Korea showed a narrower reading distance. When comparing the TECNIS® Monofocal IOL with the TECNIS EyhanceTM IOL, Prof. Choi was able to observe consistent graphs of various pupil sizes. The TECNIS Eyhance™ IOL showed good outcomes with an additional 0.7 diopters of power for smaller pupil sizes. In patients with decentration of up to 0.25 mm, the Eyhance™ IOL showed comparable outcomes to the Monofocal IOL with 91% preservation of the MTF curve. “These are very good outcomes compared to any other trifocal or multifocal IOL,” said Prof. Choi. The last topic Prof. Choi shared with the audience was on spectrophotometer analysis. In one study, Prof. Choi compared the TECNIS Synergy™ IOL, ZEISS AT LISA tri IOL, Alcon IQ PanOptix® IOL, and HOYA Vivinex™ Toric IOL at 20 diopters of base power to determine the light-filtering capabilities of the IOLs. These IOLs were implanted in dry conditions with a transparent base glass, at an aperture size of 1 mm, and at a wavelength range of 350 nm to 800 nm. Prof. Choi studied these IOLs with ultraviolet- and violet-filtering capabilities, which may block high-energy wavelengths. These high-energy wavelengths pose a risk of potential reactive oxygen species (ROS) damage to retinal pigment epithelium (RPE) cells. However, these IOLs allow full transmission of healthy blue light, allowing for advantages in contrast sensitivity, visual performance (especially during night time), circadian rhythm, and sleep quality. In ovations in Cataract Surgery
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