EyeWorld India March 2014 Issue

37 EWAP CATARACT/IOL March 2014 above, I have been impressed with the optics of the Tecnis Toric in achieving this goal. A toric IOL typically precludes presbyopia correction, unless we aim for a monovision target. The Trulign Toric, based on the Crystalens accommodating IOL, does provide a broader range of vision than other toric options. Like the Crystalens, it offers very good intermediate vision; the near acuity is less consistent or predictable, so I usually talk to patients about an improved range of vision with this lens, with an expectation that they will need to wear mild reading glasses. Ease of implantation One reason for the appeal of one-piece lenses like the AcrySof and Tecnis IOLs is that they are traditionally easy to insert and position. The Tecnis Toric has relatively stiffer haptics that let it open in a controlled fashion. A nice feature is that it can be rotated clockwise or counterclockwise. This reduces intraoperative manipulation and allows fine- tuning of the axis position without having to dial the IOL close to 180 degrees if I miss my mark initially. The Trulign has an entirely different delivery system, of course. Many surgeons feel that it is technically more challenging. The capsulorhexis must be sized perfectly. The lens can’t be vaulted anteriorly or positioned too far posteriorly and the anterior chamber must be absolutely stable, so implantation of this lens does require a certain degree of skill. Surgeons who are comfortable implanting the Crystalens will be comfortable implanting the Trulign as well. The inserter for this lens also requires a larger incision (2.85 mm) than either of the one-piece lenses. We are fortunate to have four toric IOL options now in the U.S. market. These are all good lenses; cataract surgeons should understand the features and relative advantages of each in order to best meet the visual needs of our astigmatic patients. EWAP References 1. Ma JJ, Tseng SS. Simple method for accurate alignment in toric phakic and aphakic intraocu- lar lens implanta- tion. J Cataract Refract Surg. 2008;34(10):1631- 6. 2. AcrySof IQ Toric Product Informa- tion, 2009. Alcon Laboratories. 3. Chang DF. Early rotational stabil- ity of the longer STAAR toric intraocular lens: fifty consecutive cases. J Cataract Refract Surg. 2003;29(5):935- 40. 4. Chua WH, Yuen LH, Chua J, et al. Matched compari- son of rotational stability of 1-piece acrylic and plate-haptic silicone toric intraocular lenses in Asian eyes. J Cat- aract Refract Surg. 2012;38(4):620-4. 5. Terwee T, Weeber H, van der Mooren M, Piers P. Visualization of the retinal image in an eye model with spherical and aspheric, diffractive, and refrac- tive multifocal intraocular lenses. J Refract Surg. 2008;24(3):223-32. 6. Zhao H, Mainster MA. The effect of chromatic dispersion on pseudopha- kic optical performance. Br J Ophthal- mol. 2007;91:1225-9. Editor’s Note: Dr. Matossian is founder and CEO of Matossian Eye Associates, a private integrated ophthalmology and optometry group practice with three offices in Pennsylvania and New Jersey. She is clinical instructor, Department of Ophthalmology, Temple University School of Medicine, Philadelphia. Dr. Matossian has financial interests with Abbott Medical Optics. Contact information Matossian : cmatossian@matossianeye.com