NEWS & OPINION 38 EWAP DECEMBER 2022 by Lisa Koenig, MD, Charles Cole, MD, Brigette Cole, MD, Grace Sun, MD, and the Weill Cornell Medicine ophthalmology residents Contact information Koenig: lrk2002@nyp.org Sun: grs2003@med.cornell.edu Review of ‘Real-world incidence of monofocal toric intraocular lens repositioning: Analysis of the American Academy of Ophthalmology IRIS Registry’ A mong eyes undergoing cataract surgery, corneal astigmatism is common. In a systematic review of 31 studies published in 2018, nearly half (47%) of eyes undergoing cataract extraction were found to have at least 1 D of corneal astigmatism.1 Postoperative residual uncorrected astigmatism carries an economic burden primarily in the need for spectacles, estimated to be several thousand dollars over a lifetime. To address this need, toric IOLs were developed. Approved by the FDA in 1998, toric lenses originally had a plate-haptic design, and were subsequently updated to enhance rotational stability; modern-day lenses have an open loop haptic design. When compared to non-toric IOLs, even in situations where limbal relaxing incisions are used, toric lenses have been shown to deliver enhanced visual outcomes, quality of life, and spectacle independence.2 Critically, to optimize postoperative visual outcomes, toric lenses must not only be placed at the proper axis intraoperatively but also must remain well-aligned postoperatively. Modern-day IOLs are associated with a <3% rate of second surgeries for realignment.3 To date, these data regarding rates of surgical realignment come from controlled trials or single-center series. In this retrospective study, Kramer et al. used the Intelligent Research in Sight (IRIS) Registry to reflect real-world experience of reoperation rates for IOL realignment in eyes implanted with the AcrySof toric lens (Alcon) versus the TECNIS toric lens (Johnson & Johnson Vision). Methods The IRIS Registry collates data from the electronic medical records of U.S. ophthalmologists. In 2016, it included data from 7,400 ophthalmologists over 2,300 practices representing approximately 40% of U.S. ophthalmologists.3,4 The authors used ICD-10 and CPT codes to identify adults over age 45 with age-related cataracts who had undergone cataract extraction between January 1, 2016, and December 31, 2017. Inclusion criteria stipulated that patients must have at least two postoperative visits within 180 days of surgery. Patients were excluded based on a number of preoperative complicating ocular diagnoses and if any CPT codes indicating intraoperative surgical complications were present. The authors then identified cases that were associated with the CPT code indicating need for surgical repositioning within the first year after surgery. Their primary interest was the repositioning rate of the AcrySof toric IOL compared to the TECNIS toric IOL. Finally, the authors used logistic regression to identify risk factors for repositioning. An independent partner, Verana Health, was used to extract and statistically analyze the data. Summary of results In total, 11,012 eyes met inclusion criteria and were implanted with a toric lens over this period: 4,530 with a multifocal toric IOL and 6,482 with a monofocal toric IOL. However, given the imbalance in frequency of AcrySof and TECNIS among the multifocal toric eyes (98.5% were implanted with TECNIS), the authors focused on the monofocal toric eyes only, which had a more balanced distribution between AcrySof (4,469, 68.9%) and TECNIS (2,013, 31.1%) lenses. Overall, the mean age was 70 years, and the majority were women (60.3%) and white (88.2%). Importantly, these demographic characteristics did not differ significantly between the AcrySof- and TECNIS-implanted eyes. Within 1 year of surgery, 1.3% of eyes underwent a second surgery to reposition the lens, This article originally appeared in the September 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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