Optimizing Patient Outcomes with IIn a lunch symposium hosted on Sunday June 12, 2022, three leaders in cataract surgery presented on new research findings and ways to optimize patient outcomes in the world of IOLs. With Professor Chul Young Choi, South Korea, and Professor Oliver Findl, Austria, as moderators, audience members were first asked to consider their confidence in managing their patients’ visual expectations. The survey questions were asked again after the three presentations, and there was a trend in improved confidence in the audience’s own abilities to customize treatment for patients and meet their visual expectations in cataract and refractive surgery. Maximizing Surgical Success with Phaco and Toric IOLs Using Latest Innovations Professor Tetsuro Oshika, Japan Astigmatism is an increasingly important consideration in refractive surgery. From an ESCRS 2019 survey, the percentage of cataract procedures that involve a toric intraocular lens (IOL) for patients with clinically significant astigmatism is increasing year by year. To begin his presentation, Prof. Tetsuro Oshika, Japan described the three patterns of astigmatism: with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. In WTR astigmatism, the vertical meridian is the steepest and stays close to 90 degrees. In ATR astigmatism, the horizontal meridian stays close to 180 degrees, which is steeper than the vertical meridian. Finally, oblique astigmatism occurs if the principal meridians are neither at 90 degrees nor 180 degrees. The impact of these types of astigmatism on visual function is different as there are age-related changes that come with corneal astigmatism. As patients get older, WTR astigmatism takes over ATR astigmatism in the anterior chamber due to a thicker vertical cornea in older patients. Prof. Oshika further explained the role of K value in astigmatism. K value actually does not equal total corneal astigmatism. In fact, the K value overestimates WTR astigmatism while the toric IOL overcorrects WTR astigmatism. On the other hand, K values also underestimate ATR astigmatism while the toric IOL undercorrects ATR astigmatism. Furthermore, Prof. Oshika performed an analysis on astigmatism type and uncorrected distance visual acuity (UDVA) and found that age was considered a confounding factor within their analysis. As for long-term outcomes of toric IOL implantation, Prof. Oshika found in his studies that eyes with preoperative WTR astigmatism and preoperative oblique astigmatism, vision after toric IOL implantation remained stable over 8 years. However, eyes with preoperative ATR astigmatism experienced a reduced astigmatism-correcting effect after 5 years post-toric IOL implantation. “From these findings, we recommend overcorrection for ATR astigmatism,” said Prof. Oshika. Another topic Prof. Oshika discussed was precise axis marking. According to the ESCRS 2019 survey, 41% of ophthalmologists prefer ink marking using an aid instrument and 29% preferink marking at slit lamp without an aid instrument. Twenty-two percent (22%) prefer using digital image registration for aligning the toric IOL axis. Prof. Oshika noted that a recent study reported that digital marking is more time Supported by an educational grant from Johnson & Johnson Vision Long-term outcomes of toric IOL implantation shows stable vision for eyes with preoperative WTR and oblique astigmatism, while eyes with preoperative ATR astigmatism showed a reduced astigmatism-correcting effect after 5 years. Supplement to EyeWorld Asia-Pacific September 2022 i i i ti t tc es ith IIn a lunch sy posiu hosted on Sunday June 12, 202 , thre leaders in cataract surgery presented on ne research findings and ays to optiize patient outco es in the world of IOLs. With rofessor Chul Young Choi, South Korea, and Professor Oliver Findl, Austria, as moderators, audience members were first asked to consider their confidence in managing their patients’ visual expectations. The survey questions were asked again after the three presentations, and there was a trend in improved confidence in the audience’s own abilities to customize treatment for patients and meet their visual expectations in cataract and refractive surgery. Maximizing Surgical Success with Phaco and Toric IOLs Using Latest Innovations Professor Tetsuro Oshika, Japan Astigmatism is an increasingly important consideration in refractive surgery. From an ESCRS 2019 survey, the percentage of cataract procedures that involve a toric intraocular lens (IOL) for patients with clinically significant astigmatism is increasing year by year. To begin his presentation, Prof. Tetsuro Oshika, Japan described the three patterns of astigmatism: with-the-rule (WTR), against-the-rule (ATR), and oblique astigmatism. In WTR astigmatism, the vertical meridian is the steepest and stays close to 90 degrees. In ATR astigmatism, the horizontal meridian stays close to 180 degrees, which is steeper than the vertical meridian. Finally, oblique astigmatism occurs if the principal meridians are neither at 90 degrees nor 180 degrees. The impact of these types of astigmatism on visual function is different as there are age-related changes that come with corneal astigmatism. As patients get older, WTR astigmatism takes over ATR astigmatism in the anterior chamber due to a thicker vertical cornea in older patients. Prof. Oshika further explained the role of K value in astigmatism. K value actually does not equal total corneal astigmatism. In fact, the K value overestimates WTR astigmatism while the toric IOL overcorrects WTR astigmatism. On the other hand, K values also underestimate ATR astigmatism while the toric IOL undercorrects ATR astigmatism. Furthermore, Prof. Oshika performed an analysis on astigmatism type and uncorrected distance visual acuity (UDVA) and found that age was considered a confounding factor within their analysis. As for long-term outcomes of toric IOL implantation, Prof. Oshika found in his studies that eyes with preoperative WTR astigmatism and preoperative oblique astigmatism, vision after toric IOL implantation remained stable over 8 years. However, eyes with preoperative ATR astigmatism experienced a reduced astigmatism-correcting effect after 5 years post-toric IOL implantation. “From these findings, we recommend overcorrection for ATR astigmatism,” said Prof. Oshika. Another topic Prof. Oshika discussed was precise axis marking. According to the ESCRS 2019 survey, 41% of ophthalmologists prefer ink marking using an aid instrument and 29% prefer ink marking at slit lamp without an aid instrument. Twenty-two percent (22%) prefer using digital image registration for aligning the toric IOL axis. Prof. Oshika noted that a recent study reported that digital marking is more time Supported by an educational grant from Johnson & Johnson Vision Long-term outcomes of toric IOL implantation shows stable vision for eyes with preoperative WTR and oblique astigmatism, while eyes with preoperative ATR astigmatism showed a reduced astigmatism-correcting effect after 5 years. rl i - ifi Se te ber 202
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