Eyeworld

Today's top challenges with toric IOLs Best practices are key to success in surgical management of astigmatism N inety-five percent of 2018 ASCRS Clinical Survey respondents believe patients with clinically significant astig- matism should be offered astigmatism correction during cataract surgery (Figure 1). 1 However, the survey revealed that an average of 20% of patients with clinically signifi- cant astigmatism receive toric intraocular lenses (IOLs). Sumit "Sam" Garg, MD, explained that surgeons may face several challenges when incorporating toric IOLs into their practices. They include integrating assessments into workups, identifying astigma- tism, determining the most appropriate correction meth- od, and achieving optimal results. Dr. Garg offered tips to help surgeons make the most of toric technologies and de- liver optimal visual outcomes. Identifying solutions Dr. Garg includes corneal topography in the routine workup of cataract surgery candidates, which determines whether astigmatism is regular or irregular and confirms biometry and autokeratometry readings. Topography images also can be shared with pa- tients as the surgeon educates them about astigmatism man- agement. He also emphasized the need to examine corneal astigmatism. "Oftentimes, surgeons focus on refractive continued on page 2 Click to read and claim CME credit Accreditation Statement This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the American Society of Cataract and Refractive Surgery (ASCRS) and EyeWorld magazine. ASCRS is accredited by the ACCME to provide continuing medical education for physicians. Educational Objectives • Outline the importance of and best practices for preoperative, intraoperative, and postoperative planning and execution to improve outcomes in the surgical management of astigmatism. • Identify steps to mitigate refractive surprises and manage postoperative dissatisfaction to increase postoperative success with toric and presby- opia-correcting IOLs. • Describe new and emerging technological advanc- es for the treatment of presbyopia and astigmatism. • Integrate proper patient education and conversation techniques for the astigmatic and presbyopic patient. Designation Statement The American Society of Cataract and Refractive Sur- gery designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits ™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Notice of Off-Label Use Presentations This activity may include presentations on drugs or devices or uses of drugs or devices that may not have been approved by the Food and Drug Administration (FDA) or have been approved by the FDA for specific uses. Claiming Credit To claim credit, participants must visit bit.ly/2m1aKmB to review content and download the post-activity test and credit claim. All participants must pass the post-activity test with score of 75% or higher to earn credit. Alternatively, the post-test form included in this supplement may be mailed or emailed in for credit to be awarded, and a certificate will be mailed within 2 weeks. When viewing online or downloading the material, standard internet access is required. Adobe Acrobat Reader is needed to view the materials. CME credit is valid through April 30, 2020. CME credit will not be awarded after that date. Financial Interest Disclosures Zaina Al-Mohtaseb, MD, has received a retainer, ad hoc fees, or other consulting income from Allergan. She is a member of the speaker's bureau for Alcon. Daniel Chang, MD, has an investment interest in Omega Ophthalmics. He has received a retainer, ad hoc fees, or other consulting income from Allergan, Johnson & Johnson Vision, Mynosys Cellular Devices, Omega Ophthalmics, and Carl Zeiss Meditec. He is a member of the speaker's bureau for Johnson & Johnson Vision and Carl Zeiss Meditec. He has received research support from AcuFocus, Allergan, Johnson & Johnson Vision, and Mynosys Cellular De- vices. He has received travel support from AcuFocus, Allergan, Johnson & Johnson Vision, and Zeiss. Nicole Fram, MD, has an investment interest in CorneaGen and Ocular Science. She has received a retainer, ad hoc fees, or other consulting income from Alcon, Allergan, Bio-Tissue, CorneaGen, Johnson & Johnson Vision, Notal Vision, Ocular Science, RxSight, and Carl Zeiss Meditec. She is a member of the speaker's bureau for Alcon, Bausch + Lomb, Bio-Tissue, Johnson & Johnson Vision, Shire, and Sun Pharmaceutical. She has received research support from Allergan. Sumit "Sam" Garg, MD, has received a retainer, ad hoc fees, or other consulting income from Johnson & Johnson Vision, Kala, OcyTrx, RxSight, RySurg, Shire, SightLife, VIsionCare, and Carl Zeiss Meditec. He is a member of the speaker's bureau for Johnson & Johnson Vision and Shire. He has an investment interest in OcyTrx and RPS. Douglas Koch, MD, has an investment interest in Ivantis and PowerVision. He has received a retainer, ad hoc fees, or other consulting income from Alcon, CAPSULaser, Johnson & Johnson Vision, Perfect Lens, Vivior, and Carl Zeiss Meditec. Cynthia Matossian, MD, has an investment interest in Checked Up, PRN, and Strathspey Crown/Alpheon. She has received a retainer, ad hoc fees, or other consulting income from Aerie, Allergan, Bausch + Lomb, Bio-Tissue, Bruder Health, Eyepoint, Eyevance, GuardiOn, Imprimis, iOptics, Johnson & Johnson Vision, Kala, Lenstec, Marco, MDBackline, Mentho- latum Company, Ocular Science, Ocular Therapeutix, Omeros, PRN, Quidel, Shire, Sun Pharmaceuticals, TearLab, and Carl Zeiss Meditec. She is a member of the speaker's bureau for Aerie, Allergan, Bausch + Lomb, Bruder Health, EyePoint, Johnson & Johnson Vision, Kala, Marco, Ocular Science, Ocular Therapeu- tix, Omeros, PRN, Quidel, Shire, Sun Pharmaceuticals, TearLab, and Carl Zeiss Meditec. She has received re- search support from Bruder Health and Shire. She has provided practice management or marketing consulting services to EyePoint and Carl Zeiss Meditec. Staff member Kate Fehlhaber has no ophthal- mic-related financial disclosures. Supported by an unrestricted educational grant from Johnson & Johnson Vision, Alcon, and Carl Zeiss Meditec. Sumit "Sam" Garg, MD Figure 1. According to the 2018 ASCRS Clinical Survey, 95% of respondents believe patients with clinically significant astigmatism should be offered astigmatism correction at the time of cataract surgery. toric toolbox: Building skills and strategies to surgically manage astigmatism ASCRS 60% 35% 3% 2% 1% Strongly Agree Agree Neutral Disagree Strongly Disagree

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