Eyeworld

SEPTEMBER 2022 | EYEWORLD | 21 References 1. Anderson DF, et al. Global prevalence and economic and humanistic burden of astig- matism in cataract patients: a systematic literature review. Clin Ophthalmol. 2018;12:439–452. 2. Kessel L, et al. Toric intraoc- ular lenses in the correction of astigmatism during cataract surgery: a systematic review and meta-analysis. Ophthalmology. 2016;123:275–286. 3. Visser N, et al. Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and compli- cations. J Cataract Refract Surg. 2013;39:624–637. 4. Dang S, et al. Estimating patient demand for ophthalmol- ogists in the United States using Google Trends. Invest Ophthal- mol Vis Sci. 2021;62:1724. 5. Oshika T, et al. Comparison of incidence of repositioning surgery to correct misalignment with three toric intraocular lenses. Eur J Ophthalmol. 2020;30:680–684. 6. Lee BS, Chang DF. Comparison of the rotational stability of two toric intraocular lenses in 1273 consecutive eyes. Ophthalmolo- gy. 2018;125:1325–1331. of misalignment from the intended astigmatic axis associated with TECNIS versus AcrySof lenses and have shown greater frequency of re- alignment operations in TECNIS-implanted eyes versus AcrySof-implanted eyes. 5,6 Beyond TECNIS as a risk factor for realign- ment, this study also identified younger age as a significant risk factor. The authors posit several hypotheses to explain why this might be: (1) younger patients may be more visually demand- ing and therefore less tolerant of misalignment, (2) greater activity in the immediate postoper- ative period may be a cause for postoperative rotation in younger patients, (3) an unspecified difference in the composition of the capsule, or (4) younger patients have more with-the-rule significant risk factors were identified (includ- ing sex, race, or region of country where the surgery was performed). Discussion The authors concluded, using IRIS Registry data, that second surgery for IOL realignment was significantly more frequent in eyes implant- ed with TECNIS monofocal toric IOLs as com- pared to those implanted with AcrySof monofo- cal toric IOLs. For both lenses, they found higher rates of surgical repositioning as compared to the registration trials (3.1% versus 2.3% for the TECNIS and 0.6% versus 0.4% for the AcrySof). For context, this difference between AcrySof and TECNIS in terms of frequency of second surger- ies for realignment has been demonstrated be- fore; prior studies have shown greater degrees Real-world incidence of monofocal toric intraocular lens repositioning: analysis of the American Academy of Ophthalmology IRIS Registry Kramer BA, et al. J Cataract Refract Surg. 2022;48:298–303 n Purpose: To determine the 12-month incidence of reoperation to realign 2 commercially available types of implanted monofocal toric acrylic intraocular lenses (IOLs) n Setting: American Academy of Ophthalmology IRIS (Intelligent Research in Sight) Registry n Design: Registry retrospective study n Methods: Eyes that underwent cataract extraction and were implanted with a TECNIS (Johnson & Johnson Vision) or AcrySof (Alcon) monofocal toric IOL in 2016 and 2017 were identified. The rate of reoperation for IOL realignment (Current Procedural Terminology code 66825) within 365 days of implantation was determined for each IOL group. Risk factors for repositioning were evaluated using logistic regression modeling. n Results: A total of 6,482 eyes were implanted with a monofocal toric IOL, including 2,013 (31.06%) with a TECNIS and 4,469 (68.94%) with an AcrySof IOL. During the first postoperative year, 87 (1.3%) eyes underwent surgical IOL repositioning. The incidence of repositioning was significantly higher (P<.0001) for TECNIS-implanted (3.1%, 62/2013) than for AcrySof- implanted (0.6%, 25/4469) eyes (odds ratio [OR] 5.6; 95% CI, 3.5–8.9). Younger age (OR 0.76; 95% CI, 0.67–0.86 per 5-year increase) was associated with a higher risk for IOL repositioning. n Conclusion: Real-world analysis of U.S. patients in the IRIS Registry revealed that the rate of surgical IOL repositioning was 5 times higher in eyes implanted with TECNIS than with AcrySof monofocal toric IOLs for astigmatic correction at the time of cataract surgery. These findings should be considered when selecting a toric IOL for correction of astigmatism in cataract patients, particularly in younger patients with a higher risk for misalignment requiring repositioning. continued on page 22

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