Eyeworld

18 | EYEWORLD | WINTER 2024 ASCRS NEWS Contact Sheybani: sheybaniar@wustl.edu References 1. 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. 2. Kent C. 37 ways to get great outcomes with torics. Review of Ophthalmology. 2012. Accessed October 19, 2024. www.reviewo- fophthalmology.com/article/37- ways-to-get-great-outcomes- with-torics 3. Hoffmann PC, et al. Results of higher power toric intraocular lens implantation. J Cataract Refract Surg. 2011;37:1411–1418. 4. Beheregaray S, et al. Astig- matic overcorrection and axis flip for targeting minimal remaining refractive astigmatism with toric intraocular lenses. J Cataract Refract Surg. 2018;44:109–110. 5. Hasegawa Y, et al. Type of residual astigmatism and uncorrected visual acuity in pseudophakic eyes. Sci Rep. 2022;12:1225. study, however, combining these two cohorts together is less ideal than if there were a single group of patients being studied where preop- erative cylinder had been addressed in a single fashion. Lastly, their proxies for tolerance of axis-flip were visual acuity and PROMs and do not include a defocus curve. VA and PROMs are important to assess and do clearly suggest tolerance of axis-flip given their results. How- ever, any true effect of these factors to suggest astigmatic intolerance may be missed due to the smaller cohort of patients, which might have been revealed if defocus curves could have been completed. Nevertheless, this study certainly provides important evidence that axis-flip, even WTR to ATR, may not impact final VA or affect patient satisfaction. Factoring this into preoperative se- lection of TIOLs may lead to more accurate and effective reduction of a patient's cylinder power. This mindset in conjunction with consideration of PCA and the drift to ATR with time provides an exciting future opportunity to optimize visu- al outcomes for patients. for patient-specific considerations for under- or overcorrection of WTR or ATR, respectively, to optimize visual outcome. This study challenges the suggestion that flipping the patient's preoperative baseline cy- lindrical axis might result in reduced postopera- tive visual acuity and patient satisfaction. Their conclusion that axis-flipping did not impact post-TIOL visual acuity or PROMs may support the surgical decision to completely correct all preoperative astigmatism regardless of axis. While this study does oppose common no- tions of axis-flip that can lead to more optimized visual outcomes for post-TIOL patients, there are certainly limitations as well. Although they do indicate that the initial prospective study was sufficiently powered to determine significant differences in outcomes between their control group and investigative group, their follow-up attendance of 84 patients at the 6-month time point does make extrapolating clinical signif- icance from their study more difficult. Addi- tionally, they do comment that there was no significant difference in the mean postoperative axis change between the control group and in- vestigative group from the original prospective continued from page 17 The effects of axis-flip of the refractive cylinder on vision and patient-reported outcome measures following toric intraocular lens implantation Naderi K, et al. J Cataract Refract Surg. 2024. Online ahead of print. n Purpose: To investigate the effects of cylinder axis-flip after toric intraocular lens (TIOL) implantation on vision and patient-reported outcome measures (PROMs). n Setting: Teaching hospital in the United Kingdom. n Design: Post hoc analysis of data from patients who participated in a prospective randomized study of TIOLs. n Methods: Axis-flip was defined as a change in postoperative refractive cylinder (RC) axis of 90±22.5 degrees from the preoperative biometric axis. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual RC, and CATPROM-5 and EQ-5D-3L quality-of-life scores were analyzed. n Results: At 6 months, axis-flip occurred in 29 (34.5%) of 84 eyes of which 28 had with-the-rule (WTR) astigmatism preoperatively. Mean (±SD) UDVA (logMAR) was 0.13 (0.16) in flipped cases (FCs) and 0.10 (0.14) in unflipped cases (UFs) (P=.88). CDVA was 0.01 (0.11) in FC and was 0.00 (0.09) in UF (P=.68). Mean RC was 0.74 diopters (D) (0.41) in FC and 0.93 D (0.47) in UF (P=.08). Mean CATPROM-5 score was 6.22 (2.56) in FC and 5.52 (3.03) in UF (P=.29). Mean EQ-5D-3L calibrated score was 0.89 (0.19) in FC and 0.85 (0.19) in UF (P=.35). Retrospectively applying coefficients of adjustment to account for posterior corneal astigmatism (PCA) suggested that 6 eyes (21%) of FC with WTR might have avoided axis-flip. n Conclusions: Axis flipping after TIOL implantation did not adversely influence visual acuity or PROMs scores. Most FC had WTR preoperatively. Adjusting for PCA might have reduced axis-flip in some of these eyes.

• Blank Page
• Blank Page (1)