Eyeworld

Astigmatism Management Discussing what amount of postop astigmatism is clini- cally significant for an eye with a monofocal IOL, 34% of respondents said 0.75 D, while 0.5 D and 1 D had close to 25% of respondents. It depends on if it's with-the-rule or against-the- rule, but obviously, the closer you can get patients to plano, the better. Part of that is also affected in the U.S. by the fact that we don't have a T2 lens; the Bausch + Lomb lens corrects close to 1 D, and the other ones are about 1.25 D. If you have someone who has 0.75 D, it's hard to treat them. The reality also is if you get to half a diopter or three quarters with-the- rule, there are some benefits in terms of compound myopic astigmatism that help the patient get a little extended depth of focus, too. Similarly, respondents commented on the amount of postoperative astigmatism that they consider clini- cally significant for an eye with a multifocal IOL—with 43% indicating 0.5 D and 25% indicating 0.75 D (and an average of 0.61 D, compared to 0.76 in the monofo- cal question). With a multifocal, the closer you get patients to emmetropia, the better their vision is going to be, and the happier they're going to be. It starts to become a bit of the same technology issues where the rest of the world has a T2 multifocal, and they're not available in the U.S. David F. Chang, MD, and others, myself in- cluded, met with the FDA to try to see what we could do to get that passed through. I think the regulatory issues are going to be too great. When considering toric IOL implantation and how many degrees of postop rotational error are acceptable before uncorrected visual acuity is affected, 31% said less than or equal to 5 degrees and 41% said 6–10 degrees. I think most people would like to be within 9 de- grees of target. Some of it depends on how good your biometry is and what technology you're using both for axis marking and for placing the lens. In general, I wouldn't want to scare people off. It's an incredibly forgiving technology. But the closer you are to the axis, the better. —Richard Tipperman, MD ASCRS Cataract Clinical Committee Chair pq Statistically significant difference between segments n=817 What amount of postoperative astigmatism is clinically significant for an eye with a monofocal IOL (in diopters), assuming no spherical equivalent refractive error? (Select one) AVERAGE DIOPTERS BY SEGMENT 2026 Practice location U.S. 0.77 International 0.74 Years in practice Early stage (0–5 years) 0.73 Mid-stage (6–10 years) 0.70 Late stage (11+ years) 0.78 p Perform majority of surgeries in Hospital outpatient department (HOPD) 0.77 Office 0.82 Gender Male 0.75 Female 0.77 0.25 D or less 2% 2% 5% 10% 1.50 D 1.75 D or greater 24% 23% 0.50 D 1.25 D 34% 0.75 D 1.00 D 0.76 D Average diopters for monofocal IOL eyes pq Statistically significant difference between segments n=817 What amount of postoperative astigmatism is clinically significant for an eye with a multifocal IOL (in diopters), again assuming no spherical equivalent refractive error? (Select one) AVERAGE DIOPTERS BY SEGMENT 2026 Practice location U.S. 0.62 p International 0.58 Years in practice Early stage (0–5 years) 0.61 Mid-stage (6–10 years) 0.54 q Late stage (11+ years) 0.61 Perform majority of surgeries in Hospital outpatient department (HOPD) 0.60 Office 0.62 Gender Male 0.60 Female 0.62 0.25 D or less 1% 1% 2% 17% 1.50 D 1.75 D or greater 43% 11% 0.50 D 1.25 D 25% 0.75 D 1.00 D 0.61 D Average diopters for multifocal IOL eyes pq Statistically significant difference between segments Based on those who currently implant toric IOLs; n=676 After implanting a toric IOL, how many degrees of postoperative rotational error (in degrees) is acceptable before uncorrected visual acuity is significantly affected? (Select one) AVERAGE DEGREES BY SEGMENT 2026 Practice location U.S. 9.6 p International 8.4 Years in practice Early stage (0–5 years) 9.7 p Mid-stage (6–10 years) 8.3 Late stage (11+ years) 8.8 Perform majority of surgeries in Hospital outpatient department (HOPD) 8.9 Office 9.8 Gender Male 8.9 Female 9.4 ≤5 degrees 1% 1% 2% 31% 26 to 30 degrees >30 degrees 41% 7% 6 to 10 degrees 21 to 25 degrees 17% 11 to 15 degrees 16 to 20 degrees 9.2 Average degrees acceptable

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