Eyeworld

World view Toric IOLs major innovation in cataract/refractive surgery field F ifteen years ago Howard Fine, MD, one of the great innovators in cataract surgery, made a prediction. It was the heyday of LASIK and we were speculating about the future of refractive surgery. At the time, excimer lasers, femtosecond flaps, and wavefront analyses were on the leading edge of innovation. Dr. Fine predicted that refractive surgery would increasingly be done with intra- ocular lenses. Few believed him. Fast forward to 2015, and it is abundantly clear that cataract surgery is now the refractive procedure of choice for the Baby Boomer generation. The expecta- tion of excellent unaided vision following cataract surgery is the new norm. Our patients now judge the skill of their surgeon by how well they can see without glasses. David R. Hardten, MD, stated it clearly: "To increase the number of patients that have their goals met with cataract surgery, correcting astigmatism is a big part of meeting the expectations." Continued improve- ment in the diagnostic equipment that supports cataract surgery has helped make predictable refractive outcomes possible. This issue of EyeWorld covers the current thinking in the management of astigmatism and the effective use of toric IOLs. The diagnostic technology supporting cataract surgery has improved, but it is only one aspect of what we need to obtain optimal results. The first and most important step is simply getting started with premium IOLs. Once we get started, we have to make using toric IOLs a routine part of our practice. According to the ASCRS Clinical Survey, almost 15% of cataract surgeons have never used a toric IOL, and more than half of surgeons use them in less than 5% of their patients. By all accounts, the leading surgeons in our field agree that if you are not already using toric IOLs, now is the time to start. If you are using them only rarely, your patients are missing out. The barrier to entry is low and the fundamental equipment necessary to get start- ed is already present in most practices. Optical biometry and corneal topog- raphy are the 2 foundational devices necessary to drive accurate outcomes with astigmatism correcting IOLs. Careful attention to technique is the only other requirement. In this issue of EyeWorld, we ask several experts to share their tips and techniques to nail the proper alignment of toric lenses. It turns out that toric axial alignment is not hard to do, adds little time to surgery, and, importantly, uses skills that any intraocular surgeon already possesses. If you are new to toric IOLs, read on, be encouraged, and get motivated. If you use toric IOLs only rarely, both you and your patients are missing out. No matter where you are on the continuum of adopting premium IOLs, the pages that follow should contain helpful advice for you in your ophthalmic practice. EW John A. Vukich, MD, international editor The official publication of the American Society of Cataract & Refractive Surgery A S C R S June 2015 Volume 20 • No. 6 Publisher Donald R. Long don@eyeworld.org Editorial Editor Erin L. Boyle erin@eyeworld.org Managing Editor Stacy Majewicz stacy@eyeworld.org Staff Writer Ellen Stodola ellen@eyeworld.org Staff Writer Lauren Lipuma lauren@eyeworld.org Production Graphic Designer Julio Guerrero julio@eyeworld.org Graphic Design Assistant Susan Steury susan@eyeworld.org Production Manager Cathy Stern cathy@eyeworld.org 703-383-5702 Production Assistant Carly Peterson carly@eyeworld.org Contributing Writers Vanessa Caceres Lakeland, Fla. Michelle Dalton Reading, Pa. Matt Young Malaysia Enette Ngoei Dublin Rich Daly Arlington, Va. Senior Contributing Writer Maxine Lipner Nyack, N.Y. Advertising Sales ASCRSMedia 4000 Legato Road Suite 700 Fairfax, VA 22033 703-591-2220 fax: 703-591-0614 eyeworld@eyeworld.org www.eyeworld.org Advertising Sales Jeff Brownstein jeff@eyeworld.org 703-788-5745 Paul Zelin paul@eyeworld.org 703-383-5729 Classified Sales Cathy Stern cathy@eyeworld.org 703-383-5702 EyeWorld Special Projects and Events Jessica Donohoe jessica@eyeworld.org 703-591-2220 ASCRS Publisher: EyeWorld (ISSN 1089-0084) is published monthly by ASCRS Ophthalmic Services Corp., 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; telephone: 703-591-2220; fax: 703-591-0614. Printed in the U.S. Editorial Offices: EyeWorld News Service, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. Advertising Offices: ASCRSMedia, 4000 Legato Road, Suite 700, Fairfax, VA 22033-4055; toll-free: 800-451-1339, 703-591-2220; fax: 703-591-0614; email: eyeworld@eyeworld.org. 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