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EW FEATURE 58 Intraoperative continued from page 57 is in place and the eye is still filled with viscoelastic," Dr. Rubenstein said. "Although the spherical read- ings are not very accurate after IOL placement, the toric axis readings are helpful in determining correct axis placement and showing maxi- mal reduction of cylinder." According to Dr. Kontos, if you are consistent with your surgical technique and meticulous with laser for all of his toric IOL patients to ensure that the capsulotomy is perfectly circular and well centered. "I think it is critical that the capsule is intact," Dr. Kontos said. "The anterior capsulorhexis needs to be circular and continuous, and it needs to be well centered. All of those things are important for the alignment of the lens." Consistency is also important when it comes to tapping the lens against the posterior capsule. "I think you need to be very consistent with that because if you do it in some cases and not in others, you can get variability in your effective lens position," Dr. Hamilton said. "I'm not a big anterior capsule polisher; I think again you need to be consistent, either do it or don't do it. "Fortunately, with higher levels of astigmatism, you need to be clos- er to spot on, but those are the ones that are easier to get spot on," he continued. "With the lower powers, it's harder to get spot on, but it's more forgiving if you're slightly off." Looking at the big picture Astigmatism correction is quickly becoming the standard of care in ophthalmology, but toric IOLs are considered premium products, so they may not become the standard option for cataract patients just yet. "I think it is the standard of care to discuss astigmatism correction options with any patient consider- ing surgery," Dr. Kontos said. "But because it is a non-covered service, it will be a significant part of cataract surgery, more than a niche, but not a standard procedure." By consistently achieving accu- rate alignment and delivering great refractive results, surgeons can help unlock the benefits of this technolo- gy and possibly make it the standard of care in the future. EW Reference Zhang L, Sy ME, Mai H, Yu F, Hamilton DR. Effect of posterior corneal astigmatism on refractive outcomes after toric intraocular lens implantation. J Cataract Refract Surg. 2015 Jan; 41(1):84–9. Editors' note: Dr. Kontos has financial interests with Abbott Medical Optics and Allergan (Irvine, Calif.). Dr. Rubenstein has financial interests with Alcon. Dr. Hamilton has no financial interests related to this article. Contact information Kontos: mark.kontos@empireeye.com Hamilton: hamilton@jsei.ucla.edu Rubenstein: Jonathan_Rubenstein@rush.edu Toric IOLs June 2015 For Simplifying My Life Go to www.LENSAR.com to learn more. The LENSAR Laser System – fs 3D (LLS-fs 3D) is intended for use in patients undergoing cataract surgery for removal of the crystalline lens. Intended uses in cataract surgery include anterior capsulotomy, laser phacofragmentation, and the creation of full and partial thickness single-plane and multi- plane arc cuts/incisions in the cornea, which may be performed either individually or consecutively during the same procedure. Laser Capsulotomy, laser phacofragmentation and/or corneal incisions surgery is contraindicated in patients: who are of pediatric age, whose pupils will not dilate or remain dilated to a diameter greater than that of the intended treatment and for capsulotomies and/or laser phacofragmentation with intended diameters of less than 4 mm or greater than 7 mm, who have existing corneal implants, who have previous corneal incisions that might provide a potential space into which the gas produced by the procedure can escape, who have conditions that would cause inadequate clearance between the intended capsulotomy cut and the corneal endothelium, such as: hypotony, uncontrolled glaucoma, who have corneal disease or pathology that precludes transmission of light at the laser wavelength or causes distortion of laser light, such as: corneal opacities, residual, recurrent, active ocular or uncontrolled eyelid disease or any corneal abnormalities (including endothelial dystrophy, guttata, recurrent corneal erosion, etc.) in the eye to be treated, ophthalmoscopic signs of keratoconus (or keratoconus suspect) in the eye to be treated, a history of severe dry eye that has not responded to therapy, or a history of herpes zoster or herpes simplex keratitis. Potential contraindications are not limited to those included in the list. WARNING: The safety and effectiveness of this laser have NOT been established in patients with diabetic retinopathy, a history of uncontrolled glaucoma, or prior intraocular surgery. © 2015 LENSAR, Inc. All rights reserved. LENSAR and the LENSAR logo are registered trademarks and Streamline is a trademark of LENSAR, Inc. Cassini is a trademark of i-Optics, Corporation. 50-00118-000 05/15 S t r e a m l i n e ™ INTRODUCING The LENSAR ® Laser with Streamline is the first cataract laser system to enable automation of your LACS surgical procedure planning and execution with the introduction of five new applications, including wireless integration with the Cassini ™ Corneal Shape Analyzer, iris registration, cataract density imaging, automatic fragmentation patterns and arcuate incision planning. Let us show you how you can Streamline your laser-assisted cataract procedures. determining the axis of orientation, intraoperative aberrometry isn't necessary. "You have to have a good way to measure the axis and magnitude of the astigmatism, and make sure you're uncompromising in the way you do your surgery," he said. "Then you can get good results with toric lenses and not need to have that technology." Be consistent Drs. Kontos and Hamilton agreed that consistency in every step of the pro- cedure is the key for success with toric IOLs. Using the same technique with every toric IOL patient will ensure consistency in the effective lens posi- tion and help prevent postop rotation of the lens. Dr. Kontos performs femtosecond laser-assisted surgery with the Catalys

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