Eyeworld

Driving adoption and outcomes with toric IOLs: Pre-, intra-, and postoperative pearls for success continued from page 1 calculate their surgically induced astigmatism based on their own recent surgical results. Clearly, we have come to understand that our surgical techniques affect outcomes and must be taken into consideration. The survey showed that 25% of respondents overall ignore posterior corneal cylinder because they believe it is insignificant. However, we continue to learn that this may be an important factor that we should take into account. Nearly one-third of sur- vey respondents stated that 10 degrees or more of rotational error is acceptable after toric IOL implantation before visual quality and acuity are significantly af- fected. Although I think this view is shifting substantially, we will need to improve our efforts to hit our target to attain optimal visual outcomes. When respondents were asked about the procedure they use most often to manage astig- matism in patients with cataracts, only 54% reported that they implant a toric IOL in patients with 1.25 D of astigmatism. Toric IOL strategies for success Responding to some of the edu- cational gaps identified by this survey, this supplement shares the astigmatism management strat- egies and toric IOL optimization techniques of some of our most noted experts. They will discuss the im- pact of rotational error, ways to improve treatment planning, techniques for intraoperative alignment, and how to manage postoperative error in toric IOL patients. Reference 1. 2014 ASCRS Clinical Survey. Global Trends in Ophthalmology. Fairfax, VA: American Society of Cataract & Refractive Surgery, 2014. Dr. Vukich is a partner at the Davis Duehr Dean Center for Refractive Surgery in Madison, Wis. He can be contacted at javukich@facstaff.wisc.edu. " Nearly one-third of survey respondents stated that 10 degrees or more of rotational error is acceptable after toric IOL implantation. " 2 The 2014 ASCRS Clinical Survey asked, "After implanting a toric IOL, how many degrees of postoperative rotational error is acceptable before visual quality and visual acuity are significantly affected?" 30.2% of respondents believe 10 degrees or more is acceptable 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Less than 5 5 6 to 9 10 Greater Depends than 10 U.S. Non-U.S. Overall The 2014 ASCRS Clinical Survey asked, "How do you manage posterior corneal cylinder?" Overall, 25% of respondents ignore posterior corneal cylinder because they believe it is insignificant Ignore it because it is typically insignificant Estimate it based on published average values Measure for each patient and include it in my calculations 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% U.S. Non-U.S. Overall The 2014 ASCRS Clinical Survey asked, "What is your most common procedure to manage astigmatism in a cataract patient with the following levels of cylinder?" Only 54% of respondents reported they would implant a toric IOL in a patient with 1.25 D of astigmatism On axis incision 0.75 D 1.25 D 2 D 3 D 42.1% 12.0% 0.9% 0.5% Manual LRI or AK 13.2% 17.1% 3.5% 1.1% Femtosecond laser LRI or AK 7.9% 8.3% 1.6% 1.1% Toric IOL 5.9% 53.9% 89.7% 91.6% Postop laser vision correction 0.9% 1.6% 2.7% 3.6% Glasses or contact lenses 7.1% 5.3% 1.5% 1.8% No special correction needed 22.9% 1.9% 0.1% 0.2%

• Cover