Eyeworld

Driving adoption and outcomes with toric IOLs: Pre-, intra-, and postoperative pearls for success software, and then these data, along with the plan, are trans- ferred to the LenSx laser (Alcon) and surgical microscope with a USB stick. The Zeiss Cataract Suite uses the IOLMaster (Carl Zeiss Med- itec, Jena, Germany) in the clinic to capture noncontact biometry numbers. Based on data ob- tained from the Zeiss Forum data management system, the Callisto Eye (Carl Zeiss Meditec) creates custom overlays and transfers this information to the OPMI Lumera microscope (Carl Zeiss Meditec) (Figure 2). The Cassini (i-Optics, The Hague, the Netherlands) relies on LED point-to-point ray tracing of the cornea and also provides information about the posterior corneal curvature (Figure 3). The Holos IntraOp system (Clarity Medical Systems, Pleas- anton, Calif.), which is under de- velopment, displays continuous, real time refractions throughout surgery (Figure 4). A built-in digital video recorder records the procedure. The ORA system (Alcon) shows real-time refractive data. It performs aphakic calculations that take into consideration the corneal incision and posterior corneal curvature. Pseudophakic calculations check the power and alignment of the toric IOL and as- sess the effects of limbal-relaxing incisions. If the IOL is misaligned during surgery, we can continue rotating the lens until we reach our target (Figure 5). Conclusion Many high-tech and low-tech tools are available to guide IOL alignment. Device manufacturers are linking systems with preopera- tive, intraoperative, and postop- erative data collection to decrease human error and improve overall outcomes. Reference 1. Swami AU, Steinert RF, Osborne WE, White AA. Rotational malposition during laser in situ keratomileusis. Am J Ophthal- mol. 2002;133(4):561–562. Dr. Henderson is clinical professor of ophthalmology at Tufts University School of Medicine, Boston, and a partner at Ophthalmic Consultants of Boston. She can be contacted at bahenderson@eyeboston. com. Figure 4. The Holos IntraOp provides continuous, real time feedback. Figure 3. The Cassini relies on LED point-to-point ray tracing of the cornea to perform corneal analysis and high-resolution images to direct surgery. Figure 5. Screenshot of the ORA system, which shows whether additional IOL rotation is necessary continued from page 5 6 Practice pearl: When using toric IOLs, it is important to take into consideration the effects of cyclorotation. Additionally, using marking instruments or a refractive reference unit is important to align the IOL properly.

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