163
April 2016
EW MEETING REPORTER
cataract surgery for greater amounts
of cylinder are preferred.
Richard Tipperman, MD, Bala
Cynwyd, Pennsylvania, highlighted
the 4 types of toric IOLs currently
on the market and said "the oppor-
tunity to correct patients' complete
refractive error, including their
astigmatism, far outweighs the rare
potential of lens rotation," a situa-
tion that could affect the refractive
outcome.
Using the right formulas—and
several of them—to calculate IOL
power to achieve the best refrac-
tive outcome is important as well,
Dr. Donnenfeld said. Calculating
IOL power for a patient with prior
corneal refractive surgery requires
measurement of both the anterior
and posterior corneal refractive pow-
er, effective lens placement, and the
ability to confirm the correct IOL
power intraoperatively, if possible.
Residual astigmatism after
toric IOL implants can result from
a variety of factors including the
wrong IOL calculation, the implant
being oriented on the wrong axis or
rotating, corneal edema, ocular sur-
face disease, or epithelial basement
membrane dystrophy.
In the event of residual astigma-
tism, Tal Raviv, MD, New York, said
physicians should determine if the
IOL was placed on the intended axis,
if that axis was appropriate, whether
the IOL rotated, and if the right IOL
power was selected.
When it comes to selecting
the correct IOL power, Dr. Raviv
reminded the audience about the
importance of taking into account
posterior astigmatism, which intra-
operative aberrometry does, for the
best refractive outcome.
Treatment options for residual
astigmatism include LASIK/PRK,
IOL rotation, IOL exchange, or
prescribing glasses or contacts.
Dr. Solomon recommended
www.astigmatismfix.com for
cases of residual astigmatism with
toric IOLs to help determine the best
course of action.
Christopher Starr, MD,
New York, spoke about how
ocular surface disease and meibo-
mian gland disease (MGD) could
affect refractive outcomes."The tear
film is arguably the most important
refracting interface in the eye," he
said, recommending tear testing for
all patients and treating any ocu-
lar surface disease prior to cataract
surgery.
continued on page 164
