Eyeworld

EW NEWS & OPINION June 2016 25 Dr. Yeu said she uses the full range of toric IOLs, including more recent incorporation of the Trulign (Bausch + Lomb, Bridgewater, New Jersey) as a toric offering to patients. in the equator of the capsular bag along the haptics. "After the viscoelastic is out, I give the IOL a gentle posterior 'love tap,'" he said. 1 eye and the AcrySof for those getting a toric in both eyes. He does not go behind the IOL to remove viscoelastic, but does an "aggressive rock and roll" instead, also spending extra time to remove the viscoelastic The CALLISTO orientation line (yellow) is used to orient the ORA intraoperative aberrometer. The CALLISTO toric positioning line (blue) is used to help the surgeon position an IOL. Source: Bryan Lee, MD Regarding single vision toric IOLs, Dr. Yeu leans toward the AcrySof toric because of her extensive expe- rience with this family of IOLs and, as a result, finds she has predictable outcomes. When it comes to LRIs, she primarily performs femtosecond laser arcuate incisions and does not open the incisions until postop if she needs to titrate and enhance the astigmatic correction. As for addressing surgically in- duced astigmatism, Dr. Yeu said she accounts for 0 in her surgically in- duced astigmatism because although it averages about 0.1 D, she has found it to be quite variable in range from patient to patient. Dr. Weikert said he factors in 1/10th of a diopter in the astigmatism estimation, but noted that surgically induced astig- matism seems to be becoming less of an issue with smaller incision sizes. In all of this, Dr. Weikert said managing patient expectations is still an important factor. "Despite all of the different methods and all of the technology that goes into this, you still can have errors that enter into the calcula- tions," he said. "There's a chance [patients] may need a touchup after surgery." Although the physicians men- tioned some relatively sophisticated technology used to make intraoper- ative management of astigmatism more successful, Dr. Lee pointed out that you don't need it to achieve ex- cellent outcomes. He cited "careful preoperative measurements" and "meticulous surgical technique in marking and alignment" as the keys to success. EW Editors' note: Dr. Yeu has financial interests with Alcon, Abbott Medical Optics, Bausch + Lomb, and i-Optics. Dr. Lee and Dr. Weikert have no finan- cial interests related to their comments. Contact information Lee: bryan@bryanlee.pro Weikert: mweikert@bcm.tmc.edu Yeu: eyeulin@gmail.com

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