Eyeworld

107 EW FEATURE March 2018 • Current and future IOL choices he said, allows you to get a little more plus power compared to the Symfony, which is a little better at intermediate. Dr. Woodard also mentioned the AcrySof and Tecnis families of IOLs. "We also have the STAAR Surgical [Monrovia, California] toric family of IOLs available, which is an older one and not used as common- ly now," he said, adding that it can correct up to 3 D of astigmatism in the corneal plane. "I think the nice part is we have continuing emergence of more and more toric IOL platforms," Dr. Swan said. The one he thinks is most widely used is the AcrySof toric platform. Most recently, there has been a move to extended depth of focus, particularly the Symfony toric. The first toric IOL introduced was from STAAR, Dr. Holland said, and it was a single-piece plate toric IOL. "It was a breakthrough because it was the first time an IOL could be used to address astigmatism," he said. However, this first toric didn't have rotational stability. He thinks that the AcrySof lens- es have the best rotational stability. High corneal astigmatism Dr. Holland said there may be patients with a higher degree of astigmatism than toric IOLs can correct. If you plan on augmenting a toric IOL with incisional keratoto- my, it's important to ensure that the astigmatism is regular astigmatism. He has used limbal relaxing incisions (LRIs) or femto arcuate incisions in these cases of high astigmatism. However, in cases of high astigmatism that is asymmet- ric, such as forme fruste keratoco- nus, incisional keratotomy should never be used. This is because of the unpredictable nature of the tissue response. "In these eyes, I would consider a toric IOL if the asymme- try is mild, but I would avoid corne- al incisions of any kind," he said. If you have a patient who has more than can be corrected by a toric lens, Dr. Greenwood said a surgeon has the option to pair the toric with relaxing incisions to give it a little extra boost. "A lot of surgeons like to use relaxing incisions up to 1.5 D," he said. "You can also do LASIK after placing the toric." For example, if the patient has more than 4 D, you could place the lens and do refractive surgery to correct the residual refractive error, Dr. Greenwood said, adding that for someone with a long eye, the surgeon may want to do refractive surgery or piggyback on top of the toric. There aren't any other IOLs available to correct higher corneal astigmatism, Dr. Woodard said. "If I have a patient who has more continued on page 108 Trulign IOL Source: Bausch + Lomb Poll size: 128 Important improvements in current monofocal IOLs would be: Better range of powers Small increments in IOL power Minimized chromatic aberrations Optimized delivery systems For presbyopic correction in my patients I use: Accommodative IOLs High add MFIOLs Low add MFIOLs Monovision EDOF IOLs Mix and match (blended vision) with MFIOL/ EDOF IOL

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