TORIC IOLSNawat Watanachai

2015

CHOICES TO TREAT ASTIGMATISM ALONG WITH CATARACT SX➤ (glasses)➤ corneal Sx

➤ LRI➤ manual➤ femtosecond

➤ astigmatic keratotomy➤ Toric IOLs

CHOICES TO TREAT ASTIGMATISM ALONG WITH CATARACT SX➤ (glasses)➤ corneal Sx

➤ LRI➤ astigmatic keratotomy

➤ Toric IOLs➤ cylinder on 1 surface➤ spherical on the other surface

➤ ONLY for regular astigmatism➤ correct corneal astigmatism

WHY TORIC?➤ because it is one of the

best way to treat astigmatism

CANDIDATE FOR TORIC➤ minimum 1.25D cylinder➤ regular astigmatism

TORIC IOL IS NOT INDICATED IN➤ cylinder <1.25D➤ pts willing only for SICS,

ECCE➤ traumatic cataract➤ irregular astigmatism

➤ corneal scar/ pterygium➤ combined Sx

➤ corneal/ glaucoma/ retina

➤ squint

WHY TORIC?

manual LRI femto LRI toric IOL

accuracy less/ tend to undercorrect/ regressed equal? equal?

reversible no no yes

weaken cornea yes/ perforation yes no

price low high fair

TORIC IOLS➤ STAAR IOL➤ Acrysof toric(Alcon)➤ Tecnis toric (AMO)➤ Crystalens Trulign (B&L)

TORIC IOLS➤ STAAR IOL

➤ 1-piece plate-type➤ may not fit to all capsular bag

➤ 10.8 and 11.2 mm width➤ silicone

➤ less reflectivity➤ anterior capsule fibrosis

➤ Acrysof toric(Alcon)➤ Tecnis toric (AMO)➤ Crystalens Trulign (B&L)

IOL power

acrysof toric single pieceaspheric hydrophobic yellow +6 to + 30

tecnis toric single piece hydrophobic clear

corrective power at corneal

plane (D)

acrysof toric 0.75-4.0 higher RI1.55

higher reflectivity

tecnis toric 1, 1.5, 2, 2.75

harden surface (less

scratch)lower RI lower reflectivity

light filtration

acrysof toricfull 6mm refractive

opticmore sticky

haptic UV, blue

tecnis toric less sticky haptic

more -ve spheric aberration,

less chromatic aberration

CYLINDER POWER OPTIONS : ACRYSOF

ALCON® LENS MODEL SN6AT2 SN6AT3 SN6AT4 SN6AT5 SN6AT6 SN6AT7 SN6AT8 SN6AT9

IOL Plane 1.00 D 1.50 D 2.25 D 3.00 D 3.75 D 4.50 D 5.25 D 6.00 D

Corneal Plane* .68 D 1.03 D 1.55 D 2.06 D 2.57 D 3.08 D 3.60 D 4.11 D

Recommended Corneal Astigmatism Correction

Range .50 D to .90 D .90 D to 1.50 D 1.50 D to 2.00 D 2.00 D to 2.50 D 2.50 D to 3.00 D 3.00 D to 3.50 D 3.50 D to 4.00 D 4.00 D and up

TORIC IOLS➤ STAAR IOL➤ Acrysof toric(Alcon)➤ Tecnis toric (AMO)➤ Crystalens Trulign (B&L)

➤ 3-piece?➤ good stability, less rotation

MAKING THE MOST OF TORIC➤ give this option to all the pts c signif. astigmatism➤ look for any obstacles

➤ irregular astigmatism➤ corneal scar/ pterygium/ old IK/ corectopia etc.

➤ multi-measures➤ IOL master + corneal topo➤ IOL master + automated keratometryhyyokkll;.➤ IOL master X2

➤ special consideration needs in eyes after refractive Sx eg. LASIK

Input Screen

Patient informationDoctor namePatient name or ID numberOperative eye

Keratometry & Biometry dataFlat K reading (in diopters)Flat meridian (in degrees)Steep K reading (in diopters)Steep meridian (in degrees) IOL spherical power as determined by the

surgeon’s preferred formula with conventional monofocal IOLs

Surgeon-dependent inputEstimated surgically induced cylinder Incision location (0 to 360°)

MAKING THE MOST OF TORIC➤ procedures

➤ make reference marking (in UPRIGHT position)➤ manually mark 0’, (90’), 180’➤ automatically mark with the machine➤ note : 1’IOL rotation —> loss of 3.3% of IOL

cylinder power➤ CCC➤ intact capsular bag

SURGICAL TIPS➤ on-axis placement

➤ gross alignment : 20-30’ short➤ OVD removal➤ final alignment

SURGICAL TIPS

➤ single piece IOL➤ remove visco behind the lens to prevent rotation

➤ average SIA is 0.25-0.5D for 2.8mm incision➤ incision location can varied (temporal/ superior) to

achieve the least residual astigmatism

CALCULATORS FOR TORIC IOL➤ websites

➤ www.aurolab/optical.com➤ www.toriccalculator.com➤ www.doctor-hill.com➤ www.acrysoftoriccalculator.com

➤ apps➤ toricIOL