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Pearls for Acrysof Toric IOL in Practice Dr Suresh K Pandey, kota, india
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Pearls for Acrysof Toric IOL in Practice Dr Suresh K Pandey, kota, india

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Dear Friends, We would like to share with you a presentation entitled "Pearls for introducing Toric IOL in your Practice" presented during Toric RTM meet at Raipur, Chhatisgarh, India held at Hotel ...

Dear Friends, We would like to share with you a presentation entitled "Pearls for introducing Toric IOL in your Practice" presented during Toric RTM meet at Raipur, Chhatisgarh, India held at Hotel Babylon on August 28, 2011. Your feedback/comments are welcome. Thanks, Dr Suresh Pandey, Kota, India


-The surgeon should make a small change in routine practice, by screening the patient for Keratometry first and then counsel patient for cataract surgery. Patients having ≥1.00 D corneal cylinder are candidate for Toric IOL. The counselor/surgeon should educate patient that the technology is available for cylindrical correction. Toric IOL cases have high level of spectacle freedom for distance when implanted bilaterally (97%). The surgeon/counselor should give option to all patients having astigmatism. One should emphasize that after removal of cataract surgery their distance vision will improve (with need of using minor correction), however, they will need spectacle for near and intermediate work (reading, computer). Staff training and patient education is important.
– Proper patient selection is critical to achieve success for toric IOL implantation. Suitable candidates are cataract patients with pre-existing corneal astigmatism > 1.00 D with the following characteristics: Manual keratometry: steep and flat meridians ~90° apart; Corneal topography: symmetrical astigmatism; During Surgery: Intact capsular bag compatible with continuous curvilinear capsulotomy performed with in-the-bag placement of the IOL.
– Though automatic keratometer can be helpful to take Keratometry reading in a busy OPD, however, it is recommended to use manual keratometry and topography for magnitude, orientation, and type of pre-existing corneal astigmatism. Subjective refraction data is not advised in order to avoid the influence of any lenticular astigmatism, which will be eliminated when the cataractous lens is removed.
The surgeon should defer using toric IOL in cases of irregular corneal astigmatism caused by corneal opacity, scarring, pterigium, peripheral corneal degeneration, cases of previous ocular trauma leading to compromised capsular bag, capsular bag- zonular complex. etc.

Pearls for introducing AcrySof Toric IOL can be helpful for surgeons

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  • Proper patient selection is critical to achieve success Use personal judgment in patients with pre-existing ocular disease conditions Give special consideration to patients with prior keratorefractive surgery
  • Appropriate marking of the eye for implantation of the AcrySof ® Toric IOL involves two steps: reference and axis marking of the eye.   Reference marking: During the pre-induction period with the patient in an upright position, two reference marks are placed at the limbus 180 degrees apart (e.g., at the 3 o’clock and 9 o’clock positions). These reference marks will be used later in the procedure to help align the marking instrument for placement of axis marks.
  • Axis marking: After phacoemulsification, using the reference marks as a guide, the patient’s eye is marked accurately at two positions (180 degrees apart) that define the optimal axis of IOL placement as determined by the AcrySof ® Toric IOL Calculator.
  • I haven’t performed a single astigmatic keratotomy since introducing Toric IOLs Visual outcomes and patient satisfaction have been excellent Patients referred for ‘new lens’

Pearls for Acrysof Toric IOL in Practice Dr Suresh K Pandey, kota, india Presentation Transcript

  • 1. Pearls for Introducing AcrySof® TORIC IOL in Your Practice Dr Vidushi Sharma MD (AIIMS), FRCS (UK) Dr. Suresh K Pandey MS (Ophthalmology, PGIMER, CHANDIGARH), Anterior Segment Fellowship (USA) SuVi Eye Institute & Lasik Laser Centre C-13, TALWANDI, KOTA, RAJASTHAN, INDIA Phone +91 9351412449, +91 744 2406744, 2433575 Website: www.suvieye.com Email- [email_address] Visiting Assistant Professor, John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Sydney Eye Hospital, University of Sydney, Australia
  • 2. Pearls for Introducing AcrySof® TORIC IOL in Your Practice ACRYSOF TORIC RTM at Raipur, Chhatisgarh, India Hotel Babylon, Raipur, India August 28, 2011
  • 3. Dr Suresh Pandey presenting talk on “Pearls for IntroducingToric IOL”, RTM, Raipur, Chhatisgarh, India, Aug. 28, 2011
  • 4.
    • Dr Suresh Pandey presenting talk on “Pearls for IntroducingToric IOL”, RTM, Raipur, Chhatisgarh, India, Aug. 28, 2011
  • 5. Dedicated to Late Professor David J. Apple, a world renowned ophthalmologist, Mentor and Researcher Passed away on August 18, 2011 at age of 67 years
  • 6. Astigmatism Correction during cataract surgery is a Medical Necessity As a surgeon/optometrist/counselor, it becomes our responsibility to educate our patients about this!
  • 7. Training of Entire Hospital Staff All understand Astigmatism … Astigmatism- a Ref. Error needing TREATMENT
  • 8. Training of Hospital Staff
  • 9. PATIENT INFORMATION LITERATURE At SuVi Eye Inst., Kota, India
  • 10. PATIENT INFORMATION LITERATURE at SuVi Eye Inst., Kota, India
  • 11. Counseling…
    • Make a small change in your routine practice, by screening the patient for Keratometry first and then counsel patient for cataract surgery
    • Patients having ≥1D Cyl are candidate for toric IOL
  • 12. Auto-Keratometry for Screening cases for Toric IOL (Video)
  • 13. Counseling…
    • Emphasize that after removal of cataract surgery they will need spectacle for distance .
    • Educate patient that the technology is available for astigmatism correction.
    • Give option of toric IOL to your patients having astigmatism
    • High level of spectacle freedom for distance when implanted Bilaterally (97%)
  • 14. AcrySof ® TORIC IOL
  • 15. Centration Patient Selection
  • 16. Pre Operative Measurements
  • 17. AcrySof ® TORIC Procedure
  • 18. TORIC IOL requires SIA (Surgically Induced Astigmatism) Remember!
  • 19. Surgically Induced Astigmatism Assessment e.g. temporal incision likely result 0.43 at 93 degrees e.g. superior limbal incision likely 0.35 at 5 degrees
  • 20. SIA Calculator: Download from www.doctor-hill.com
  • 21. SIA Report
  • 22. Align to Steep Axis of cornea Meridian of Power
  • 23. Precise Keratometry
  • 24.  
  • 25. Measuring the ‘K’
    • Any ‘K’ that works well for you
    • But - Use a dedicated Keratometer
    • Only use corneal keratometric measurements
      • NOT refractive astigmatism
      • Look for differences/unusual measurements
    • Go for topography for unusual readings,
    • poor quality mires etc.,
  • 26. Calibrating the Manual Keratometer Establish a schedule for routine checks of instrumentation accuracy
  • 27. Don’t use refractive astigmatism!
    • Measurements may not always agree
      • Lenticular astigmatism may account for some of this disparity pre-op
      • Tilted or displaced IOL probably only accounts for a maximum of 0.50D astigmatism post-op 1
      • Refraction may underestimate true keratometric astigmatism 2
    • 1. Lakshminarayanan, V. et al Arch Opthalmol 1986;104:90-92
    • 2. Buzard, K.A. et al J Refract Surg 1988;4:173-178
  • 28. Surgeon Factor
    • Data Acquisition of K Readings
    • Multiple Readings – till 3 same readings are obtained
    • More reliable
      • Manual Keratometry
      • Automated Keratometry only with Steps of 0.12D
    • Reading – Quick ~ avoid drying of cornea
    • – Don’t rub on the cornea
    • – Centration
  • 29. Calculator Inputs Surgeon / Patient Information Input for K Value K Notation (mm/diopter) Flat K @ Flat Axis Steep K @ Steep Axis Other Inputs IOL Spherical Power Surgically Induced Astigmatism Incision Location
  • 30. Calculator Input / Output Lens Details Calculation Details Pre-Op Information Graphical Representation For Axis of placement Surgeon / Patient Information
  • 31. Take the print out copy to the OR Incision Location @ 110°
  • 32. Steep Axis
  • 33. Marking Instruments
  • 34. AcrySof ® TORIC IOL
    • Suitable candidates are cataract patients with pre-existing corneal astigmatism 1.0 D or more with the following characteristics
      • Manual keratometry: steep and flat meridians ~90° apart
      • Corneal topography: symmetrical astigmatism
  • 35. OT Staff and Anesthetist Must Understand the Process
    • Need to sit patient up to mark horizontal axis before sedation/block NOT LYING DOWN
    • Be sure all staff know the TORIC patient on the list to be sure that necessary procedures are followed
  • 36. Marking of the Eye – Reference Marking
    • Two steps
      • Reference Marking
      • Axis Marking
    • Reference Marking
      • Pre-induction period
      • Patient in upright position
      • Two reference marks placed at the limbus, 180 degrees apart
      • Used later to align the marking instrument for placement of axis marks
  • 37. Marking for Maximum Benefit
    • Pen and ‘eyeball’
    • Slit lamp with sp. device
    • Commercial markers
  • 38. Practice on non-TORIC IOLs
    • Extra steps needed for Toric
      • Marking
      • Rotating IOL to precise axis
      • Removing visco-elastic from behind IOL
    • Builds confidence and skill
      • Only changing one part of your technique at a time
      • Safer and less stressful when you start
  • 39. Practice of Non-Toric IOL (Video)
  • 40. Marking of the Eye – Axis Marking
    • Axis Markings
      • Define the optimal axis of IOL placement
      • Determined by the AcrySof ® Toric IOL Calculator
      • Using the reference marks as a guide, the patient’s eye is marked accurately at two positions, 180 degrees apart
  • 41. Marking Tips
    • Dry the conjunctiva with a swab
    • Enhance the markings at 3 “O” Clock and 9 “O” clock positions
    • The pre op marking is best done with the help of slit lamp for stabilizing
    • Apply the marking pen with a twisting motion (capillary action will create a tattoo effect)
    • The violet mark will last although it may fade.
  • 42. AcrySof ® TORIC IOL Alignment
  • 43. AcrySof Toric IOL Implantation in a Pediatric Cataract (VIDEO)
  • 44.  
  • 45. Video
  • 46. Introducing Toric lenses has been one of the most significant advances in surgical practice in the last 4 years
  • 47. Thanks for your attention ?Question/Comment Always under promise & over deliver!!
  • 48. Pearls for Introducing AcrySof® TORIC IOL in Your Practice Dr Vidushi Sharma MD (AIIMS), FRCS (UK) Dr. Suresh K Pandey MS (Ophthalmology, PGIMER, CHANDIGARH), Anterior Segment Fellowship (USA) SuVi Eye Institute & Lasik Laser Centre C-13, TALWANDI, KOTA, RAJASTHAN, INDIA Phone +91 9351412449, +91 744 2406744, 2433575 Website: www.suvieye.com Email- [email_address] Visiting Assistant Professor, John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Sydney Eye Hospital, University of Sydney, Australia