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Toric lenses san diego 07


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Perfect Vision's Dr Con Moshegov presentation on: Toric lenses san diego 07

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Toric lenses san diego 07

  1. 1. Alcon AcrySof ® Toric IOL Con Moshegov Stephen Bambery Australia
  2. 2. IOL Design <ul><li>AcrySof Single piece foldable acrylic </li></ul><ul><li>Soft and malleable </li></ul><ul><li>Allows easy manipulation while positioning </li></ul><ul><li>Axis marks on the posterior surface </li></ul><ul><li>IOL placed with marks aligned with the steep axis of the cornea </li></ul>
  3. 3. <ul><li>Blue-light filter </li></ul><ul><li>Injector delivery same as conventional SN60AT IOLs </li></ul>
  4. 4. Other toric IOLs <ul><li>Silicone plate haptic: rotation in capsular bag has been an issue </li></ul><ul><li>First toric FDA approval </li></ul>
  5. 5. AcrySof Single Piece IOL <ul><li>Adhesive property </li></ul><ul><li>Advantage taken to prevent rotation after implantation </li></ul>Oshika T, et al. Adhesion of lens capsule to intraocular lenses of PMMA, silicon, and acrylic foldable materials: an experimental study. Br. J Ophthalmol , 1998;82:468.
  6. 6. IOL Design – Rotational Stability <ul><li>Lens stability is important </li></ul><ul><li>Off-axis rotation reduces the corrective cylinder power </li></ul>
  7. 7. <ul><li>For every 1°of rotation, 3.3% of the lens cylinder power is lost </li></ul><ul><li>For 30° of rotation there is a complete loss of astigmatic correction </li></ul><ul><li>Additional astigmatism or visual problems with greater than 30° of rotation </li></ul>
  8. 8. Error Induced from Cyclotorsional Movements <ul><li>Residual PSF and Blurred Eye Chart Letters </li></ul><ul><li>Real eye: –0.15DS –1.01DC x 0˚ </li></ul>
  9. 9. IOL Power Selection Process <ul><li>Determine the required spherical lens power </li></ul>
  10. 10. Select an AcrySof ® Toric IOL Model <ul><li>The data are entered into the AcrySof ® Toric IOL Calculator to determine the optimal model </li></ul><ul><li>Calculator </li></ul><ul><ul><li>Considers effect of incision location and surgically induced cylinder to make a more precise calculation </li></ul></ul><ul><ul><li>Determines the correct IOL model and optimal axis placement of the IOL in the capsular bag </li></ul></ul>
  11. 11. AcrySof ® Toric IOL Models <ul><li>Three AcrySof ® Toric IOL models available </li></ul><ul><li>Cylinder power option is combined with SE power 16 D to 25 D in 0.5 D increments </li></ul><ul><li>Additional power options will be added in the future to address a broader range of astigmatic conditions </li></ul>
  12. 14. ASICO instruments
  13. 15. Pre-op mark
  14. 16. Marking of the Eye – Axis Marking
  15. 17. Astigmatism SEC Holladay Data Base 0.916 D Average K astig 2.4% >/= 3 D 8.6% >/= 2 D 39% >/= 1 D n = 3538
  16. 18. Surgically induced astigmatism <ul><li>Holladay IOL Consultant </li></ul><ul><li>SIA = 0.13 (SD 0.39) </li></ul><ul><li>N = 41 </li></ul><ul><li>2.75 mm (pre implantation) temporal clear corneal wound </li></ul><ul><li>OD 180 ° OS 10° </li></ul><ul><li>No other incisions </li></ul>
  17. 19. Pre op: Toric vs. LRI N=55 N=75 -0.25 -0.25 aim 100% 96% cyl >/= 1 D 32% 21% cyl >/= 2 D 1.84 D 1.75 D Pre-op cyl SN60AT with LRIs n=55 Acrysof Toric n=75
  18. 20. Post op: Toric vs. LRI -0.575 -0.45 Mean SE 0.97 D 0.48 D Post-op refractive cyl 85% 93% >/= 6/12 24% 56% >/= 6/6 SN60AT + LRIs Acrysof Toric
  19. 21. SEC experience <ul><li>25.5% of cataract patients have a toric IOL </li></ul><ul><li>Over half are T3 </li></ul>56% T3 25% T5 19% T4
  20. 22. IOL rotation <ul><li>Follow-up: about a month later </li></ul><ul><li>n = 38 </li></ul><ul><li>Av = 2.66 (0 –7.5 °) </li></ul><ul><li>92% < 5 ° </li></ul><ul><li>Direction: equal clockwise and anticlockwise </li></ul>
  21. 23. Measuring axis post-op
  22. 24. Conclusion <ul><li>AcrySof ® Toric IOL </li></ul><ul><li>We can confirm that the lens has excellent rotational stability at 1 month </li></ul><ul><li>It handles just as easily as any AcrySof single piece lens </li></ul><ul><li>More reliable than spherical lens and LRIs in improving uncorrected distance visual acuity </li></ul>