Pearls for Introducing AcrySof®  TORIC IOL in Your Practice Dr Vidushi Sharma MD (AIIMS), FRCS (UK) Dr. Suresh K Pandey MS...
Pearls for Introducing AcrySof®  TORIC IOL in Your Practice ACRYSOF TORIC RTM at Raipur, Chhatisgarh, India Hotel Babylon,...
Dr Suresh Pandey presenting talk on “Pearls for IntroducingToric IOL”, RTM, Raipur, Chhatisgarh, India, Aug. 28, 2011
<ul><li>Dr Suresh Pandey presenting talk on “Pearls for IntroducingToric IOL”, RTM, Raipur, Chhatisgarh, India, Aug. 28, 2...
Dedicated to Late  Professor David J. Apple,  a world renowned ophthalmologist, Mentor and Researcher Passed away on Augus...
Astigmatism Correction during cataract surgery  is a  Medical Necessity As a surgeon/optometrist/counselor, it becomes  ou...
Training of Entire Hospital Staff All understand Astigmatism  … Astigmatism- a Ref. Error needing TREATMENT
Training of Hospital Staff
PATIENT INFORMATION LITERATURE At SuVi Eye Inst., Kota, India
PATIENT INFORMATION LITERATURE at SuVi Eye Inst., Kota, India
Counseling… <ul><li>Make a small change in your routine practice, by screening the patient for Keratometry first and then ...
Auto-Keratometry for Screening cases for Toric IOL (Video)
Counseling… <ul><li>Emphasize that after removal of cataract surgery they will need spectacle for distance .  </li></ul><u...
AcrySof ®  TORIC IOL
Centration Patient Selection
Pre Operative Measurements
AcrySof ®  TORIC Procedure
TORIC IOL requires SIA (Surgically Induced Astigmatism) Remember!
Surgically Induced Astigmatism  Assessment e.g. temporal incision likely result 0.43 at 93 degrees e.g. superior limbal in...
SIA Calculator: Download from  www.doctor-hill.com
SIA Report
Align to Steep Axis of cornea Meridian of Power
Precise Keratometry
 
Measuring the ‘K’ <ul><li>Any ‘K’ that works well for you </li></ul><ul><li>But - Use a dedicated  Keratometer </li></ul><...
Calibrating the Manual Keratometer Establish a schedule for routine checks of instrumentation accuracy
Don’t use refractive astigmatism! <ul><li>Measurements may not always agree </li></ul><ul><ul><li>Lenticular astigmatism m...
Surgeon Factor <ul><li>Data Acquisition of K Readings </li></ul><ul><li>Multiple Readings –  till 3 same readings are obta...
Calculator Inputs Surgeon / Patient Information Input for K Value K Notation (mm/diopter) Flat K @ Flat Axis Steep K @ Ste...
Calculator Input / Output Lens Details Calculation Details Pre-Op Information Graphical  Representation For Axis of  place...
Take the print out copy to the OR Incision Location @ 110°
Steep Axis
Marking  Instruments
AcrySof ®   TORIC IOL <ul><li>Suitable candidates are cataract patients with pre-existing corneal astigmatism   1.0 D or m...
OT Staff and Anesthetist  Must  Understand the Process <ul><li>Need to sit patient up to mark horizontal axis before sedat...
Marking of the Eye – Reference Marking <ul><li>Two steps </li></ul><ul><ul><li>Reference Marking </li></ul></ul><ul><ul><l...
Marking for Maximum Benefit <ul><li>Pen and ‘eyeball’ </li></ul><ul><li>Slit lamp with sp. device </li></ul><ul><li>Commer...
Practice on non-TORIC IOLs <ul><li>Extra steps needed for Toric </li></ul><ul><ul><li>Marking </li></ul></ul><ul><ul><li>R...
Practice of Non-Toric IOL (Video)
Marking of the Eye – Axis Marking <ul><li>Axis Markings </li></ul><ul><ul><li>Define the optimal axis of IOL placement </l...
Marking Tips <ul><li>Dry the conjunctiva with a swab </li></ul><ul><li>Enhance the markings at 3 “O” Clock and 9 “O” clock...
AcrySof ®  TORIC IOL Alignment
AcrySof Toric IOL Implantation in a Pediatric Cataract (VIDEO)
 
Video
Introducing Toric lenses has been one of the most significant advances in surgical practice in the last 4 years
Thanks for your attention ?Question/Comment Always under promise &  over deliver!!
Pearls for Introducing AcrySof®  TORIC IOL in Your Practice Dr Vidushi Sharma MD (AIIMS), FRCS (UK) Dr. Suresh K Pandey MS...
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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 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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Pearls for Acrysof Toric IOL in Practice Dr Suresh K Pandey, kota, india

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

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