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