TORIC

Enhancing Vision, Expanding Horizons

Management of Astigmatism by Toric IOLs
Management of Astigmatism with Toric IOLs
WHY TORIC IOLs?

 With the use of Toric IOLs, we can minimise residual astigmatism

postoperatively
 Higher visual outcome demands from patients
 Toric IOLs are more predictable in reducing corneal astigmatism than limbal
relaxing incisions
 Any patient with corneal astigmatism more than 1 D should be treated with
TORIC IOLs
REQUIREMENTS

 Have patience
 Good Phaco surgical skill
 Check K readings twice (Cross check K with manual keratometry)
 Cross verify all the readings
Common Errors

 Measurement Errors
 Calculation Errors
 Alignment Errors
Measuring Accurate K : Use multiple Instrument

 -MANUAL KERATOMETRY
 -AUTO K
 -IOL MASTER
 -LENSTAR
 -TOPOGRAPHY
 -i Trace
 -SLIT SCANNING K
 -Schiemflug CAMERA K
Measuring Accurate K : Know Your Instrument

MANUAL K 3.2 MM IOL MASTER K 2.6 MM

...
Non Correlating K

 Primary Instrument Vs Secondary Instrument

 For Power
 For Axis
Validation Criteria

 K < 40D or > 47D

 < 40 d may indicate previous refractive surgery
 > 47 d may indicate Keratoconus
 K correlates poorly with refraction.
 Difference in K values between two eyes
Past limitations for perfection

 No consideration of posterior corneal surface

 Recently Biotech took one step ahead to consider posterior corneal curvature in
their online as well as offline calculator

 www.biotechcalculators.com
Post Corneal Astigmatism

 Post corneal astigmatism differs from ant

 Usually vertical meridian steep
 Adds to the ATR
 Overestimates WTR and may leads to overcorrection
 Underestimates ATR and may lead to under correction
 Average PCA
 ATR–0.5 D WTR–0.3 D
Measurment errors

 Biometry
 Refraction measurements
 Conversion Factor same(1.46) , irrespective of ACD
 Use Holladay 2 consultant Program or routine calculation
 IOL with low power n deep AC- 0.5 power more toricity
 IOL with High power n Shallow AC – 0.5 power less toricity
 Or use online Barrett Toric Calculator
 Available on APACRS and ASCRS website
Alignment Errors

1° rotation
• 3.3% IOL toricity is lost

15° rotation
• Reduces astigmatism correction by 50%

30° rotation
• Complete loss of toric correction + axis flip
Angle Kappa

 Visual axis & Pupil center

 5 degree or 0.4mm
 More in hypermetropes
 Can be measured by synaptophore
 IOL is tilted by angle Alpha relative to visual
axis
 It is slightly decentered when it is in center of
bag
 If your IOL cylinder is >3D induces aberration
and coma and can reduce BCVA
 To avoid –IOL center slightly nasal in bag
 To achieve this Haptics should be vertical or
oblique
 Not possible always in Toric IOL
IMPROVING TORIC OUTCOMES

 Counsel patients appropriately

 Use appropriate visual media to counsel the
patients
 Counsel patients with minimum expectations
 Involve patient’s relative for counseling
IMPROVING TORIC OUTCOMES

 Manage paralax error

 ASICO electronic toric marker
 Use comfortable marking method
 Cross check your marking
 Axis Markings
 Define the optimal axis of IOL placement
 Determined by the EYECRYL TORIC IOL Calculator
 Using the reference marks as a guide, the patient’s eye is marked
accurately at two positions, 180 degrees apart
MARKING

Reference
Marks

Toric Reference Marker

Axis
Marks

Toric Axis Marker

Prominent marking for precise alignment on required axis

TORIC marks
 TORIC MARK

REFERENCE MARK

FINAL ALIGNMENT
FINAL ALIGHMENT
Achieving Optimal Results

 EYECRYL TORIC IOL demonstrates exceptional rotational stability

within the capsular bag

 Critical to ensure that regardless of the technique used, final

placement is precisely on the axis recommended by the EYECRYL
TORIC IOL calculator

 Doing so should yield optimal results in the management of patients

with cataracts and corneal astigmatism
Eyecryl Toric Calculation Sheet
EYECRYL TORIC IOL Specifications
TM

 Optic Size : 6.00 mm

 Overall Size : 13.00 mm
 Material : Natural Yellow Hydrophobic
 Astig. Adds : +1.5 D, + 2.25 D, + 3.0 D, + 3.75, + 4.50, + 5.25, +
6.00
 Angulation : 0 Degree
 Theo. A Const : 118.5
 Index of Refraction : 1.483
Eyecryl Toric IOL: 360o Square Posterior Edge

Actual Electron Microscopic Picture of IOL Square Edge

Pre-Operative Details

 Patient’s Name
 Patient’s ID No.
 Patient’s Age
 Selection of Eye
 K1 @ ___ °
 K2 @ ___ °
 Incision Location
 SIA Value
 Spherical Power Selection
Calculator Interface (Sample)
Selection of Model
You can choose from available models based on value of Residual
Astigmatism

Cylinder Power Recommended Correction

Model Range Corneal
At IOL Plane At Corneal Plane* Astigmatism

HFY-10 1.50 D 1.01 D 0.75 – 1.50 D

HFY-20 2.25 D 1.52 D 1.51 – 2.00 D
HFY-30 3.00 D 2.02 D 2.01 – 2.50 D
HFY-35 3.75 D 2.57 D 2.51 – 3.00 D
HFY-40 4.50 D 3.08 D 3.01 – 3.50 D
HFY-50 5.25 D 3.60 D 3.51 – 4.00 D
HFY-60 6.00 D 4.11 D 4.01 – 5.00 D
IOL MODEL OPTIONS
Follow Up

Day 1 Slit lamp exam

Week 1 UCVA, Slit lamp

Week 4 Acuity, Residual Astigmatism

Month 3 Residual Astigmatism, Rotational Stability

Comparison:
Different yellow materials

Natural Dark
Clear Yellow Yellow
 TM
EYECRYL TORIC IOL Features

 Smooth Surface
 Natural Yellow
 Easy Handling
 Easy Loading
 Axis marks on IOL optic – easily visible
 TM
• EYECRYL TORIC IOL

High Index (1.483)

Thin IOL

Small Incision (2.2 - 2.4 mm)

Clinical Results with Eyecryl Toric IOLs

 The study included 40 eyes of 20 patients.

 Keratometric, refractive and visual data were collected on patients

listed for cataract surgery.

 Toric IOLs were suggested to where corneal cylinder was greater than
or equal 1.00 diopters.

 Bilateral implantation of Eyecryl Toric IOL was performed after

phacoemulsification.

 The eyes were followed for 3 months

Post – 3 Months Residual Astigmatism

40

35
35

30
87.5 % of patients within 0.00
- 0.50 D
25
Eyes

20
18
Pre- Op
15 3 Month Post Op

10
10
7
5 5
5

0 0 0 0
0
0 - 0.50 0.50 - 1.00 1.00 - 1.50 1.50 - 2.00 Above 2.00
Pre- Op 0 5 18 10 7
3 Month Post Op 35 5 0 0 0
Residual Astigmatism
Summary of Results

 The UCVA was 0.3 LogMAR (20/40 SNELLEN) or better in 100 % of

eyes and 0.1 LogMAR ( 20/25 SNELLEN) or better in 63.00 %.
 The mean residual refractive astigmatism was 0.5 ± 0.5 (SD).
 All eyes achieved 0.1 LogMAR (20/25 SNELLEN) or better BCVA.
 At the last follow up visit IOL alignment was within ± 5° in % 93 of
patients and ± 10° in % 100 of patients.
Eyecryl Toric Implanted