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Our Experience Toric IOL with AcrySof

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 EmailEmail- suvieye@gmail.com Visiting Assistant Professor, John A Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Sydney Eye Hospital, University of Sydney, Australia

Our Experience with AcrySof Toric IOL

ACRYSOF TORIC RTM at Raipur, Chhatisgarh, Chhatisgarh, India August 28, 2011

Dr Suresh K Pandey Speaking at AcrySof TORIC Round Table Meeting at Raipur, Chhatisgarh, India, August 28, 2011

Dr Suresh K Pandey Speaking at AcrySof TORIC Round Table Meeting at Raipur, Chhatisgarh, India, August 28, 2011

WHY TORIC IOL?


Patients expect good quality vision and as much spectacle independence as possible In the age of fast dissemination of information, not long before we deal with well-informed patients even in smaller places Astigmatism pre-existing and induced contribute mainly to less than 6/6 UCVA
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

After spherical errors, astigmatism remains the major cause of reduced UCVA

Astigmatism - How Big Is this problem ?


Astigmatism in Practice
Holladay Data Base

n = 3538 Average K astig >/= 1 D >/= 2 D >/= 3 D 0.916 D 39% 8.6% 2.4%

SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

Management of Astigmatism
Measures to deal with astigmatism include tailoring the wound construction and other modalities (LRI/PRK etc) Most of the procedures do not have a predictable result over a long period of time

SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

Emerging Management Option


Spectacles and CL

Toric IOLs

Astigmatism

Excimer Laser

Astigmatic Keratotomy/LRI
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

VIDEO LIMBAL RELAXING INCISION

What stops us?


Our own doubts
Will the results be good? Would the patient appreciate the difference? Will the patient expect more as he/she is paying more?

The patients point of view:


Worth the cost?

SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

How did we start?


We too had our doubts We selected a patient who we were sure, had trust in us a patient operated in the other eye Stressed on accurate keratometry/biometry, monitored our results over months for accuracy Increased chair time for counseling
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

How did we start?


We needed a start to clear our own doubts We shared our experience across hospitals results, as well as counseling and motivating patients Our conviction increased as we dealt with more cases.
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

Toric IOL
We found that the patients were more satisfied than even the routine monofocal probably because:
They had never worn glasses before and hence had never realized the potential of that eye They could not be completely corrected for their astigmatism, and hence once corrected had vision like never before
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

TORIC IOL
Correcting astigmatism with Toric IOLs does not demand extra skill from the surgeon If at all only accurate biometry and axis markings as already discussed.

SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

Currently Available Toric IOLs


Rayner T-flex Toric

Zeiss Acri.Comfort 646 TLC

Alcon AcrySof Toric IOL (Most preferred as it provide best rotational stability)

Cylinder Powers AcrySof Toric SN60T3-T9

* Based on an average pseudophakic human eye

Spherical Powers : 6.0 D 30.0 D

SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

Our Experience with AcrySof Toric IOL

PURPOSE
To evaluate visual outcome and astigmatic correction following implantation of the first 52 AcrySof Toric IOLs at our centre during 2008 to 2010

PATIENTS & METHODS


Patients undergoing cataract surgery with coexistent regular Corneal Astigmatism of > 1.5 D All cases (except 2) underwent topical phacoemulsification with AcrySof toric IOL implantation
SUVI EYE INSTITUTE & LASIK LASER CENTER, KOTA, RAJASTHAN

EXCLUSION CRITERIA
Corneal surface abnormalities Irregular astigmatism Extensive retinal pathology Previous ocular surgery/trauma causing astigmatism

CASE SELECTION
Counseling Keratometry (Auto/Manual) A Scan Biometry Complete ophthalmic examination Preoperative informed consent

ACRYSOF TORIC IOL


Design
AcrySof Single-Piece platform Open loop, modified-L haptics Posterior toricity Toric axis marks

Dimensions
Overall length: 13.0 mm Optic diameter: 6.0 mm

Delivery
Monarch II Injector C and D Cartridge

IOL POWER CALCULATION


AcrySof Toric online calculator used for determination of correct lens platform. 0.5 D of surgically induced astigmatism was used. Main incision (2.8 mm ) at steep axis Targeted spherical outcome plano to -0.50D

CORNEAL MARKING
The preoperative Reference markings were made with the patients sitting upright to negate any possible cyclotorsion in the supine position An intraoperative toric axis marker was used for determination of actual axis placement.

SURGICAL PROCEDURE
After injection, all IOLs were rotated 15-25 degrees from intended axis and the viscoelastic was then removed from posterior to the lens. The IOLs were then rotated to their final position to coincide with corneal axis markings.

VISUAL OUTCOME
Visual acuity and Refraction checked at 1st postop day, 2 weeks and 6 weeks Final correction at 6 weeks IOL rotation also checked at 6 weeks correlating with incision placed at steep axis

RESULTS
No. of AcrySof toric IOLs used since 2008 to 2010 52 (47 patients) 42 cases were unilateral; 5 had bilateral toric IOL Gender distribution

AGE DISTRIBUTION (N=47)

PREOP CYLINDER (N=52)

POST OP CYLINDER (N=52)


35 30 25 20 15 10 5 0 0 5D 0 5 0 75D 075 1 0D 1 1
0 5D 0 5 0 75D 075 1 0D

35

POST OP UNAIDED VA (N=52)


2
25 22

2 5

5
o b

o b

<

2
<

o 2

POST OPERATIVE BCVA (N=52)

POST OP IOL ROTATION

<

<

First Case
65 year old male One Eyed Other Eye NVG following CRVO IOL model 21.50 D T3 Preop Visual acuity 6/60 Corneal Astigmatism 1.50 D Postop VA 6/6 unaided

Youngest Case
4 years old boy with zonular cataract Preop Cylinder 1.50 diopter IOL power used 21.0 Diopter T3 Preop VA FC at 2 meters Postop VA 6/9

AcrySof Toric IOL with implantation of Piggyback Monofocal IOL


45 years patient, high hypermetropia Refractive Error (+ 16.0 D with 1.50 D Cyl at 170 degree) K Reading : 44.00/45.50 (1.50 D Cyl at 170 degree) Early lenticular changes Post Op UAVA 6/9

PiggyBack IOL

AcrySof ReSTOR Toric IOL


First AcrySof IQ ReSTOR Multifocal Toric IOL in at SuVi Eye Institute, Kota, India in May 2011. Three Implantation from May 2011 to August 2011 This IOL designed to offer a single surgical procedure for the correction of presbyopia and astigmatism Lens is currently available in +16.0 to +25.0 D and cylinder correction in the T2 to T5 range

AcrySof RESTOR Toric IOL in a 9 year old Child

AcrySof ReSTOR Toric IOL

DISCUSSION
In our series, 65% patients achieved 0.5D astigmatism and 95% patients achieved postoperative astigmatism within 0.75D 95% patients achieved an unaided visual acuity of 6/12 or better markedly decreasing their spectacle dependence for distance vision

DISCUSSION
One patient had postoperative best corrected visual acuity of 6/12 and had macular edema One 8 year old child had surgery for developmental cataract and achieved postoperative BCVA of 6/12 (amblyopia) Only 1 patient had IOL rotation > 5 (postoperative cylinder - 0.75D)

DISCUSSION
Our series compared favorably with most published series possibly due to case selection Most patients reported seeing much better unaided than they had ever seen

CONCLUSION
AcrySof toric IOL shows excellent rotational stability, if placed accurately during surgery due to its sticky surface Accurate keratometry, biometry is crucial and should be rechecked Calculate surgeons induced astigmatism (SIA)

CONCLUSION
Preoperative counseling extremely important to select the most appropriate cases medically, financially and psychologically!! Results with AcrySof toric IOL are very gratifying to most patients with a difference they can truly appreciate

POINTS TO REMEMBER
IOL placed and marks aligned precisely with the steep axis of the post-incisional cornea For every 1 of rotation, 3.3% of the lens cylinder power is lost For 30 of rotation there is a complete loss of astigmatic correction

Just one final word


One will in any case achieve a better UCVA by implanting a Toric IOL in an eye with high pre-op astigmatism, than implanting a spherical monofocal of the same power in the same eye So, let us make a start..

Patient Experience with AcrySof Toric IOL (9.0 D, T5)

Our Experience with AcrySof Toric IOL


Dr. Suresh K Pandey,
MS (Ophthalmology, PGIMER, CHANDIGARH), Anterior Segment Fellowship (USA) Director, SuVi Eye Hospital & Research Centre C-13, TALWANDI, KOTA, RAJASTHAN, INDIA

Dr. Vidushi Sharma, MBBS (AIIMS, New Delhi), MD (Ophthalmology, AIIMS, New Delhi), FRCS (UK) EmailEmail- suvieye@gmail.com Phone +91 9351412449, 0744 2433575 www.suvieye.com

Our Experience with AcrySof Toric IOL

TORIC RTM at Raipur, Chhatisgarh August 28, 2011

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