nw2015 toric iol02
TRANSCRIPT
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TORIC IOLSNawat Watanachai
2015
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CHOICES TO TREAT ASTIGMATISM ALONG WITH CATARACT SX➤ (glasses)➤ corneal Sx
➤ LRI➤ manual➤ femtosecond
➤ astigmatic keratotomy➤ Toric IOLs
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CHOICES TO TREAT ASTIGMATISM ALONG WITH CATARACT SX➤ (glasses)➤ corneal Sx
➤ LRI➤ astigmatic keratotomy
➤ Toric IOLs➤ cylinder on 1 surface➤ spherical on the other surface
➤ ONLY for regular astigmatism➤ correct corneal astigmatism
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WHY TORIC?➤ because it is one of the
best way to treat astigmatism
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CANDIDATE FOR TORIC➤ minimum 1.25D cylinder➤ regular astigmatism
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TORIC IOL IS NOT INDICATED IN➤ cylinder <1.25D➤ pts willing only for SICS,
ECCE➤ traumatic cataract➤ irregular astigmatism
➤ corneal scar/ pterygium➤ combined Sx
➤ corneal/ glaucoma/ retina
➤ squint
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WHY TORIC?
manual LRI femto LRI toric IOL
accuracy less/ tend to undercorrect/ regressed equal? equal?
reversible no no yes
weaken cornea yes/ perforation yes no
price low high fair
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TORIC IOLS➤ STAAR IOL➤ Acrysof toric(Alcon)➤ Tecnis toric (AMO)➤ Crystalens Trulign (B&L)
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TORIC IOLS➤ STAAR IOL
➤ 1-piece plate-type➤ may not fit to all capsular bag
➤ 10.8 and 11.2 mm width➤ silicone
➤ less reflectivity➤ anterior capsule fibrosis
➤ Acrysof toric(Alcon)➤ Tecnis toric (AMO)➤ Crystalens Trulign (B&L)
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IOL power
acrysof toric single pieceaspheric hydrophobic yellow +6 to + 30
tecnis toric single piece hydrophobic clear
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corrective power at corneal
plane (D)
acrysof toric 0.75-4.0 higher RI1.55
higher reflectivity
tecnis toric 1, 1.5, 2, 2.75
harden surface (less
scratch)lower RI lower reflectivity
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light filtration
acrysof toricfull 6mm refractive
opticmore sticky
haptic UV, blue
tecnis toric less sticky haptic
more -ve spheric aberration,
less chromatic aberration
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CYLINDER POWER OPTIONS : ACRYSOF
ALCON® LENS MODEL SN6AT2 SN6AT3 SN6AT4 SN6AT5 SN6AT6 SN6AT7 SN6AT8 SN6AT9
IOL Plane 1.00 D 1.50 D 2.25 D 3.00 D 3.75 D 4.50 D 5.25 D 6.00 D
Corneal Plane* .68 D 1.03 D 1.55 D 2.06 D 2.57 D 3.08 D 3.60 D 4.11 D
Recommended Corneal Astigmatism Correction
Range .50 D to .90 D .90 D to 1.50 D 1.50 D to 2.00 D 2.00 D to 2.50 D 2.50 D to 3.00 D 3.00 D to 3.50 D 3.50 D to 4.00 D 4.00 D and up
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TORIC IOLS➤ STAAR IOL➤ Acrysof toric(Alcon)➤ Tecnis toric (AMO)➤ Crystalens Trulign (B&L)
➤ 3-piece?➤ good stability, less rotation
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MAKING THE MOST OF TORIC➤ give this option to all the pts c signif. astigmatism➤ look for any obstacles
➤ irregular astigmatism➤ corneal scar/ pterygium/ old IK/ corectopia etc.
➤ multi-measures➤ IOL master + corneal topo➤ IOL master + automated keratometryhyyokkll;.➤ IOL master X2
➤ special consideration needs in eyes after refractive Sx eg. LASIK
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Input Screen
Patient informationDoctor namePatient name or ID numberOperative eye
Keratometry & Biometry dataFlat K reading (in diopters)Flat meridian (in degrees)Steep K reading (in diopters)Steep meridian (in degrees) IOL spherical power as determined by the
surgeon’s preferred formula with conventional monofocal IOLs
Surgeon-dependent inputEstimated surgically induced cylinder Incision location (0 to 360°)
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MAKING THE MOST OF TORIC➤ procedures
➤ make reference marking (in UPRIGHT position)➤ manually mark 0’, (90’), 180’➤ automatically mark with the machine➤ note : 1’IOL rotation —> loss of 3.3% of IOL
cylinder power➤ CCC➤ intact capsular bag
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SURGICAL TIPS➤ on-axis placement
➤ gross alignment : 20-30’ short➤ OVD removal➤ final alignment
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SURGICAL TIPS
➤ single piece IOL➤ remove visco behind the lens to prevent rotation
➤ average SIA is 0.25-0.5D for 2.8mm incision➤ incision location can varied (temporal/ superior) to
achieve the least residual astigmatism
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CALCULATORS FOR TORIC IOL➤ websites
➤ www.aurolab/optical.com➤ www.toriccalculator.com➤ www.doctor-hill.com➤ www.acrysoftoriccalculator.com
➤ apps➤ toricIOL
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