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

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. Pearls for Introducing AcrySof® TORIC IOL in Your Practice ACRYSOF TORIC RTM at Raipur, Chhatisgarh, India Hotel Babylon, Raipur, India August 28, 2011

3. Dr Suresh Pandey presenting talk on “Pearls for IntroducingToric IOL”, RTM, Raipur, Chhatisgarh, India, Aug. 28, 2011

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. 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. Training of Entire Hospital Staff All understand Astigmatism … Astigmatism- a Ref. Error needing TREATMENT

8. Training of Hospital Staff

9. PATIENT INFORMATION LITERATURE At SuVi Eye Inst., Kota, India

10. PATIENT INFORMATION LITERATURE at SuVi Eye Inst., Kota, India

12. Auto-Keratometry for Screening cases for Toric IOL (Video)

14. AcrySof ® TORIC IOL

15. Centration Patient Selection

16. Pre Operative Measurements

17. AcrySof ® TORIC Procedure

18. TORIC IOL requires SIA (Surgically Induced Astigmatism) Remember!

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. SIA Calculator: Download from www.doctor-hill.com

21. SIA Report

22. Align to Steep Axis of cornea Meridian of Power

23. Precise Keratometry

26. Calibrating the Manual Keratometer Establish a schedule for routine checks of instrumentation accuracy

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

30. Calculator Input / Output Lens Details Calculation Details Pre-Op Information Graphical Representation For Axis of placement Surgeon / Patient Information

31. Take the print out copy to the OR Incision Location @ 110°

32. Steep Axis

33. Marking Instruments

39. Practice of Non-Toric IOL (Video)

42. AcrySof ® TORIC IOL Alignment

43. AcrySof Toric IOL Implantation in a Pediatric Cataract (VIDEO)

45. Video

46. Introducing Toric lenses has been one of the most significant advances in surgical practice in the last 4 years

47. Thanks for your attention ?Question/Comment Always under promise & over deliver!!

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