toric IOL for beginners

1. TORIC IOLSNawat Watanachai
2015

2. CHOICES TO TREAT ASTIGMATISM
ALONG WITH CATARACT SX➤ (glasses)
➤ corneal Sx
➤ LRI
➤ manual
➤ femtosecond
➤ astigmatic keratotomy
➤ Toric IOLs

3. 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

4. WHY TORIC?
➤ because it is one of the best
way to treat astigmatism

5. CANDIDATE FOR
TORIC➤ minimum 1.25D cylinder
➤ regular astigmatism

6. 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

7. 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

8. TORIC IOLS
➤ STAAR IOL
➤ Acrysof toric(Alcon)
➤ Tecnis toric (AMO)
➤ Crystalens Trulign (B&L)

9. 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)

10. IOL power
acrysof toric
single piece
aspheric
hydrophobic yellow +6 to + 30
tecnis toric single piece hydrophobic clear

11. corrective
power at
corneal plane
(D)
acrysof toric 0.75-4.0
higher RI
1.55
higher
reflectivity
tecnis toric 1, 1.5, 2, 2.75
harden
surface (less
scratch)
lower RI lower reflectivity

12. light filtration
acrysof toric
full 6mm
refractive
optic
more sticky
haptic
UV, blue
tecnis toric
less sticky
haptic
more -ve spheric
aberration,
less chromatic
aberration

14. 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

15. TORIC IOLS
➤ STAAR IOL
➤ Acrysof toric(Alcon)
➤ Tecnis toric (AMO)
➤ Crystalens Trulign (B&L)
➤ 3-piece?
➤ good stability, less rotation

16. 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

17. Input Screen
Patient information
Doctor name
Patient name or ID number
Operative eye
Keratometry & Biometry data
Flat 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 input
Estimated surgically induced cylinder
Incision location (0 to 360°)

18. 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

20. SURGICAL TIPS
➤ on-axis placement
➤ gross alignment : 20-30’ short
➤ OVD removal
➤ final alignment

21. 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

22. CALCULATORS FOR TORIC IOL
➤ websites
➤ www.aurolab/optical.com
➤ www.toriccalculator.com
➤ www.doctor-hill.com
➤ www.acrysoftoriccalculator.com
➤ apps
➤ toricIOL