April 04, 2014
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Toric IOLs require complex clinical judgment, proficient use of technologies

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TOKYO — Toric IOLs are gaining wide acceptance, but they require careful evaluation and complex clinical judgment, according to one surgeon.

An increasing number of patients want to be spectacle-free, and 30% have significant astigmatism, Richard B. Packard, MD, said at the World Ophthalmology Congress.

“If you are planning to fit a multifocal toric lens, you know that an error of just half a diopter will degrade the image,” he said.
Also, astigmatism can now be effectively addressed with toric lenses in patients with keratoconus and those who had keratoplasty.

“Once you have made the decision to go with toric, you must choose the right lens. The IOLMaster (Carl Zeiss Meditec) is not enough. You need topography and Pentacam (Oculus) measurements. Also, the tear film can interfere, particularly in older patients,” Packard said.

Axis alignment is crucial, and the posterior corneal power has to be considered. New algorithms have been produced to calculate power more accurately.

“We have now a wide range of lenses with different powers to choose from. Some of them will only correct up to 3 D, some up to 12 D,” he said. “We have the technologies for best choice, calculation, selection, correct alignment, and our ability to manage and master them can make a dramatic change in our patients’ vision and quality of life.”

Disclosure: Packard has no relevant financial disclosures.