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    Misaligned toric IOLs require prompt surgical management

    Ophthalmologists need to determine exact orientation, decide how lens should be shifted



    New tools are facilitating repositioning of a misaligned toric IOL. The corrective procedure is best undertaken sooner than later.


    By Cheryl Guttman Krader; Reviewed by Randall J. Olson, MD

    Irvine, CA—When IOL misalignment underlies a suboptimal outcome with a toric implant and the problem is identified in the early postoperative period, surgeons should not procrastinate about taking the patient back to the operating room for a repositioning procedure, said Roger F. Steinert, MD.

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    “It is easy to open the capsular bag and rotate the IOL within the first several weeks after surgery,” said Dr. Steinert, Irving H. Leopold Professor and Chair, Department of Ophthalmology, University of California, Irvine. “So, if you identify that the IOL is in the wrong place, fix it.”

    Strategies for correction

    Outlining the steps for correcting toric IOL misalignment, Dr. Steinert said the first task is to determine the exact orientation of the IOL. This is done at the slit lamp, and there are now two free smartphone apps (iHandy level and Axis Assistant) that can help to identify the axis.

    The next step is to decide how the IOL should be shifted. While this may be done using the postoperative refraction and vector analysis that will take into account posterior and anterior corneal changes, use of an online tool developed by John Berdahl, MD, and David Hardten, MD, offers a much easier option. Available as a free download at www.astigmatismfix.com, the program requires input of the refractive data, but then it automatically does the mathematical calculations to determine exactly where the implant should be aligned in order to minimize final residual astigmatism.

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