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    Treating all lenses equally

    Unique benefits of monofocal, toric, and premium lenses

    Durham, NCIOLs have come a long way in the 66 years since Harold Ridley first inserted one, said Alan Carlson, MD, professor of ophthalmology, Duke University, Durham, NC. Between Dr. Ridley’s foresight and David Apple’s visionary approaches, Dr. Carlson said they laid the foundation for today’s lenses, including the toric lens.

    Related: Customized IOL calculator helps cataract surgeons navigate lens choices

    “With respect to the toric IOL, one of the key aspects is rotational stability,” he said. “These lenses are offered now in both the loop design lens as well as the plate design lens.” The robust preoperative diagnostics patients undergo, coupled with the intraoperative measurements and postop follow-up, has made these once difficult surgeries considerably easier, he said.

    Coupling the rotational stability with multiple IOL calculators that are available translates to the overwhelming majority of surgeries performed without any complications.

    Related: How new ‘evolving’ IOL formula maximizes lens accuracy

    “Even with all of these options out there, things can still go wrong,” Dr. Carlson said, adding that Warren Hill, MD, “has given us his top four preoperative measurement errors,” starting with incorrectly marking a reference point in the cornea.

    “When we take these measurements in the upright position and move the patient into the supine position, there is an utricle mediated cyclotorsional rotation that is quite unpredictable, both in direction and magnitude,” he said. “Third, there is the incorrect placement of the IOL, and finally, the failure to take into account the impact of surgically-induced astigmatism.”

    Douglas Koch, MD, also gave surgeons another component to consider—the posterior cornea.

    The Baylor University toric nomogram that Dr. Koch’s group developed “allows us to prevent this against-the-rule error that I was noticing early on in my patients before taking this into account,” Dr. Carlson said.

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    The latest addition to help surgeons prevent or overcome potential errors is the “www.astigmatismfix.com” site developed by John Berdahl, MD, and David Hardten, MD.

    “That helps tell you where the optimal position ought to be with your toric lens. I found this to be a very useful website,” Dr. Carlson said.

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