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Toric lens helps with spectacle-free distance vision


A toric IOL enables patients with corneal astigmatism undergoing lens surgery to achieve the same clear uncorrected vision on day 1 as patients with minimal astigmatism.

Key Points

Dr. Ernest was an investigator in the multicenter clinical study that led to FDA approval of the toric lens. He has been implanting it in patients seeking refractive lens exchange since it became available in 2005 and began performing several procedures a week with the lens in patients undergoing cataract surgery since the Centers for Medicare & Medicaid Services ruling this past January allowing Medicare beneficiaries undergoing cataract surgery to choose an astigmatism-correcting IOL.

"I have had no patients who are unhappy, and I can only say positive things about this lens," Dr. Ernest told Ophthalmology Times. "The opportunity to allow individuals with more than minimal corneal astigmatism to see well at distance without glasses on the first day after surgery has been impressive and very rewarding for me and my patients."

"While these patients are informed [that] their vision will improve with spectacle correction, they also need to be told that they won't get their prescription until their second eye surgery is done," said Dr. Ernest, a private practitioner in Jackson, MI, and clinical associate professor, Kresge Eye Institute, Wayne State University, Detroit. "However, they may be reluctant to have the fellow eye procedure because of the first eye outcome, and so it takes some patient trust and physician encouragement to get them to the point where they can enjoy good vision."

A proven platform

The toric IOL uses the same performance-proven, single-piece platform as the one-piece spherical IOL (AcrySof IOL, Alcon), and its haptic design prevents rotational movement after lens implantation as the capsular bag contracts.

"Part of the beauty of this platform is that there is some adhesion between the lens and the capsular bag so that the lens position is stable-the optic stays wherever it is put at the time of surgery," Dr. Ernest said.

"Out of more than 100 patients with the toric IOL implanted, only one has undergone laser vision surgery for astigmatism correction," he said.

Positioning of the toric IOL is accomplished easily using the markings on its anterior surface, which are oriented with respect to the steepest meridian of the cornea, he said. In addition, Dr. Ernest noted that Warren Hill, MD, has devised a software program that calculates the magnitude and axis of astigmatism to be corrected, considering up to 0.50 D of astigmatism induced by the phaco incision.

"That program is very helpful, especially in eyes with lower powers of corneal astigmatism," he said.

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