Transcription
Management of ResidualAstigmatism after ToricIOL PlacementDavid R. Hardten, M.D.Minneapolis, MinnesotaHave done research, consulting, or speaking for:Allergan, AMO, Calhoun Vision, CXL-USA, ESI, Humanoptics, Oculus, OSD, Quantel, TLCVSome of the information may represent off-label uses of approved drugs or deviceswww.mn-eye.comPh: 612-813-3600Fax: 612-813-3636D.R. Hardten, M.D.Astigmatic CorrectionMany Options at time of Cataract Surgery Corneal Relaxing Incisions – Blade vs. Femtosecond Toric IOLs – increasing acceptance Preoperative laser vision correctionLASIKPRK Postoperative laser vision correctionLASIKPRKD.R. Hardten, M.D.Custom Cataract Surgery 70% of patients have 0.5 D of pre-op astigmatismCritical to AddressFor GoodUncorrected VisionHoffmann & HutzJCRS 2010;36:1479D.R. Hardten, M.D.Page 1
Timing of Secondary InterventionAstigmatism Correction after IOLs Enhance large corrections earlier Small corrections – wait longer Typically I wait 1-2 months to do IOL Rotation orIOL exchange for large corrections Typically I wait 3-6 months to do laser visioncorrectionCapsule considerations – contraction or PCOYag first in many patientsD.R. Hardten, M.D.Residual Astigmatism after Toric IOLQuestions to Ask 1. Is it Regular or Irregular? 2. Is the Spherical Equivalent where youwant? 3. Is it correctable by rotation of theIOL? Example: SN6AT5 at 150 degreesWSR: -2.69 4.05 x 90MR: -2.00 3.00 x 95 20/40-2HOA: 0.46 µ @ 4.75mm pupilHumphrey Astig 4.12 D at 80 degreesD.R. Hardten, M.D.Irregular AstigmatismSN6AT5 at 150 degreesPentacam Astig 2.3 D at 54 degreesMR: -2.00 3.00 x 95 20/40-2WSR: -2.69 4.05 x 90Humphrey Astig 4.12 D at 80 degreesD.R. Hardten, M.D.Page 2
Options – Irregular AstigmatismToric after RK - - Options? Rotate Toric based on Refraction (to 115o 0.94 D x 115)www.astigmatismfix.comRotate Toric based on Wavescan(to 105o 1.45 D x 106)Easier to rotate based on change of positionChange from 150 to 115 is 35 degrees clockwisePerform totally based on intraoperative analysis for best accuracyRemove toric IOL? (baseline astig of eye likely 3.5 to 4 D)PRK? (only 4.75 mm capture) – Might be useful for irregular componentExchange IOL for higher powered toric?D.R. Hardten, M.D.Occasionally Confusion on Preop AxisD.R. Hardten, M.D.Management of Regular Astigmatism ExamplePreop Steep Axis OD K’s 101oPentacam 113oHumphrey Topography 101oIOL Calculator suggests100o based on K and topo113o based on PentacamPlaced at 108oPostop at 108oResidual refraction: -1.75 1.75 x 150Residual Wavescan: -1.64 1.75 x 133D.R. Hardten, M.D.Page 3
Options – Regular AstigmatismResidual Astigmatism after Toric - - Options? Rotate Toric based on Refractionwww.astigmatismfix.com(to 120o 0.4 D x 112) Rotate Toric based on Wavescan(to 115o 1.29 D x 116) Easier to rotate based on change of positionChange from 108 to 120 is 12 degrees counterclockwisePerform totally based on intraoperative analysis for bestaccuracy Remove toric IOL? (baseline astig of eye likely 4.5 to 5.4D) PRK? Refraction based results suggests rotation likely to beuseful. Exchange IOL for higher powered toric? – not available hereD.R. Hardten, M.D.Toric IOL Rotation ProcedureMoving from Axis 108o to 120o Rotate12o Counterclockwise168o ClockwiseUCVA 20/20-0.50 0.50 x 116D.R. Hardten, M.D.Illuminating Surgical KeratoscopeHelpful for axis identificationISKPatent PendingD.R. Hardten, M.D.Page 4
Residual Sphere and CylinderAfter Toric IOL PRK or LASIK Wavefront usuallypossibleD.R. Hardten, M.D.SummaryResidual Astigmatism after Toric IOL Decide whether astigmatism is mostly regular or significantlyirregular Spherical Error also? Calculate if enough correction by rotating IOLwww.astigmatismfix.com Consider IOL rotation or exchange for lower or higher powered IOL PRK or LASIK in some cases is best option High expectations of patients will require occasional enhancementsD.R. Hardten, M.D.Page 5
LASIK PRK Postoperative laser vision correction LASIK PRK D.R. Hardten, M.D. . IOL Calculator suggests 100o based on K and topo 113o based on Pentacam Placed at 108o . Mgmt of Residual Astigmatism-Toric-Hardt
