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Robert Montesmico - One of the best experts on this subject based on the ideXlab platform.
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visual and optical outcomes of a diffractive multifocal Toric Intraocular Lens
Journal of Cataract and Refractive Surgery, 2013Co-Authors: Tiago B Ferreira, Eduardo F Marques, Antonio Carlos Lottelli Rodrigues, Robert MontesmicoAbstract:Purpose To evaluate the visual and wavefront outcomes after cataract surgery with implantation of a diffractive multifocal Toric Intraocular Lens (IOL). Setting Two clinical centers, Lisbon, Portugal. Design Case series. Methods This study comprised patients with cataract and corneal astigmatism between 0.75 diopter (D) and 2.50 D who had phacoemulsification with implantation of an Acrysof IQ Restor Toric IOL. Over a 3-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 80 cm, uncorrected near visual acuity (UNVA) at 40 cm, spherical equivalent (SE) refraction, residual astigmatism, rotational stability of the IOL, higher-order aberrations, and the presence of dysphotopic phenomena. Results The study included 38 eyes (19 patients). The mean UDVA was 0.07 logMAR ± 0.10 (SD), the mean UIVA was 0.16 ± 0.10 logMAR, and the mean UNVA was 0.02 ± 0.09 logMAR. Predictability of refractive results was very good, with an SE refraction within ±0.50 D of the attempted spherical correction in 33 eyes (87%). The mean Toric IOL axis rotation was 2.97 ± 2.33 degrees. One eye required a second surgery to align the IOL axis. Ocular aberrometry and dysphotopic phenomena results were similar to those published for the nonToric version of the Toric IOL. Conclusion Implantation of the diffractive multifocal Toric IOL in patients with cataract and corneal astigmatism provided excellent distance, intermediate, and near visual outcomes; predictability of the refractive results; rotational stability; and good optical performance, allowing all patients to achieve complete spectacle independence. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
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cataract surgery with Toric Intraocular Lens implantation in patients with high corneal astigmatism
Journal of Cataract and Refractive Surgery, 2011Co-Authors: Nienke Visser, Noel J C Bauer, Rudy M M A Nuijts, Ramon Ruizmesa, Francisco Pastor, Robert MontesmicoAbstract:Purpose To evaluate the visual and refractive outcomes after Toric Intraocular Lens (IOL) implantation in patients with high amounts of corneal astigmatism. Setting University Eye Clinic, Maastricht, The Netherlands; Oftalvist Centro Integral Ocular and Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Design Cohort study. Methods This study comprised eyes with cataract and more than 2.25 diopters (D) of corneal astigmatism who had Toric Acrysof SN60T6, SN60T7, SN60T8, or SN60T9 IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, visual potential index (ratio of postoperative UDVA to postoperative CDVA), residual refractive cylinder, IOL misalignment, and surgically induced astigmatism (SIA) were evaluated. Results The mean follow-up in this study of 67 eyes (45 patients) was 6.3 months. Postoperatively, the mean UDVA was 0.61 ± 0.26 (SD) and the mean CDVA, 0.81 ± 0.21. The UDVA of 20/40 was better in 83% of eyes and 20/30 or better in 50% of eyes. The mean visual potential index was 0.78. The residual refractive cylinder was less than 0.75 D in 62% of eyes and less than 1.00 D in 81% of eyes. The mean IOL misalignment was 3.2 ± 2.8 degrees. The mean SIA was −0.40 ± 0.60 D with a superior incision and −0.19 ± 0.78 D with a temporal incision (P=.034). Conclusion Implantation of the Toric IOL during cataract surgery was effective and safe in correcting high amounts of corneal astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
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refractive Lens exchange with foldable Toric Intraocular Lens
American Journal of Ophthalmology, 2009Co-Authors: Ramon Ruizmesa, Daniel Carrascosanchez, Sara B Diazalvarez, Angeles M Ruizmateos, Teresa Ferrerblasco, Robert MontesmicoAbstract:Purpose To assess visual and refractive outcomes, and rotational stability after refractive Lens exchange (RLE) with Toric Intraocular Lens (IOL) implantation to correct ametropia and preexisting astigmatism. Design Prospective, nonrandomized, observational case series (self-controlled). Methods This prospective, nonrandomized, and self-controlled study included 32 eyes of 19 consecutive patients with more than 1.00 diopter (D) of preexisting corneal astigmatism having RLE with AcrySof Toric IOL implantation (Alcon Laboratories Inc, Fort Worth, Texas, USA). Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive sphere, and keratometric and refractive cylinder were recorded preoperatively and 6 months after surgery. Toric IOL axis shift was also measured. A patient satisfaction, visual phenomena, and spectacle dependency questionnaire was also carried out. Results At 6 months postoperatively, UCVA was 20/32 or better in 100% of the eyes, with 84.3% achieving 20/25 or better. One hundred percent of eyes achieved 20/25 or better BCVA. No eye lost ≥2 lines, 1 eye lost 1 line, 16 eyes did not change, 4 eyes gained 1 line, and 11 eyes gained ≥2 lines of BCVA after the surgery. Mean refractive cylinder was reduced significantly after surgery from −2.46 ± 0.99 D to −0.53 ± 0.30 D ( P 0 and J 45 ). Mean Toric IOL axis rotation was 0.90 ± 1.76 degrees, being ≤ 5 degrees in 96.8% of eyes evaluated. Patients were satisfied with their vision without reporting severe visual phenomena (from none to moderate). Conclusions RLE with Toric IOL implantation showed good visual and refractive outcomes for correcting spherical and cylindrical refractive errors.
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Toric Intraocular Lens versus opposite clear corneal incisions to correct astigmatism in eyes having cataract surgery
Journal of Cataract and Refractive Surgery, 2009Co-Authors: Javier Mendicute, Cristina Irigoyen, Teresa Ferrerblasco, Miguel Ruiz, Igor Illarramendi, Robert MontesmicoAbstract:Purpose To compare Toric Intraocular Lens (IOL) implantation with paired opposite clear corneal incisions (OCCIs) for astigmatism correction in patients having cataract surgery. Setting Ophthalmology Service, Donostia Hospital, San Sebastian, Spain. Methods This randomized prospective clinical study comprised eyes with more than 1.00 diopter (D) of preexisting corneal astigmatism. One group had AcrySof Toric IOL implantation and the other, paired 2.75 mm/3.20 mm OCCIs in the steep axis with spherical IOL implantation. Uncorrected (UCVA) and best corrected (BCVA) visual acuity, refraction, corneal and total higher-order aberrations (HOAs), photopic and mesopic contrast sensitivity, and Toric IOL axis were measured 3 months postoperatively. Results Forty eyes (40 patients) were evaluated. In the Toric group, 95% of eyes achieved 20/40 or better UCVA and 70%, 20/25 or better. In the OCCI group, 80% of eyes achieved 20/40 or better UCVA and 50%, 20/25 or better. All eyes achieved 20/25 or better BCVA. Mean refractive cylinder decreased significantly from preoperatively to postoperatively (−1.75 ± 0.71 to −0.62 ± 0.46 D, Toric group; −1.61 ± 0.67 to −0.97 ± 0.51 D, OCCI group) (P .1). Contrast sensitivity was similar except at the highest spatial frequency, being better in the Toric group (P Conclusion Toric IOL implantation achieved a slight enhanced effect over OCCIs in treating preexisting astigmatism.
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foldable Toric Intraocular Lens for astigmatism correction in cataract patients
Journal of Cataract and Refractive Surgery, 2008Co-Authors: Javier Mendicute, Cristina Irigoyen, Jaime Aramberri, Ana Ondarra, Robert MontesmicoAbstract:Purpose To evaluate the results of AcrySof Toric Intraocular Lens (IOL) (Alcon) implantation to correct preexisting astigmatism in patients having cataract surgery. Setting Ophthalmology Service, Donostia Hospital, San Sebastian, Spain. Methods This prospective observational study included 30 eyes of 15 consecutive patients with more than 1.00 diopter (D) of preexisting corneal astigmatism having cataract surgery. Bilateral implantation of the AcrySof Toric IOL was performed after phacoemulsification. The uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), residual refractive sphere, residual keratometric and refractive cylinders, and Toric IOL axis were measured. Results The UCVA was 20/40 or better in 93.3% of eyes and 20/25 or better in 66.6%. All eyes achieved 20/25 or better BCVA. The mean refractive cylinder decreased significantly after surgery from −2.34 D ± 1.28 (SD) to −0.72 ± 0.43 D (P Conclusions The results indicate that phacoemulsification and posterior chamber AcrySof Toric IOL implantation is an effective option to correct preexisting astigmatism in cataract surgery. The AcrySof Toric IOL showed good rotational stability.
Rudy M M A Nuijts - One of the best experts on this subject based on the ideXlab platform.
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image guided system versus manual marking for Toric Intraocular Lens alignment in cataract surgery
Journal of Cataract and Refractive Surgery, 2017Co-Authors: Valentijn S C Webers, Nienke Visser, Noel J C Bauer, Tos T J M Berendschot, Frank J H M Van Den Biggelaar, Rudy M M A NuijtsAbstract:Purpose To compare the accuracy of Toric Intraocular Lens (IOL) alignment using the Verion Image-Guided System versus a conventional manual ink-marking procedure. Setting University Eye Clinic Maastricht, Maastricht, the Netherlands. Design Prospective randomized clinical trial. Methods Eyes with regular corneal astigmatism of at least 1.25 diopters (D) that required cataract surgery and Toric IOL implantation (Acrysof SN6AT3-T9) were randomly assigned to the image-guided group or the manual-marking group. The primary outcome was the alignment of the Toric IOL based on preoperative images and images taken immediately after surgery. Secondary outcome measures were residual astigmatism, uncorrected distance visual acuity (UDVA), and complications. Results The study enrolled 36 eyes (24 patients). The mean Toric IOL misalignment was significantly less in the image-guided group than in the manual group 1 hour (1.3 degrees ± 1.6 [SD] versus 2.8 ± 1.8 degrees; P = .02) and 3 months (1.7 ± 1.5 degrees versus 3.1 ± 2.1 degrees; P .05). The mean UDVA was 0.03 ± 0.10 logarithm of minimum angle of resolution (logMAR) and 0.04 ± 0.09 logMAR, respectively (both P > .05). No intraoperative complications occurred during any surgery. Conclusion The IOL misalignment was significantly less with digital marking than with manual marking; this did not result in a better UDVA or lower residual refractive astigmatism.
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visual acuity and refraction with a diffractive multifocal Toric Intraocular Lens
Journal of Cataract and Refractive Surgery, 2013Co-Authors: Roberto Bellucci, Sheraz M Daya, Nienke Visser, Noel J C Bauer, Giorgio Santin, Miriam Cargnoni, Rudy M M A NuijtsAbstract:Purpose To evaluate clinical outcomes and optical performance of the AT Lisa 909M diffractive multifocal Toric Intraocular Lens (IOL). Setting Multicenter study. Design Cohort study. Methods The measured outcomes included refractive error; distance, near (40 cm), and intermediate (60 cm and 80 cm) visual acuities; defocus curve; rotational stability; and monocular and binocular photopic and mesopic contrast sensitivity. Astigmatism was evaluated by Alpins vector analysis. Results The multifocal Toric IOL was implanted in 284 eyes of 142 patients. At 6 months, 89.4% of eyes were within ±1.00 diopter (D) of emmetropia. The mean refractive cylinder decreased from −2.39 D ± 1.48 (SD) to −0.49 ± 0.53 D; it was lower than 1.00 D in 80.9% of eyes. The mean visual acuities (logMAR) were monocular uncorrected distance 0.16 ± 0.22, monocular corrected distance 0.04 ± 0.15, binocular corrected distance −0.00 ± 0.09; monocular uncorrected near 0.21 ± 0.22, monocular corrected near 0.08 ± 0.16, binocular distance-corrected near 0.07 ± 0.14; intermediate at 60 cm (80 cm): monocular uncorrected 0.16 ± 0.21 (0.09 ± 0.21), monocular distance corrected 0.13 ± 0.19 (0.07 ± 0.20), and binocular distance corrected 0.07 ± 0.17 (0.00 ± 0.18). At 3 months and 6 months, 95.8% of IOLs showed no rotation over 5 degrees. Conclusions This is the largest study yet on the first commercially available diffractive multifocal Toric IOL. Results confirm its efficacy, predictability, and safety in restoring distance, near, and intermediate vision and allowing patients with significant levels of corneal astigmatism to achieve spectacle independence. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
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residual astigmatism following Toric Intraocular Lens implantation related to pupil size
Journal of Refractive Surgery, 2012Co-Authors: Nienke Visser, Noel J C Bauer, Rudy M M A NuijtsAbstract:PURPOSE To present two patients with residual astigmatism following Toric Intraocular Lens (IOL) implantation. METHODS Case reports. RESULTS A 58-year-old woman underwent Toric IOL implantation (spherical power 29.50 diopters [D], cylinder power 3.00 D; SN60T5, Alcon Laboratories Inc) to correct 2.33 D @ 80° of corneal astigmatism. Postoperatively, uncorrected distance visual acuity (UDVA) was 20/30 and corrected distance visual acuity (CDVA) was 20/22 (0 -1.75 × 95), indicating an overcorrection of astigmatism. Slit-lamp examination demonstrated no IOL misalignment. Wavefront aberrometry showed a large pupil diameter (>6 mm) and a lower corneal astigmatism in a 6-mm zone (-1.40 D @ 174°) compared to a 4-mm zone (-2.21 D @ 171°). The second patient, a 60-year-old man, underwent multifocal Toric IOL implantation (spherical power 22.50 D, cylinder power 2.25 D; SND1T4, Alcon Laboratories Inc) to correct 1.51 D @ 173° of corneal astigmatism. Postoperatively, UDVA was 20/50 and CDVA was 20/20 (+0.25 -1.00 × 102), indicating an undercorrection of astigmatism. Slit-lamp examination showed no misalignment. CONCLUSIONS Both cases indicate that unexplained residual astigmatism following Toric IOL implantation may be the result of multiple factors: the effect of the spherical power and anterior chamber depth on Toric IOL calculations, the effect of posterior corneal astigmatism, and the effect of a large pupil size. The first two issues may be compensated for by improving Toric IOL calculations. The latter indicates that pupillometry is indicated in relatively young patients who undergo Toric IOL implantation.
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cataract surgery with Toric Intraocular Lens implantation in patients with high corneal astigmatism
Journal of Cataract and Refractive Surgery, 2011Co-Authors: Nienke Visser, Noel J C Bauer, Rudy M M A Nuijts, Ramon Ruizmesa, Francisco Pastor, Robert MontesmicoAbstract:Purpose To evaluate the visual and refractive outcomes after Toric Intraocular Lens (IOL) implantation in patients with high amounts of corneal astigmatism. Setting University Eye Clinic, Maastricht, The Netherlands; Oftalvist Centro Integral Ocular and Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Design Cohort study. Methods This study comprised eyes with cataract and more than 2.25 diopters (D) of corneal astigmatism who had Toric Acrysof SN60T6, SN60T7, SN60T8, or SN60T9 IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, visual potential index (ratio of postoperative UDVA to postoperative CDVA), residual refractive cylinder, IOL misalignment, and surgically induced astigmatism (SIA) were evaluated. Results The mean follow-up in this study of 67 eyes (45 patients) was 6.3 months. Postoperatively, the mean UDVA was 0.61 ± 0.26 (SD) and the mean CDVA, 0.81 ± 0.21. The UDVA of 20/40 was better in 83% of eyes and 20/30 or better in 50% of eyes. The mean visual potential index was 0.78. The residual refractive cylinder was less than 0.75 D in 62% of eyes and less than 1.00 D in 81% of eyes. The mean IOL misalignment was 3.2 ± 2.8 degrees. The mean SIA was −0.40 ± 0.60 D with a superior incision and −0.19 ± 0.78 D with a temporal incision (P=.034). Conclusion Implantation of the Toric IOL during cataract surgery was effective and safe in correcting high amounts of corneal astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
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cataract surgery with Toric Intraocular Lens implantation in keratoconus a case report
Cornea, 2011Co-Authors: Nienke Visser, Sacha T J M Gast, Noel J C Bauer, Rudy M M A NuijtsAbstract:Purpose:We report 2 cases in which cataract extraction with a foldable acrylic Toric Intraocular Lens (IOL) implantation was used to correct (irregular) corneal astigmatism in patients with keratoconus and cataract.Methods:Case 1 was a 78-year-old man with cataract and keratoconus in the left eye. H
Oliver Findl - One of the best experts on this subject based on the ideXlab platform.
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rotational performance and corneal astigmatism correction during cataract surgery aspheric Toric Intraocular Lens versus aspheric nonToric Intraocular Lens with opposite clear corneal incision
Journal of Cataract and Refractive Surgery, 2014Co-Authors: Sophie Maedel, Nino Hirnschall, Yenan Chen, Oliver FindlAbstract:Purpose To compare the astigmatism-reducing effect of an aspheric Toric Intraocular Lens (IOL) and an aspheric nonToric IOL with an opposite clear corneal incision (OCCI) in cataract surgery. Setting Vienna Institute for Research in Ocular Surgery, Hanusch Hospital, Vienna, Austria. Design Prospective randomized clinical study. Methods Patients with low to moderate corneal astigmatism scheduled for cataract surgery received an aspheric Toric IOL (Lentis L-312T) or an aspheric nonToric IOL (Lentis L-312) combined with an OCCI. Keratometry and corneal tomography were performed 1 hour, 1 week, 3 months and 9 months postoperatively. Postoperative residual astigmatism was measured using an autorefractor. Rotational Toric IOL stability was analyzed using retroillumination photography. Results Fifty-five patients were included. Three months postoperatively, the mean reduction in corneal astigmatism was 0.67 diopter (D) ± 0.58 (SD) in the Toric group and 0.18 ± 0.52 D in the nonToric–OCCI group. The mean uncorrected distance visual acuity was 0.29 ± 0.30 logMAR and 0.09 ± 0.18 logMAR, respectively ( P =.02). The mean refractive astigmatism was 1.02 ± 0.54 D and 0.68 ± 0.52 D, respectively ( P =.05). One hour, 3 months, and 9 months postoperatively, the mean absolute IOL misalignment of Toric IOLs was 4.99 ± 4.66 degrees, 13.59 ± 11.29 degrees, and 19.90 ± 14.48 degrees, respectively. Conclusions The Toric IOL tended to rotate significantly postoperatively. Visual acuity was good in both groups. Residual refractive cylinder was significantly lower in the Toric IOL group. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
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evaluation of factors influencing the remaining astigmatism after Toric Intraocular Lens implantation
Journal of Refractive Surgery, 2014Co-Authors: Nino Hirnschall, Peter Hoffmann, Petra Draschl, Sophie Maedel, Oliver FindlAbstract:PURPOSE: To evaluate the influencing factors on remaining astigmatism after implanting a Toric Intraocular Lens during cataract surgery. METHODS: In this observational study, consecutive patients with cataract from three different centers who received Toric Intraocular Lenses were included. Keratometry was performed with an optical biometry device preoperatively. The IOLMaster 500 (Carl Zeiss Meditec AG, Jena, Germany) was used in Vienna, Lenstar (Haag-Streit, Koniz, Switzerland) in Castrop-Rauxel, and IOLMaster (Carl Zeiss Meditec AG) in London. Partial least squares regression was used to detect the influence of different parameters on remaining astigmatism. RESULTS: In total, 235 eyes of 200 patients were included. Mean corneal astigmatism measured preoperatively with the optical biometry device was -2.24 ± 0.87 diopters (D) (range: -5.75 to -1.00 D). Mean absolute and vector difference between the aimed for and the postoperatively measured astigmatism were 0.48 ± 0.37 D (range: 0.00 to 2.05 D) and 0.73 ± 0.46 D (range: 0.031 to -2.20 D), respectively (P = .576). Partial least squares regression showed a significant effect of preoperatively measured corneal astigmatism and deviation between preoperative measurements of the cornea on the postoperative (unintended) remaining astigmatism. CONCLUSIONS: The main source of error when using Toric Intraocular Lenses is the preoperative measurement of corneal astigmatism, especially in eyes with low astigmatism. The influence of the postoperative anterior chamber depth on the cylindrical power of Toric Intraocular Lenses and the effect of misalignment on the reduction of the astigmatism-reducing effect can be easily calculated.
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correction of moderate corneal astigmatism during cataract surgery Toric Intraocular Lens versus peripheral corneal relaxing incisions
Journal of Cataract and Refractive Surgery, 2014Co-Authors: Nino Hirnschall, Vinod Gangwani, Alja Crnej, John Koshy, Vincenzo Maurino, Oliver FindlAbstract:Purpose To compare the astigmatism-reducing effect of a Toric Intraocular Lens (IOL) and peripheral corneal relaxing incisions (PCRIs). Setting Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom. Design Prospective masked bilateral randomized study. Methods Cataract patients with a preoperative corneal astigmatism of 1.0 to 2.5 diopters (D) were included. All patients received a Toric IOL in 1 eye and a nonToric IOL plus a PCRI in the other eye. Postoperative follow-up was at 1 hour, 1 month, and 6 months. The uncorrected distance visual acuity, corrected distance visual acuity, autorefraction (Topcon RM-8800), and subjective refraction were recorded. The IOL axis was assessed using retroillumination photographs. Results The study enrolled 60 eyes of 30 patients. The mean astigmatism vector reduction was 1.74 D ± 0.64 (SD) in the Toric IOL group and 1.27 ± 0.76 D in the PCRI group; the difference was statistically significant (P=.042). The mean absolute rotation of the Toric IOL was 2.5 ± 1.8 degrees (maximum 6.3 degrees) in the first 6 postoperative months. Astigmatism increased in the PCRI group between the 1-month and 6-month follow-up (mean 0.38 ± 0.27 D; maximum 1.00 D) (P Conclusion Toric IOLs and PCRIs both reduced astigmatism; however, Toric IOLs reduced astigmatism to a higher extent and they were more predictable. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
Douglas D Koch - One of the best experts on this subject based on the ideXlab platform.
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new algorithm for Toric Intraocular Lens power calculation considering the posterior corneal astigmatism
Journal of Cataract and Refractive Surgery, 2018Co-Authors: Carmen Canovas, Douglas D Koch, Aixa Alarcon, Robert Rosen, Sanjeev Kasthurirangan, Joseph J K, Patricia Ann PiersAbstract:Purpose To assess the accuracy of Toric Intraocular Lens (IOL) power calculations of a new algorithm that incorporates the effect of posterior corneal astigmatism (PCA). Setting Abbott Medical Optics, Inc., Groningen, the Netherlands. Design Retrospective case report. Methods In eyes implanted with Toric IOLs, the exact vergence formula of the Tecnis Toric calculator was used to predict refractive astigmatism from preoperative biometry, surgeon-estimated surgically induced astigmatism (SIA), and implanted IOL power, with and without including the new PCA algorithm. For each calculation method, the error in predicted refractive astigmatism was calculated as the vector difference between the prediction and the actual refraction. Calculations were also made using postoperative keratometry (K) values to eliminate the potential effect of incorrect SIA estimates. Results The study comprised 274 eyes. The PCA algorithm significantly reduced the centroid error in predicted refractive astigmatism (P Conclusions The use of the new PCA algorithm decreased the error in the prediction of residual refractive astigmatism in eyes implanted with Toric IOLs. Therefore, the new PCA algorithm, in combination with an exact vergence IOL power calculation formula, led to an increased predictability of Toric IOL power.
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new regression formula for Toric Intraocular Lens calculations
Journal of Cataract and Refractive Surgery, 2016Co-Authors: Adi Abulafia, Douglas D Koch, Li Wang, Ehud I Assia, Warren Hill, Maria Franchina, Graham D BarrettAbstract:Purpose To evaluate and compare the accuracy of 2 Toric Intraocular Lens (IOL) calculators with or without a new regression formula. Setting Ein-Tal Eye Center, Tel-Aviv, Israel, and the Lions Eye Institute, Nedlands, Western Australia, Australia. Design Retrospective case series. Methods A new regression formula (Abulafia-Koch) was developed to calculate the estimated total corneal astigmatism based on standard keratometry measurements. The error in the predicted residual astigmatism was calculated by the Alcon and Holladay Toric IOL calculators with and without adjustments by the Abulafia-Koch formula. These results were compared with those of the Barrett Toric calculator. Results Data from 78 eyes were evaluated to validate the Abulafia-Koch formula. The centroid errors in predicted residual astigmatism were against-the-rule with the Alcon (0.55 diopter [D]) and Holladay (0.54 D) Toric calculators and decreased to 0.05 D ( P x -axis], P = .776 [ y -axis]) and 0.04 D ( P x -axis], P = .726 [ y -axis]) with adjustments by the Abulafia-Koch formula. The Alcon and the Holladay Toric calculators had a higher proportion of eyes within ±0.50 D of the predicted residual astigmatism with the Abulafia-Koch formula (76.9% and 78.2%, respectively) than without it (both 30.8%). There were no significant differences between the results of the Abulafia-Koch-modified Alcon and the Holladay Toric calculators and those of the Barrett Toric calculator. Conclusion Adjustment of commercial Toric IOL calculators by the Abulafia-Koch formula significantly improved the prediction of postoperative astigmatic outcome. Financial Disclosure Dr. Abulafia received a speaker's fee from Haag-Streit AG. Dr. Barrett has licensed the Barrett Toric Calculator to Haag-Streit AG. Dr. Koch is a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., and Revision Optics, Inc. Dr. Hill is a paid consultant to Haag-Streit AG and Alcon Laboratories, Inc. None of the other authors has a financial or proprietary interest in any material or method mentioned.
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accuracy of Toric Intraocular Lens axis alignment using a 3 dimensional computer guided visualization system
Journal of Cataract and Refractive Surgery, 2016Co-Authors: Li Wang, Mitchell P Weikert, Sumitra S Khandelwal, Zaina Almohtaseb, Douglas D KochAbstract:Purpose To evaluate the accuracy of Toric Intraocular Lens (IOL) alignment in femtosecond laser–assisted cataract surgery using the Truevision 3-dimensional (3-D) computer-guided visualization system compared with a manual marking method. Setting Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. Design Retrospective comparative case series. Methods Preoperatively, all patients had corneal topography measurements with a color light-emitting diode topographer. The 3-D system used the anterior keratometry values to create an optimized plan for the Toric IOL alignment. Intrastromal marks were created by the femtosecond laser at the intended Toric meridian, guided by manual ink marks placed at the 3 o'clock and 9 o'clock limbus with the patient sitting upright. Intraoperatively, the 3-D system was used to align the IOL and measure the angular position of the femtosecond marks relative to the IOL meridian. Three weeks postoperatively, the manifest refraction, corrected distance visual acuity, and Toric IOL alignment were recorded. Results The mean 3-D imaging error was −0.58 degrees ± 3.90 (SD) (range −9 to 5 degrees), and the mean manual ink error was −0.27 ± 3.65 degrees (range −8 to 5 degrees); neither was statistically significantly different from zero (P = .28 and P = .76, respectively). The mean absolute errors were 2.96 ± 2.54 degrees and 2.88 ± 2.18 degrees, respectively. Conclusion The 3-D computer-guided system and manual marking combined with femtosecond laser marks were similar in accuracy for Toric alignment. Financial Disclosures Dr. Wang received research support from Ziemer USA, Inc. Dr. Weikert is a consultant to Ziemer USA, Inc. Dr. Koch is a consultant to Alcon Laboratories, Inc., and Abbott Medical Optics, Inc., and received research support from Ziemer USA, Inc., i-Optics Corp, and Truevision Systems. None of the other authors has a financial or proprietary interest in any material or method mentioned.
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prediction of refractive outcomes with Toric Intraocular Lens implantation
Journal of Cataract and Refractive Surgery, 2015Co-Authors: Adi Abulafia, Douglas D Koch, Li Wang, Graham D Barrett, Guy Kleinmann, Shay Ofir, Adi Levy, Arie L Marcovich, Adi Michaeli, Ehud I AssiaAbstract:Purpose To evaluate and compare the accuracy of different methods to measure and predict postoperative astigmatism with Toric Intraocular Lens (IOL) implantation. Setting Ein-Tal Ophthalmology Center, Tel-Aviv, Israel. Design Retrospective case series. Methods Postoperative corneal astigmatism was measured with 3 devices (IOLMaster 500; optical low-coherence reflectometry [OLCR]–based Lenstar LS 900; Atlas topographer) and compared with the manifest astigmatic refractive outcome in patients with Toric IOLs. The error in the predicted residual astigmatism was calculated by vector analysis according to the measurement and calculation method used to predict the required Toric IOL cylinder power. Results The centroid errors in predicted residual astigmatism were against the rule with the Alcon and Holladay Toric calculators (0.53 to 0.56 diopter [D]), were lower with the Baylor nomogram (0.21 to 0.26 D), and were lowest for the Barrett Toric calculator (0.01 to 0.16 D) (P Conclusion Prediction of astigmatic outcomes with Toric IOLs can be improved with appropriate measuring devices and methods to establish the required Toric IOL power. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
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correction of astigmatism during cataract surgery Toric Intraocular Lens compared to peripheral corneal relaxing incisions
Journal of Refractive Surgery, 2010Co-Authors: Jed T Poll, Douglas D Koch, Li Wang, Mitchell P WeikertAbstract:PURPOSE: To compare the efficacy of astigmatic correction achieved at the time of cataract surgery using Toric Intraocular Lens (IOL) implantation versus peripheral corneal relaxing incisions. METHODS: A retrospective review assessed the outcomes of phacoemulsification cataract surgery performed between January 2006 and January 2008 by a single surgeon. Patients receiving a Toric IOL (Toric IOL group) or peripheral corneal relaxing incisions (relaxing incisions group) were included in the study. Main outcome variables included postoperative uncorrected distance visual acuity (UDVA) and manifest refractive cylinder. Each treatment modality was stratified by amount of preoperative keratometric astigmatism into three groups (low, moderate, and high astigmatism) for comparative analysis. RESULTS: A total of 192 eyes were included in the study; 77 received a Toric IOL and 115 received peripheral corneal relaxing incisions. Preoperative data were not significantly different between the two groups except regarding keratometric astigmatism, which was higher in the Toric IOL group (P<.05). Average postoperative astigmatism was 0.42 diopters (D) and 0.46 D in the Toric and relaxing incisions groups, respectively. In subgroup analysis, no statistical significance separated the two treatment options in terms of amount of surgically induced astigmatism or residual astigmatism. Eyes with astigmatism ≥2.26 D were more likely to achieve 20/40 UDVA from a Toric IOL. CONCLUSIONS: Toric IOL implantation and peripheral corneal relaxing incisions yielded similar results regarding surgical correction of astigmatism at the time of phacoemulsification cataract surgery. Both treatment modalities achieved comparable results with mild-to-moderate astigmatism. Higher degrees of astigmatism favor use of a Toric IOL.
Noel J C Bauer - One of the best experts on this subject based on the ideXlab platform.
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image guided system versus manual marking for Toric Intraocular Lens alignment in cataract surgery
Journal of Cataract and Refractive Surgery, 2017Co-Authors: Valentijn S C Webers, Nienke Visser, Noel J C Bauer, Tos T J M Berendschot, Frank J H M Van Den Biggelaar, Rudy M M A NuijtsAbstract:Purpose To compare the accuracy of Toric Intraocular Lens (IOL) alignment using the Verion Image-Guided System versus a conventional manual ink-marking procedure. Setting University Eye Clinic Maastricht, Maastricht, the Netherlands. Design Prospective randomized clinical trial. Methods Eyes with regular corneal astigmatism of at least 1.25 diopters (D) that required cataract surgery and Toric IOL implantation (Acrysof SN6AT3-T9) were randomly assigned to the image-guided group or the manual-marking group. The primary outcome was the alignment of the Toric IOL based on preoperative images and images taken immediately after surgery. Secondary outcome measures were residual astigmatism, uncorrected distance visual acuity (UDVA), and complications. Results The study enrolled 36 eyes (24 patients). The mean Toric IOL misalignment was significantly less in the image-guided group than in the manual group 1 hour (1.3 degrees ± 1.6 [SD] versus 2.8 ± 1.8 degrees; P = .02) and 3 months (1.7 ± 1.5 degrees versus 3.1 ± 2.1 degrees; P .05). The mean UDVA was 0.03 ± 0.10 logarithm of minimum angle of resolution (logMAR) and 0.04 ± 0.09 logMAR, respectively (both P > .05). No intraoperative complications occurred during any surgery. Conclusion The IOL misalignment was significantly less with digital marking than with manual marking; this did not result in a better UDVA or lower residual refractive astigmatism.
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Image-guided system versus manual marking for Toric Intraocular Lens alignment in cataract surgery
'Elsevier BV', 2017Co-Authors: Webers V S C, Noel J C Bauer, Visser Nienke, Berendschot, Ttjm Tos, Biggelaar, Frank J H M Van Den, Nuijts, Rudy M M AAbstract:\u3cp\u3ePurpose To compare the accuracy of Toric Intraocular Lens (IOL) alignment using the Verion Image-Guided System versus a conventional manual ink-marking procedure. Setting University Eye Clinic Maastricht, Maastricht, the Netherlands. Design Prospective randomized clinical trial. Methods Eyes with regular corneal astigmatism of at least 1.25 diopters (D) that required cataract surgery and Toric IOL implantation (Acrysof SN6AT3-T9) were randomly assigned to the image-guided group or the manual-marking group. The primary outcome was the alignment of the Toric IOL based on preoperative images and images taken immediately after surgery. Secondary outcome measures were residual astigmatism, uncorrected distance visual acuity (UDVA), and complications. Results The study enrolled 36 eyes (24 patients). The mean Toric IOL misalignment was significantly less in the image-guided group than in the manual group 1 hour (1.3 degrees ± 1.6 [SD] versus 2.8 ± 1.8 degrees; P =.02) and 3 months (1.7 ± 1.5 degrees versus 3.1 ± 2.1 degrees; P <.05) postoperatively. The mean residual refractive cylinder was −0.36 ± 0.32 D and −0.47 ± 0.28 D in the image-guided group and manual group, respectively (P >.05). The mean UDVA was 0.03 ± 0.10 logarithm of minimum angle of resolution (logMAR) and 0.04 ± 0.09 logMAR, respectively (both P >.05). No intraoperative complications occurred during any surgery. Conclusion The IOL misalignment was significantly less with digital marking than with manual marking; this did not result in a better UDVA or lower residual refractive astigmatism.\u3c/p\u3
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visual acuity and refraction with a diffractive multifocal Toric Intraocular Lens
Journal of Cataract and Refractive Surgery, 2013Co-Authors: Roberto Bellucci, Sheraz M Daya, Nienke Visser, Noel J C Bauer, Giorgio Santin, Miriam Cargnoni, Rudy M M A NuijtsAbstract:Purpose To evaluate clinical outcomes and optical performance of the AT Lisa 909M diffractive multifocal Toric Intraocular Lens (IOL). Setting Multicenter study. Design Cohort study. Methods The measured outcomes included refractive error; distance, near (40 cm), and intermediate (60 cm and 80 cm) visual acuities; defocus curve; rotational stability; and monocular and binocular photopic and mesopic contrast sensitivity. Astigmatism was evaluated by Alpins vector analysis. Results The multifocal Toric IOL was implanted in 284 eyes of 142 patients. At 6 months, 89.4% of eyes were within ±1.00 diopter (D) of emmetropia. The mean refractive cylinder decreased from −2.39 D ± 1.48 (SD) to −0.49 ± 0.53 D; it was lower than 1.00 D in 80.9% of eyes. The mean visual acuities (logMAR) were monocular uncorrected distance 0.16 ± 0.22, monocular corrected distance 0.04 ± 0.15, binocular corrected distance −0.00 ± 0.09; monocular uncorrected near 0.21 ± 0.22, monocular corrected near 0.08 ± 0.16, binocular distance-corrected near 0.07 ± 0.14; intermediate at 60 cm (80 cm): monocular uncorrected 0.16 ± 0.21 (0.09 ± 0.21), monocular distance corrected 0.13 ± 0.19 (0.07 ± 0.20), and binocular distance corrected 0.07 ± 0.17 (0.00 ± 0.18). At 3 months and 6 months, 95.8% of IOLs showed no rotation over 5 degrees. Conclusions This is the largest study yet on the first commercially available diffractive multifocal Toric IOL. Results confirm its efficacy, predictability, and safety in restoring distance, near, and intermediate vision and allowing patients with significant levels of corneal astigmatism to achieve spectacle independence. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.
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residual astigmatism following Toric Intraocular Lens implantation related to pupil size
Journal of Refractive Surgery, 2012Co-Authors: Nienke Visser, Noel J C Bauer, Rudy M M A NuijtsAbstract:PURPOSE To present two patients with residual astigmatism following Toric Intraocular Lens (IOL) implantation. METHODS Case reports. RESULTS A 58-year-old woman underwent Toric IOL implantation (spherical power 29.50 diopters [D], cylinder power 3.00 D; SN60T5, Alcon Laboratories Inc) to correct 2.33 D @ 80° of corneal astigmatism. Postoperatively, uncorrected distance visual acuity (UDVA) was 20/30 and corrected distance visual acuity (CDVA) was 20/22 (0 -1.75 × 95), indicating an overcorrection of astigmatism. Slit-lamp examination demonstrated no IOL misalignment. Wavefront aberrometry showed a large pupil diameter (>6 mm) and a lower corneal astigmatism in a 6-mm zone (-1.40 D @ 174°) compared to a 4-mm zone (-2.21 D @ 171°). The second patient, a 60-year-old man, underwent multifocal Toric IOL implantation (spherical power 22.50 D, cylinder power 2.25 D; SND1T4, Alcon Laboratories Inc) to correct 1.51 D @ 173° of corneal astigmatism. Postoperatively, UDVA was 20/50 and CDVA was 20/20 (+0.25 -1.00 × 102), indicating an undercorrection of astigmatism. Slit-lamp examination showed no misalignment. CONCLUSIONS Both cases indicate that unexplained residual astigmatism following Toric IOL implantation may be the result of multiple factors: the effect of the spherical power and anterior chamber depth on Toric IOL calculations, the effect of posterior corneal astigmatism, and the effect of a large pupil size. The first two issues may be compensated for by improving Toric IOL calculations. The latter indicates that pupillometry is indicated in relatively young patients who undergo Toric IOL implantation.
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cataract surgery with Toric Intraocular Lens implantation in patients with high corneal astigmatism
Journal of Cataract and Refractive Surgery, 2011Co-Authors: Nienke Visser, Noel J C Bauer, Rudy M M A Nuijts, Ramon Ruizmesa, Francisco Pastor, Robert MontesmicoAbstract:Purpose To evaluate the visual and refractive outcomes after Toric Intraocular Lens (IOL) implantation in patients with high amounts of corneal astigmatism. Setting University Eye Clinic, Maastricht, The Netherlands; Oftalvist Centro Integral Ocular and Fundacion Oftalmologica del Mediterraneo, Valencia, Spain. Design Cohort study. Methods This study comprised eyes with cataract and more than 2.25 diopters (D) of corneal astigmatism who had Toric Acrysof SN60T6, SN60T7, SN60T8, or SN60T9 IOL implantation. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, visual potential index (ratio of postoperative UDVA to postoperative CDVA), residual refractive cylinder, IOL misalignment, and surgically induced astigmatism (SIA) were evaluated. Results The mean follow-up in this study of 67 eyes (45 patients) was 6.3 months. Postoperatively, the mean UDVA was 0.61 ± 0.26 (SD) and the mean CDVA, 0.81 ± 0.21. The UDVA of 20/40 was better in 83% of eyes and 20/30 or better in 50% of eyes. The mean visual potential index was 0.78. The residual refractive cylinder was less than 0.75 D in 62% of eyes and less than 1.00 D in 81% of eyes. The mean IOL misalignment was 3.2 ± 2.8 degrees. The mean SIA was −0.40 ± 0.60 D with a superior incision and −0.19 ± 0.78 D with a temporal incision (P=.034). Conclusion Implantation of the Toric IOL during cataract surgery was effective and safe in correcting high amounts of corneal astigmatism. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.