Jan 28, 2011
Of all the new "Premium IOLs" for cataract surgery it has been the Acrysoft Toric IOL that has been the most widely accepted and praised by cataract surgeons like myself. I personally have been very pleased with this IOL, because it delivers better results for patients with significant levels of astigmatism and with very little downside. Also, the cost for the patient is less that half of the cost for a multifocal IOL.
Patients who are good candidates are those with:
1. Amounts of astigmatism in the 1.50 to 4.00 diopter range.
2. Regular astigmatism that measures the same on a consistant basis.
3. Patients with minimal other eye problems such as macular degeneration, retinal disease, or corneal diseases.
4. Patients with an understanding that glasses may still be needed for the very best possible vision
Going forward, it is very important to talk about the patients that are not good toric IOL candidates. These include:
1. Keratoconus patients, since their astigmatism is usually quite irregular. Results are generally disappointing.
2. Patients with signifincant map dot fingerprint dystrophy - again they often have irregular astigmatism.
3. Previous radial keratotomy patients.
4. Some patients with previous lasik - these cases can go either way but they are not optimum cases in general.
Finally, regarding toric IOLs, there is an expectation from patients that they will see fairly well without glasses, so it is of the utmost importance for the surgeon to get excellent measurments of the eye before surgery. This means using an IOL Master or Lenstar unit, and multiple manual and automated readings of the corneal astigmatism making sure that the reading are clear and consistant. A corneal topography reading is also needed. Using Holladay IOL Consultant software and personally adjusted A-constants are very helpful as well.
If you have any specific questions about toric IOL's, don't hesitate to ask. A very common question is when are limbal relaxing incisions (LRI's) a better choice? We can get into that next time, but in general, LRI's may be better for lesser levels of astigmatism in the 1.00 to 1.50 diopter range as long as the patients don't have corneal surface problems like bad dry eyes.