Wait for SN60T7 or SN6AT5 with LRI now to correct astigmatism and cataract

[uxuh]

My right eye has cataract and has astigmatism. I plugged in the IOL master measurement in the Acrysof Toric Calculator and it suggests using SN60T7 which is not currently approved in USA. Anybody know when will it available in USA? If I do not what to wait I can use SN6AT5 with LRI to achieve 20/20, but the result of LRI is less predictable per ophthalmologist. How much risk involved for LRI? SN6AT5 is a aspheric IOL, SN60T7 is not. Anyone know if Alcon is going to develop aspheric version of SN60T7?

[uxuh]

I talked to an ophthalmologist in town and he told me that he can combine LRI and T5 in one operation to target my right eye vision to 20/20 and residue astigmatism less than 0.5D. However, he said he only needs to do one LRI arc about 40 degrees to reach the goal. But, I watched you video in you tube and you always did a pair of symmetric LRI arc. This make me to ask you that have you done one LRI cut before and out come?.

[uxuh]

Wow! 98.5% successful rate. It is quite amazing. My confident level gets huge boost. The key point is to find a surgeon in San Jose California knows this technique very well. If you know someone here, please let me know.

Thank you very much Dr. Oyakawa. This means I do not have to wait for Toric T6 or T7 come out, Just combine LRI and Toric T5 IOL to reach the goal I want.

[Ray T Oyakawa, MD]

I presented a poster at ASCR this year with 98.5 success in approximately 70 consecutive cases with astigmatism up to 3.94 diopters (vector adjusted).

Dr. O.

[uxuh]

Better yet, if the angle of IOL incision changed from 180° to 225° as shown in the video you posted in u-tube. The LRI arc decreased to a pair of 35°. Look like it is the way to go, I am going to discuss with my surgeon.  Last question, all the calculation was based on the computer simulation. In the real world, based on your experience, what is the successful rate? How many percent of patients the residue astigmatism dropped bellow 0.5D after surgery?

[Ray T Oyakawa, MD]

For the first calculation you need to put in an SIA number about 0.5 with the corneal Ks.  For the second calculation  pick a K like 42.00 and add the residual astigmatism after the first calculation and the residual astigmatism  steep axis from the first calculation.  Also you need to pick a nomogram.  Use NAPA.

It seems you did it correctly.  A Pair 40 is very easy.

Dr. O.

[uxuh]

I took the residual astigmatism from toric calculator. Then use this number as a target preop astigmatism and use toric calculator again. Kept flat k a constant and varied steep k until new pre op corneal astigmatism matched target residual astigmatism. Correct me if I am wrong.
Then applied flat k and new steep k numbers in the AMO calculator again assuming SIA is zero and AMO calculator gave me a pair of 40 degree cut. Is it acceptable in real world?

[Ray T Oyakawa, MD]

Yes, a pair of 80 is too much.  Use the Alcon toric calculator and use the residual astigmatism after a T5 for your LRI calculation.

Dr. O.

[uxuh]

I went to AMO web site and followed your instruction and found out my right eye need a pair of 80 degree LRI If I chose Restore IOL. It seems to me a pair of 80 degree cut is awful big. If I want to implant with Toric SN6AT5 IOL and do the LRI at the same time, how to calculate the LRI arc? If it is not practical to do the Toric IOL implant and LRI at the same time, Does it mean I need LRI surgery one or two month after Toric IOL implant?

[Ray T Oyakawa, MD]

Google Oyakawa and youtube and you should find a video on Is an LRI needed?

This will explain vector adjustment.  Then the NAPA nomogram is used for the LRI on the vector adjusted Axis. NAPA  (Nichamin, Age Pachymeter, Adjusted).

Dr. O.

[uxuh]

Thank you for answering my question. Unfortunately, I do not understand what "Vector, depth and age adjusted LRI" means. Can you elaborate or recommend some reference for me to read? If this kind of LRI successful rate is very high. I feel I should not wait for the SN60T7 come out and get surgery done. But how to find a surgeon specialized in this kind of LRI is a big challenge for me. Is there any way to find out?

[Ray T Oyakawa, MD]

Vector, depth and age adjusted LRIs are very successful.  We have corrected close to 4.0 diopters with this technique.  Most ophthalmologist do not depth, age, and vector adjust for LRIs.

Approval depends on the FDA and is hard to guess when they will approve something.

Dr. O.