EP: Toric IOLs: Dos and Don’ts

Podcast author: Prof Gerd Auffarth & Prof Martin Dirisamer

Summary:

German professors Gerd Auffarth and Martin Dirisamer discuss the essential aspects of implanting Toric IOLs, condensing hours of discussion into one podcast episode. They cover crucial topics, including patient identification, accurate measurements, optimal incision placement, marking system selection, and effective IOL rotation management. Additionally, they explore toric IOL materials, designs, and discuss current market models.

Bios:

Prof Gerd Auffarth (host)
Professor Gerd Auffarth is one of the world’s leading intraocular lens experts. He is a Chairman of The Department of Ophthalmology, Ruprecht-Karls University of Heidelberg, and the Head of the David J. Apple Center for Vision Research. He also serves as the Director of the IVCRC. In 2018, Gerd ranked second in the The Ophthalmologist’s Powerlist of the World’s Top 100 most influential people in the world of ophthalmology.

Prof Martin Dirisamer (guest)
Professor Martin Dirisamer is a cataract surgery specialist at Dirisamer Luft Priglinger practice in Linz, Austria. He has achieved numerous awards for various lectures and posters, and was recognised as one of the 40 most influential ophthalmologists worldwide by The Ophthalmologist magazine.

Key Takeaways:

  • Dr Dirisamer advises that surgeons should keep in mind that approximately 30% of cataract patients have more than 1 dioptre of corneal astigmatism and are therefore suitable for a toric IOL – proper measurements are therefore essential.
  • Dr Dirisamer reveals that he doesn’t 100% trust his IOL Master or Pentacam, explaining the studies which support the diagnostic masters can be conflicting.

Summarising the Dos & Don’ts:

DOs:

  • Dr Dirisamer recommends to not rush the pre-operative assessment and repeat measurements for certainty. The accurate measurement of corneal astigmatism is essential for proper IOL selection and placement. Use high-quality diagnostic equipment to measure corneal astigmatism and determine the correct power and axis for the toric IOL.
  • To ensure accurate measurements, Dr Dirisamer advises patients to stop wearing contact lenses before the corneal astigmatism measurements are taken as contact lenses can temporarily alter the shape of the cornea, which can in turn affect the accuracy of measurements. Soft contact lenses should be discontinued for two weeks prior to biometric measurements, whereas rigid gas permeable / hard lenses should be discontinued for at least three weeks.
  • Dr Dirisamer selects toric IOLs for patients with at least 1 dioptre of astigmatism. He explains that manufacturers usually have a quarter of dioptre steps and provide training and education on how to properly manage them.
  • Accurately marking the cornea is essential for proper IOL alignment and Dr Dirisamer recommends having knowledge and experience with ink marking. Dr Dirisamer suggests using a marker designed specifically for marking the cornea and double-check the markings before proceeding with surgery.
  • Prof Auffarth believes that the success of toric lenses started with ink marking to guide the alignment of the toric IOL and explains that it is still a valuable tool in their successful implantation, particularly in cases where other technologies may not be available or appropriate.
  • The surgeons agree on the importance of following established surgical techniques and guidelines for IOL implantation to minimise the risk of complications such as infection or damage to surrounding tissues.
  • The RayOne Toric IOL has a closed C-loop haptic with a specific design that prevents it from rotation and also from shrinkage when you have a capsular contracture due to fibrosis.

DON’Ts:

  • Rush the pre-operative assessment: Take the time to accurately assess the patient’s corneal astigmatism and IOL needs. Rushing this process can result in improper IOL selection and placement, leading to poor visual outcomes.
  • Misalign the toric IOL: Proper alignment of the toric IOL is critical for optimal visual outcomes. Misalignment can lead to blurred or distorted vision.

Additional Resources:

See the full line up of Rayner Toric IOLs here:
https://rayner.com/en/iol/toric/

 

Connect with Prof Gerd Auffarth on LinkedIn:
https://www.linkedin.com/in/prof-dr-med-gerd-u-auffarth-febo-a935794/

Connect with Prof Dirisamer on LinkedIn and Instagram:
https://www.linkedin.com/in/prof-dr-martin-dirisamer-b2281667/
https://www.instagram.com/martindirisamer/