2021 ASCRS Annual Meeting

Authors

Presenting Author
Grzegorz Labuz, PhD    Email the author
Authors
Dorottya Varadi, MD, Ramin Khoramnia, MD, Gerd U. Auffarth, MD, PhD

Paper Abstract

Purpose
Corneal astigmatism can be successfully corrected with implantation of a toric intraocular lens (IOL). The selection of lens power is based on astigmatism measurements taken in the central (about 3 mm) cornea. In this study, we aimed to evaluate how astigmatism in an elderly population changes from the center to the corneal periphery.

Methods
We retrospectively analyzed Pentacam Scheimpflug corneal topography data obtained between October 2004 and June 2019 during routine patient examinations at the Heidelberg University Eye Clinic. The total corneal astigmatism (i.e., from the anterior and posterior surface) was obtained and compared for 3- and 6-mm concentric areas. We included only patients who were 60 years of age or older at the time of examination who had at least 1D of astigmatism. We randomly chose one eye per subject in a total selection of 717 eyes used for statistical analysis.

Results
The mean corneal astigmatism in the center was 1.82 ±0.88D, and at the periphery, it was 1.64 ±0.98D, which was statistically significant (paired t-test, P < .001). However, this difference increased with the cylinder power, as for cases with low astigmatism (<2.0D) it was 0.13 ±0.37D, 0.27 ±0.57D in the range 2.0 to 3.0D, 0.34 ±0.57D in the range 3.0 to 4.0D, and 0.59 ±0.70D for astigmatism greater than 4.0D. The mean difference in the axis of astigmatism between the 3- and 6-mm zone was 0.1º ± 29.1º (paired t-test, P = .90).

Conclusion
We demonstrated that central corneal astigmatism differs from that measured at the periphery and that a larger difference was found in patients with higher astigmatism. Our findings suggest that toric IOLs can be improved by decreasing the cylinder power at the lens’ periphery to more accurately correct corneal astigmatism.

Authors

Presenting Author
Paige M. Noble    Email the author
Authors
Abdelhalim Awidi, MD, Yassine Daoud, MD, FACS

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Paper Abstract

Purpose
To evaluate real life outcomes following cataract surgery with toric intraocular lens implant.

Methods
A non-randomized retrospective chart review of 337 eyes of 253 patients. Patients undergoing cataract surgery with a toric lens implant, by the same surgeon, were included. Pre-operative assessments of intraocular lens measurements, and target refraction was done. Outcomes studied were: gender, age, medical and surgical history, refractive aim, predictive refractive error, and time of surgery. Patients mean UCDVA and BCDVA were evaluated, using different post-operative follow-up dates, at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months. Mean predictive refractive error, and residual astigmatism, were calculated, on follow-up months 1 and 3.

Results
In total, 337 eyes that underwent cataract surgery with a toric implant, were included. 133 males (52.6%), and 120 females (47.4%), were involved. 175 right eyes (51.9%), 162 left eyes (48.1%), mean age was 67.6 ± 9.9 years. 1 month follow-up mean residual astigmatism was 0.58±0.46D, while at 3 months, it was 0.75±0.68D. Mean predictive refractive error at 1 and 3 months, was -0.06±0.71D, and 0.10±0.73D, respectively. Mean BCDVA for patients at 1 day, 1 month, and 1 year, post-op follow-up was 0.26±0.23, 0.05±0.12, and 0.07±0.10 LogMAR, respectively. The percentage of patients who had monocular BCDVA of 20/40 (0.30 LogMAR) or better, in their one year follow-up visit was 96.5%.

Conclusion
Cataract surgery, and the utilization of a toric intraocular lens may offer excellent visual acuity results, for patients with astigmatism.

Authors

Presenting Author
Helga P. Sandoval, MD, MSc    Email the author
Authors
Richard J Potvin, OD, Kjell G. Gundersen, MD, PhD

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Paper Abstract

Purpose
To compare uncorrected and best corrected visual acuity, low contrast acuity, residual refraction and ocular biometry after implantation of a low cylinder power toric intraocular lens (IOL) or non-toric IOL.

Methods
This was a non-interventional non-randomized comparative study of visual outcomes after uncomplicated cataract or refractive lens exchange surgery with either a low cylinder IOL (T2 group) or non-toric (Non_Toric group) IOL of similar design implanted (AcrySof® T2 IQ Toric and AcrySof® IQ IOL, both Alcon, Fort Worth, USA). Subjects in both groups had to have been eligible for the low cylinder IOL based on biometry. They had to have uncorrected distance visual acuity (UDVA) of 20/32 (0.2 logMAR) or better at the time of their single diagnostic study visit. Clinical evaluation included the manifest refraction, visual acuity (VA), low contrast VA and ocular biometry.

Results
A total of 94 eyes (51 T2, 43 Non_Toric) were enrolled. Mean manifest refractive cylinder was statistically significantly lower (~ 0.25 D) in the T2 group (p < 0.01) and significantly more eyes had ≤ 0.25 D of refractive cylinder in the T2 group (p = 0.03). The orientation of preoperative anterior corneal astigmatism was a significant cofactor; the difference between groups was more evident when astigmatism was against the rule. Uncorrected high contrast VA was statistically significantly better in the T2 group (p = 0.02), as was the percentage of eyes with 20/20 VA (p = 0.05). Uncorrected low contrast VA was not statistically significantly different in mesopic or photopic conditions.

Conclusion
The AcrySof T2 (toric) IOL provided better uncorrected visual acuity and lower residual refractive cylinder than the Acrysof IQ (non-toric) IOL after cataract or refractive lens exchange surgery.

★ This paper won Best Paper of Session (BPOS) at the 2021 ASCRS Annual Meeting

Authors

Presenting Author
Kevin M. Miller, MD    Email the author
Authors
Srividhya Vilupuru, OD, PhD, Cameron Sefton, OD, MSc, Wuchen Zhao, MS, D. Priya Janakiraman, OD

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Paper Abstract

Purpose
To evaluate the rotational stability of the TECNIS Toric II Intraocular Lens (IOL) by comparing the difference in axis orientation of the IOL immediately following surgery to postoperative visits using a photographic method.

Methods
Prospective, multi-center, singe-arm study in which patients with pre-existing corneal astigmatism ≥ 1.00 diopter (D) in one or both eyes are implanted with TECNIS Toric II models ZCU 1.50 D to 6.00 D. Available data from up to 200 eyes from eight U.S. sites will be presented. Lens rotation between operative photos taken through a surgical microscope and postoperative photos taken through a slit lamp biomicroscope at 1-day, 1-week, and 3-month visits are being measured by two independent, masked analysts using custom image analysis software. Absolute IOL rotation, percentage of eyes with ≤ 5° rotation, uncorrected distance visual acuity, and manifest refraction will be presented.

Results
Preliminary data from 22 eyes were available for analysis at the 1-day and 1-week visits. For each eye and time point, rotation data were averaged from each analyst. At 1 day and 1 week, mean absolute rotation was 0.78° ± 0.56° and 0.93° ± 0.53°, respectively. At both timepoints, 100% of eyes had ≤ 5° of absolute rotation. Mean uncorrected ETDRS distance visual acuity at 1 week was 0.05 ± 0.12 logMAR (20/22) and 86.4% of eyes had 20/25 or better. Mean absolute residual cylinder at 1 week was 0.22 D ± 0.29 D and manifest spherical equivalent refraction was 0.04 D ± 0.31 D. Mean distance corrected distance visual acuity at 1 week was -0.04 ± 0.08 logMAR (20/18).

Conclusion
Interim analysis at an early postoperative timepoint showed that all eyes implanted with the TECNIS Toric II IOL demonstrated excellent rotational stability, uncorrected distance vision, and minimal residual astigmatism.