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Moderator
James T Murphy III, MD, ABO
Panelists
Helga P. Sandoval, MD, MSc
Mitra Nejad, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors, and view the full session above.
Presenting Author
Joaquin O De Rojas, MD, ABO
Co-Authors
Priya Mathews MPH, MD, William Soscia MD
Purpose
This study was designed to assess the long-term stability (12 mo.) of femtosecond laser-created arcuate incisions for the correction of astigmatism up to 1.6D. Iris registration to guide placement in combination with beveled architecture were evaluated for accuracy and stability.
Methods
Data from 59 patients who had previously undergone astigmatism correction with femtosecond laser (ALLY, Orlando, FL) beveled arcuate incisions was obtained through a review of patient records and analyzed. Data was evaluated at the 6 week and 12 month postoperative time interval. A comparison of vector analysis by Alpins method (target TIA) and surgically induced astigmatism (SIA), difference vector, correction index and angle of error was made, as well as a comparison of change in keratometric astigmatism along the original steep and orthogonal meridians. Percent of cases with ? 0.25D, 0.50D, 1.00D, 1.25 of intended astigmatic correction to target was assessed, along with UDVA.
Results
Astigmatism was reduced from a mean preoperative astigmatism of 0.74±0.34 D to 0.19±0.27 D at 4 to 6 weeks postop and 0.34±0.41 D at 12 months. The refractive cylinder was within 0.50 D in 94.3% of eyes at 4-6 weeks postop and 85.7% of eyes at 12 months. The difference vector was 0.34±0.41D, the correction index was 0.95, and the angle of error was -6.02±23.08 degrees. Of the 34 eyes that were targeted for emmetropia, UDVA of 20/30 or better was achieved in 94% of eyes at 4 to 6 weeks and 12 months. The mean postoperative MRSE was -0.09±0.20 D at 4 to 6 weeks, with 97% of eyes achieving postop MRSE within 0.50 D.
Conclusion
Lensar femtosecond laser-created beveled arcuate incisions for the correction of astigmatism yielded good astigmatic and visual outcomes that were stable over 12 months.
Presenting Author
Rom Kandavel, MD
Co-Authors
Justin Dredge MD
Purpose
To evaluate the postoperative refractive accuracy of the common toric Intraoperative marking method of Toric CAM and Mendez marking when compared to the Digital Marker Microscope(DMM)with Laser assisted cataract surgery.
Methods
Interventional, non-randomized study comparing alignment using the DMM to manual marking with Toric CAM electronic smart phone marking in 41 eyes. Toric CAM(TC) app was used to mark the horizontal axis as reference then the final IOL axis was marked with a Mendez marker intraoperatively. The difference in the final marked IOL axis and the DMM axis was measured using the DMM degree overlay intraoperatively. IOL position was confirmed on POD1 and POW 4-6. A theoretical refraction was back calculated using the double vector method for the refraction of the Mendez marking method. Manifest refraction and residual astigmatism was measured at POW 4-6.
Results
41 eyes (19 female, 22 male) with mean age 41 were analyzed. Toric IOL powers: 20 CCWOT3, 12 T4, 6 T5, 2 T6, 1 T8. Mean pre-op corneal astigmatism: 1.38D. Toric CAM marking differed from DMM by 6.61° (mean 3.39° CCW). Average residual back-calculated astigmatism (BRA): 0.57D vs actual 0.24D (p<0.05). PRA ≤0.75D 100%, ≤0.50D 94.74%, ≤0.25D 65.79%. BRA ≤1.00D in 89.47%. Mean IOL axis shift POD1 to POW4-6: 3.45°CW. No significant difference in the residual astigmatism between the different Toric IOL powers implanted. Predictive error: MRSE 0.39D, astigmatism 0.33D. 100% achieved 20/30 or better, 95% 20/25, 53% 20/20.
Conclusion
DMM intraoperative digital marking resulted in a statistically significant reduction in postoperative residual astigmatism vs back calculated residual astigmatism using Toric CAM preoperative marking. There was an average error of 6.61 degrees in the Toric CAM group vs DMM alignment. 100% of eyes achieved 20/30 or better using DMM marking.
Presenting Author
Vaishali Vasavada, MS
Co-Authors
Lajja Shastri MS, Shail Vasavada DNB, FRCS, Abhay Vasavada MS, FRCS, Samaresh Srivastava MD
Purpose
To evaluate prediction accuracy of toric intraocular lens (IOL) power calculation using a swept source optical coherence tomography (SS-OCT) biometry as a single device to perform biometry and calculate the spherical power and toric model and axis placement.
Methods
Prospective study in 100 eyes undergoing cataract surgery with monofocal toric IOL implantation. Biometry, keratometry were performed on SS-OCT. The spherical dioptric power, toricity model & implantation axis were based on input from the SS-OCT device using the Barrett Universal formula and the inbuilt Barrett toric calculator from the device. Manifest refraction 3 months postoperatively was compared with predicted refraction. Mean and absolute error of prediction were calculated. Unaided distance visual acuity (UDVA) was documented, and patients within +/- 0.5 diopters of targeted refraction were analyzed.
Results
Presently reporting results of 55 eyes. Final results will be updated. The mean UDVA at 3 mnths was 0.12 ± 0.1 LogMAR. The mean spherical equivalent at 3 mnths was -0.13 ± 0.3 diopters. The prediction error of refraction was -0.02 ± 0.1.
Conclusion
The accuracy of SS-OCT biometer to predict spherical and toric powers of IOL when used as a single device for IOL power selection was excellent
Presenting Author
Steven C. Schallhorn, MD, ABO
Co-Authors
Julie Schallhorn MD
Purpose
To compare clinical outcomes of options for managing low preoperative corneal astigmatism during cataract surgery in a large cohort of patients
Methods
Cataract outcomes obtained from Veracity Surgical Planner with preop corneal astigmatism between 0.75 D and 1.50D were evaluated. The eyes were divided into three categories: Group A – eyes with a toric IOL implantation, Group B – eyes that underwent limbal relaxing incisions, and Group C – eyes with no astigmatic correction (other than on-axis incision). Residual refractive astigmatism was compared between the three groups and the outcomes were further stratified based on the amount of preoperative corneal astigmatism (≥0.75 to <1.00D, ≥1.00 to <1.25D, ≥1.25 to ≤1.50D). Only records with a minimum of 1-month follow-up were included.
Results
50,850 eyes were included (Group A 12,294 eyes; Group B 7,112 eyes; Group C 31,444 eyes). For preop corneal cylinder ≥0.75 to <1.00D, the mean residual refractive cylinder was 0.39±0.38D, 0.48±0.42D, and 0.65±0.51D for Group A, B, and C (p<0.01). For preop corneal cyl ≥1.00 to <1.25D, the mean residual cyl was 0.39±0.39D in Group A, 0.55±0.47D in Group B, and 0.81±0.57D in Group C (p<0.01). With ≥1.25 to ≤1.50D preop corneal cyl, the mean residual cyl was 0.40±0.40D, 0.64±0.51D, 0.98±0.64D for Groups A, B, and C (p<0.01). The total % of eyes with postop cyl ≤0.50D (regardless of the amount of preop cylinder) was 77.4% in Group A, 63.7% in Group B, and 43.8% in Group C (p<0.01).
Conclusion
The outcomes showed a clear benefit of reducing postoperative astigmatism by implanting a toric IOL in patients with lower preoperative corneal astigmatism. Eyes with a toric IOL had the lowest residual refractive cylinder and the highest percentage of eyes with ?0.50 D residual astigmatism.
Presenting Author
Amit Raj, MS, DNB
Co-Authors
Zeba Khanam MS, Aditya Rajan MBBS
Purpose
To determine the change in total corneal astigmatism in patients undergoing cataract surgery with 2.2mm Opposite Clear Corneal Incisions (OCCIs) over three months postoperatively and to describe manifest refraction and final uncorrected visual acuity in eyes which underwent OCCIs
Methods
Hospital based retrospective chart review. Patients presenting to lens clinic of a tertiary eye hospital in eastern India for cataract surgery were included. Total keratometric astigmatism (TK) of more than 1 D measured using swept source optical coherence tomography (IOL master 700) and who did not opt for toric IOL underwent opposite clear corneal incision using 2.2 mm keratome on steep meridian by single surgeon after taking informed consent
Results
35 eyes of 33 patients were operated, age ranging from 28 to 80 years years with mean age of 61.91. 18/33 (54.54%) were males. The minimum and maximum value of TK1 was 38.59 D and 47.76 D respectively with a mean of 43.39 D. Similarly, the minimum and maximum value of TK2 was 39.84 D and 49.46 D with a mean of 44.99 D. The mean value of difference between TK1 and TK2 (?TK) was 1.57 D ranging from 1.00 D to 2.74 D.2.2mm OCCI corrected a mean astigmatism of 0.57D in short term (one month follow-up). A mean change of 0.62D was observed in the small number of patients who followed-up at three months, which imply that a fair stabilization of astigmatism is achieved by one month postoperatively
Conclusion
OCCI is reliable and cost-effective for moderate astigmatism that would lead to subopitimal visual acuity unless corrected. It is a relatively easier without need for expensive toric IOLs or intraoperative image guidance systems for axis marking and is helpful in decreasing keratometric astigmatism as well as improving uncorrected visual acuity.
Presenting Author
Abinaya Thenappan, MD
Co-Authors
Shamik Bafna MD, William Wiley MD, Kathleen Jee MD, Jeffrey Augustine OD, Camila Albo MD
Purpose
To determine the incidence and factors associated with the need to re-adjust toric implantable collamer lenses (ICLs) postoperatively.
Methods
A retrospective analysis of 112 eyes that underwent toric ICL implantation for the correction of myopic astigmatism was performed. Inclusion criteria included those with stable refractions and no history of previous ocular surgeries. The primary outcome measure was the incidence of postoperative ICL rotation requiring surgical intervention. Secondary measures included the degree of rotation, timing of rotation detection, and visual outcomes post-rotation.
Results
Among 112 eyes, 95% achieved 20/25 or better uncorrected vision at one month, and 99% had ≤0.25 D residual astigmatism. The most common ICL sizes were 12.6 mm (45.5%) and 13.2 mm (41.1%). Mean ICL vault on POD1 was 419 ± 119 µm, and the average preoperative cylinder was -2.06 ± 0.95 D (range: -4.75 to 0.75 D). Toric ICL rotation requiring surgical correction occurred in 3 eyes (2.7%), with a mean rotation of 12.3° ± 6.8° (range: 7°–20°). One case underwent ICL exchange, one required realignment, and one had LASIK enhancement.
Conclusion
Toric ICL rotation requiring surgical correction occurred in 2.6% of cases, with a mean rotation of 12.33°. Visual outcomes remained excellent, with 99% achieving ≤0.25 D residual astigmatism. Proper patient selection, precise sizing, and refined techniques may further reduce rotation risk, enhancing stability and optimizing outcomes.
Presenting Author
Ben R. LaHood, MD, PhD, FRANZCO
Co-Authors
Graham Barrett FRANZCO
Purpose
Toric calculators take into account factors other than anterior corneal astigmatism, including the effect of posterior corneal astigmatism. Toric IOL alignment recommendations can vary significantly from the anterior steep axis. It is important to assess whether this change in implantation axis provides improved refractive outcomes.
Methods
100 consecutive eyes undergoing routine cataract surgery were implanted by a single surgeon with the same model of hydrophobic monofocal toric IOL. Planning of IOL sphere and cylinder power was performed using the Barrett Universal II formula (BUII). However, each toric IOL was implanted on the steep anterior corneal axis rather than that recommended by the BUII calculator. One month post-operatively, biometry, IOL position and refractive outcomes were assessed. Proprietary use of the BUII formula was then used to assess whether the refractive outcome would have been better or worse if the toric IOL was implanted on the recommended axis.
Results
All patients had excellent outcomes in terms of visual and refractive outcomes with minimal residual refractive astigmatism. A small improvement in refractive outcomes could have been achieved if toric IOL implantation was performed on the recommended axis rather than the anterior steep axis.
Conclusion
Positioning toric IOLs on the axis recommended by the BUII formula should provide a better refractive outcome rather than aligning with the anterior steep axis, despite some of these axis shifts being quite significant.
Presenting Author
Pilar Maria Nano, MD
Co-Authors
Hugo Daniel Nano MD, Hugo Diego Nano MD
Purpose
To evaluate visual acuity and manifest astigmatism refraction after cataract surgery using Clareon Toric Vivity Lens in subjects with mild irregular astigmatism.
Methods
Prospective-observational study. Single surgeon, single center. N=30 eyes from 30patients with age-related cataract. Visual Acuity expressed as mean and standard deviation. Inclusion criteria patient with mild irregular astigmatism (mean K not higher than 47D,SI index not higher than 1,4D, SRI between 0,56-1.55. Indication of Clareon Vivity toric Lens (T2-T4), minimum pre-cataract BCDVA 20/200. BCDVA predicted to be 20/25 or better after cataract removal and IOL implantation. Pre and post data compared by means of student's t-test.
Results
Primary endpoint: Preop. Mean monocular distance BSCVA was 0.281 ± 0.145 logMar; 3 months post 0.105 ± 0.059 logMar. Secondary endpoints: Mean monocular distance UCVA was 1.052 ± 0.660 logMar, intermediate 0.497 ± 0.241 logMar and near 0.530 ± 0.241 logMar. At 3 months postop. 0.127 ± 0.075 for distance, 0.190 ± 0.106 logMar intermediate and 0.067 ± 0.076 logMar for near VA. Preop. Mean monocular BSCVA intermediate 0.277 ± 0.136 and near VA 0.060 ± 0.119. At 3 months postop. intermediate 0.113 ±0.089 and near VA 0 ± 0. Mean SE shifted from 1.34 ± 4.88 preop to 0.652 ± 0.610 Postop. Preop Mean astigmatism was 0.88Dp and postop mean residual astigmatism 0.31Dp .P<0,05 T-Student test).
Conclusion
Clareon Vivity Toric IOL provides good extended range of vision in eyes with mild irregular astigmatism (equal or less than 0.10 LogMar for distance). The development of an IOL with different extended depth of focus technology offers the chance to improve not only distance but also intermediate and near visual acuity whilst correcting astigmatism.
Presenting Author
Smita Agarwal, FRANZCO, MS, MBBS
Co-Authors
Erin Thornell PhD, Dakota Williams BSc, MSc
Purpose
The Clareon Panoptix combines an advanced biomaterial & proven trifocal optics. While the AcrySof platform is known to have good rotational stability, the stability of the Clareon PanOptix toric IOL has not been investigated in situ. This study assesses the 3-month rotational stability of the Clareon PanOptix Toric IOL.
Methods
The Clareon PanOptix toric IOL will be implanted in 40 eyes following standard phacoemulsification. Toric alignment will be measured approximately 1 hour following surgery, and at 1 week, 6 weeks and 12 weeks following surgery using dilated slitlamp examination and iTrace. Uncorrected distance (UDVA), intermediate (UIVA) and near (UNVA) visual acuity will be measured postoperatively as well as manifest refraction.
Results
Data collection is ongoing Results: Interim 12-week data is available for 20 eyes and data collection is ongoing. At 12 weeks postop, average UDVA was 0.08±0.11 LogMAR (skewed with one eye due to lack of diopter range needed), average UIVA was 0.1±0.13 LogMAR and average UNVA was 0.14±0.13 LogMAR and 0.15±0.15 LogMAR at 40 cm and 33 cm respectively. Average rotation of the IOL compared to target axis was -0.4±6.43° at 1 hour (P = 0.78), -1.58±5.84° at 1 week (P = 0.25), -2.3±4.75° at 6 weeks (P = 0.04) and -1.8±5.44° at 12 weeks (P = 0.22). Rotation of ≤5° was recorded for 80% of eyes at 12 weeks.
Conclusion
Data Collection is ongoing but interim conclusion: Conclusion: The Clareon PanOptix Toric IOL remained rotationally stable in situ at 12 weeks following implantation, with majority of eyes experiencing 5° or less of rotation.
Presenting Author
Jascha A. Wendelstein, MD
Co-Authors
Achim Langenbucher PhD, Michael Goggin MS, FRANZCO, FRCOphth, FRCSI
Purpose
The purpose of this study is to compare the reconstructed corneal power (RCP) by working backwards from the post-implantation spectacle refraction and toric intraocular lens power and to develop the models for mapping preoperative keratometry and total corneal power to RCP.
Methods
Retrospective single-centre study involving 442 eyes treated with a monofocal and trifocal toric IOL (Zeiss TORBI and LISA). Keratometry and total corneal power were measured preoperatively and postoperatively using IOLMaster 700. Feedforward neural network and multilinear regression models were derived to map keratometry and total corneal power vector components (equivalent power EQ and astigmatism components C0 and C45) to the respective RCP components
Results
Mean preoperative/postoperative C0 for keratometry and total corneal power was -0.14/-0.08 dioptres and -0.30/-0.24 dioptres. All mean C45 components ranged between -0.11 and -0.20 dioptres. With crossvalidation, the neural network and regression models showed comparable results on the test data with a mean squared prediction error of 0.20/0.18 and 0.22/0.22 dioptres2 and on the training data the neural network models outperformed the regression models with 0.11/0.12 and 0.22/0.22 dioptres2 for predicting RCP from preoperative keratometry/total corneal power.
Conclusion
Based on our dataset, both the FFN and multilinear regression models showed good precision in predicting vector components of RCP from preoperative keratometry or total corneal power. With a similar performance in crossvalidation and a simple implementation in consumer software, we recommend implementation of regression models in clinical practice.
Presenting Author
Andre Messias, PhD
Co-Authors
Carlos Nunomura MD, Marcelo Fernandes MD, Mayra Fagundes MD
Purpose
To compare refractive outcomes following toric intraocular lens (IOL) implantation, using either a swept-source optical coherence tomography (SS-OCT) biometer (ARGOS) integrated with a digital marking IOL planning system or traditional manual marking for IOL alignment.
Methods
Patients with cataracts and regular corneal astigmatism (0.75 to 2 D) were included. The deviation between predicted and observed astigmatism magnitude was assessed three months post-surgery. IOLs were planned and implanted using either the ARGOS SS-OCT biometer with a digital marking system (Verion) or the IOLMaster 500 with manual marking (Pendulum marker). IOL alignment was evaluated using retro-illumination images and axis references from the OPD-Scan III aberrometer. Total toric IOL misalignment was defined as the difference between the planned and observed axes three months after surgery.
Results
Follow-up was completed for 62 patients, with 32 in the ARGOS group and 30 in the MARK group. No significant differences were observed between the groups in terms of preoperative corneal astigmatism, with a mean of 1.6 ± 0.09 D in the ARGOS group and 1.5 ± 0.08 D in the MARK group (P = 0.6837), as well as for other biometric measurements. Postoperative refraction showed a mean cylinder of 0.33 ± 0.06 D in the ARGOS group and 0.39 ± 0.06 D in the MARK group (P = 0.3349). The mean absolute IOL angular displacement (deviation from the ARGOS plan or Barrett online calculator plan) was 3.9 ± 0.6° in the MARK group and 3.4 ± 0.53° in the ARGOS group (P = 0.5344).
Conclusion
Postoperative astigmatism magnitude and IOL angular displacement were comparable between the two groups. Further analysis is needed to assess the impact of the biometer and digital marking on astigmatism correction, including subgroup comparisons in eyes with low corneal astigmatism or those at higher risk of biometric measurement or planning error
