To log in, click the teal "Login" button in the upper right-hand corner of this page. If you are logged in but still do not have access, please check your 2026 Annual Meeting registration.
Moderator
Beeran Meghpara, MD, ABO
Panelists
Jason J. Jones, MD; Ken D. Novak, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Ahmed H. Assaf, MD, PhD, FRCSEd
Co-Authors
Noha Soliman (FRCSEd)
Purpose
To compare the rotational stability of Eyhance Toric II IOLs implanted using cohesive OVDs versus BSS in a paired-eye study over a period of three months, assessing whether the implantation medium influences postoperative IOL alignment
Methods
This prospective paired-eye study included patients undergoing bilateral cataract surgery with Eyhance Toric II IOLs. In each patient, one eye was implanted using cohesive OVD, while the fellow eye was implanted using BSS. Random assignment of OVD or BSS for implantation was determined via a coin toss. Two groups were identified: OVD and BSS groups. Rotational stability was measured using ray tracing aberrometry at one week, one month, and three months postoperatively. Additional study parameters included postoperative refractive astigmatism, uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) at three months postoperatively.
Results
Each group consisted of 80 eyes. The mean age of the patients was 67 ± 9.5 years. During surgery, greater difficulty was encountered when manipulating the IOL to the desired axis in the BSS group. One week after surgery, the mean IOL rotation was 1.4 ± 1.6 degrees in the OVD group and 1.7 ± 1.8 degrees in the BSS group, respectively (P>0.05). No statistically significant IOL rotation was observed at subsequent follow-up visits one month and three months. Postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and residual refractive astigmatism were comparable between the two groups without statistically significant differences.
Conclusion
The Eyhance Toric II IOL exhibited excellent postoperative rotational stability, irrespective of whether an OVD or BSS was used for implantation. Although intraoperative alignment to the target axis was more controlled in the OVD group, this did not impact final stability of the IOL.
Presenting Author
John D Stephens, MD
Co-Authors
Cristos Ifantides (MD, MBA), Farrell Tyson (MD), Bryan Munoz (MS)
Purpose
To compare the outcomes of toric IOL alignment methods using refractive capsulotomy with a femtosecond laser vs. manual capsulotomy with ORA intraoperative aberrometer
Methods
Retrospective data was analyzed for 197 subjects ? 21 years old who underwent toric IOL implantation using ALLY IntelliAxis refractive capsulorhexis (LENSAR, Orlando, FL) or manual capsulotomy with toric IOL alignment guided by ORA (Alcon, Fort Worth, TX). Subjects had stable regular keratometric astigmatism ranging up to 4.0D with a vector difference of 0.50D or less in magnitude of pre-operative anterior corneal astigmatism as measured by keratometry. Data included preoperative IOL calculations and post-operative 1-month and 1 year manifest refraction outcomes.
Results
A total of 64 eyes of 64 subjects in the ALLY group and 56 eyes of 56 subjects in the manual group met inclusion criteria and had complete postoperative data. Manifest refraction demonstrated postoperative MRSE ? 0.25 D in 67.2% and 46.4% eyes (p = 0.022), and MRSE ? 0.50 D in 89.1% and 69.6% (p = 0.08) in the ALLY and manual groups, respectively. 73% of eyes in both groups achieved residual refractive cylinder ? 0.50 D. 42.2% and 32.1% of eyes achieved UDVA 20/20 or better (p = 0.257), and 95.3% and 94.6% of eyes achieved UDVA 20/40 or better in the ALLY and manual groups, respectively. No eyes in either group required IOL repositioning or LASIK enhancement.
Conclusion
ALLY refractive capsulotomy and toric IOL implantation achieved superior refractive spherical equivalent and demonstrated a trend towards better uncorrected visual acuity compared to manual capsulotomy with intraoperative aberrometry. Both methods resulted in satisfactory outcomes, with no eyes requiring postoperative enhancement.
Presenting Author
Gary N. Wortz, MD
Purpose
To evaluate the outcomes of femtosecond laser-assisted arcuate keratotomy (FSAK) and toric IOL in cataract patients with 0.6 to 1.1 D of preoperative corneal astigmatism.
Methods
This retrospective study included 126 eyes that underwent femtosecond laser-assisted cataract surgery (FLACS) and astigmatism correction using either arcuate keratotomy (AK group) with Wortz Gupta Formula or MX60ET 1.25 D toric IOL. Key metrics included UDVA and CDVA, residual astigmatism, and spherical equivalent (MRSE).
Results
Both groups demonstrated a significant reduction in mean astigmatism from preop to postop, with more than 90% of eyes achieving postoperative cylinder within 0.50 D. The mean postoperative MRSE was also comparable, with 96.2% (AK) and 92.5% (toric) of eyes achieving MRSE within 0.50 D. Mean UDVA and CDVA were also comparable between the two groups (p>0.05).
Conclusion
Both AK and toric IOLs demonstrated equivalent performance across all metrics.
Presenting Author
Elif sah?n Ozturk, MD
Co-Authors
Emine Esra Karaca (MD), Yonca Asfuro?lu (MD, FEBO), Ozlem Evren Kemer (MD)
Purpose
Alpins vector analysis allows assessment of surgically induced astigmatic changes by separately evaluating the magnitude and axis of astigmatism. The aim of this study was to compare Alpins vector analysis parameters among three patient groups classified according to their preoperative astigmatism (ast) levels.
Methods
129 eyes of 121 patients were included.Preoperative and postoperative first-month topographic data were obtained using the Pentacam device.Patients were divided into three groups according to their preoperative astigmatism:Group A <0.75 D Group B 0.75-1.50 D and Group C >1.50 D.The target induced astigmatism (TIA) was set as 0.25 D, 0.50 D, and 1.00 D for Groups A, B, and C, respectively. Alpins parameters including surgically induced astigmatism (SIA), difference vector (DV),target induced astigmatism(TIA) magnitude of error(ME) flattening effect(FE) torque correction index (CI) index of success (IS) and angle of error (AE) were calculated and compared among groups using MannWhitneyU tests
Results
No significant differences were found in Alpins parameters among with-the-rule, against-the-rule, and oblique astigmatism subgroups. Mean SIA values were 0.48 ± 0.32 D in Group A, 0.62 ± 0.36 D in Group B, and 1.19 ± 0.69 D in Group C. DV values were 0.54 ± 0.35, 0.97 ± 0.49, and 1.43 ± 1.00 D, respectively. TIA values were 0.47 ± 0.23, 0.88 ± 0.40, and 1.84 ± 1.00 D, respectively. SIA, DV, and TIA differed significantly among groups (p<0.05). ME, FE, and torque showed significant differences between Groups A and C (p<0.05). No statistically significant differences were observed for CI, IS, and AE.
Conclusion
Higher preoperative astigmatism was associated with greater SIA and axis deviation, indicating increased corneal biomechanical susceptibility to incisional effects. Therefore, personalized surgical planning based on preoperative astigmatism level is crucial to optimize postoperative refractive outcomes.
Presenting Author
Gilles Lesieur, MD
Purpose
To evaluate whether the lens diameter, as measured by anterior segment optical coherence tomography (OCT), influences the postoperative rotational stability of an extended depth of focus (EDOF) intraocular lens (IOL) following crystalline lens surgery.
Methods
This retrospective study analyzed patients who underwent crystalline lens surgery with the EDOF IOL model 124MT (SAV-IOL, Switzerland) between July 2023 and December 2024. Eligible patients had postoperative follow-up including pupillary dilation and manual protractor assessment of IOL rotation at 1.5–3 months. No randomization or masking was applied. The main outcome was postoperative IOL rotation, correlated with preoperative biometric parameters. Variables included lens diameter by anterior segment OCT (Casia 2, Tomey), axial length, lens thickness, anterior chamber depth, corneal astigmatism, white-to-white distance, and demographics.
Results
A total of 348 eyes were evaluated. Mean postoperative rotation was 2.68 ± 2.38° (range 0–17°), with a median of 2.0° (IQR 1.0–4.0°). Statistical analysis showed no significant correlation between postoperative IOL rotation and lens diameter (ρ = –0.0033; r² = 0.003; p = 0.952). Other biometric parameters, including axial length (AL), lens thickness (LT), anterior chamber depth (ACD), corneal astigmatism, and white-to-white (W2W) distance, likewise showed no significant association with rotational stability.
Conclusion
Lens diameter measured by anterior segment OCT showed no influence on postoperative rotational stability of the EDOF IOL. Other biometric parameters (AL, LT, ACD, W2W) were also non-predictive. These findings suggest limited clinical value of these metrics in anticipating IOL rotation.
Presenting Author
Yoshihiko Ninomiya, MD
Co-Authors
Mutsumi Fuchihata (MD), Yayoi Kanazawa (OD)
Purpose
To evaluate the effectiveness of astigmatism correction with the T2 toric intraocular lens (IOL) in low corneal astigmatism by (1) comparing T2 with nontoric IOLs (T0) in retrospectively confirmed T2-eligible eyes, (2) paired-eye comparisons of T0 versus higher toric IOLs (Tx), and (3) analyzing vector outcomes of T2 versus Tx.
Methods
Seventy-five eyes from 46 patients were analyzed (T2 group: 25 eyes, T0 group: 25 eyes, Tx group: 25 fellow eyes). All underwent small-incision cataract surgery by the same surgeon. In the historical T0 group, T2 eligibility was retrospectively established using the updated Barrett Toric Calculator. Exclusion criteria included irregular corneal astigmatism and prior ocular surgery. Outcomes were assessed at 3 months, including uncorrected distance visual acuity (UDVA), refractive astigmatism, subjective astigmatism, and vector analysis of astigmatism correction.
Results
At 3 months, the T2 group had significantly lower refractive astigmatism (mean ± SD, 0.32 ± 0.21 D) and subjective astigmatism (0.40 ± 0.28 D) than the T0 group (0.78 ± 0.35 D and 0.84 ± 0.42 D, respectively; both P < .001), with better UDVA (logMAR 0.03 ± 0.07 vs 0.12 ± 0.09; P = .004). In paired-eye comparisons, T0 eyes had greater refractive astigmatism (0.92 ± 0.32 D) and subjective astigmatism (0.69 ± 0.33 D) than Tx fellows (0.53 ± 0.33 D; P < .001 and 0.39 ± 0.32 D; P = .002). Vector analysis showed T2 achieved astigmatism correction comparable to Tx in low-astigmatism eyes. A trend toward better UDVA was noted in Tx versus T0 (P = .060).
Conclusion
The T2 toric IOL provided effective astigmatism correction and improved visual outcomes in eyes with low corneal astigmatism, a group previously excluded from toric implantation. Incorporation of T2 into practice may expand the benefits of toric correction and enhance functional vision in cataract patients with low astigmatism.
Presenting Author
P Dee G. Stephenson, MD, FACS
Purpose
To validate toric IOL alignment by iris-registration-guided femtosecond laser-assisted capsular marks with intraoperative aberrometry measurements.
Methods
A retrospective analysis of over 400-500 eyes that underwent cataract surgery with a femtosecond laser and implantation of a Toric IOL, aligned using iris registration-guided capsular marks (LENSAR IntelliAxis-L, Orlando, FL) and confirmed by intraoperative aberrometry (ORA, Alcon, Ft. Worth, TX).
Results
Astigmatism decreased significantly from 0.89±0.56 D preoperatively to 0.27±0.22 D postoperatively, with all (100%) of the eyes achieving postoperative residual refractive cylinder within 0.50 D. The mean postoperative MRSE was -0.02±0.23 D, and 98.0% of eyes achieved MRSE within 0.50 D. Mean postoperative UDVA was 0.05±0.07 logMAR; 98.7% of eyes achieved UDVA of 20/30 or better. CDVA was 20/25 or better in 99.6% eyes. For the final IOL power implanted, ORA confirmed the preoperative IOL power calculations in 39.8% of cases, and ORA influenced the surgeon’s choice in 47.6% of cases. In 12.6% cases, the IOL power implanted was based solely on the preoperative IOL power calculation.
Conclusion
Femtosecond laser-assisted cataract surgery and the use of iris registration-guided capsular marks for toric IOL alignment effectively reduced astigmatism and yielded excellent visual and refractive outcomes.
Presenting Author
Clayton G. Blehm, MD
Purpose
This study aims to assess the accuracy of toric intraocular lens (IOL) alignment axes as calculated and displayed by a novel digital guidance system. In addition, it evaluates the time required to initiate surgical guidance and postoperative refractive astigmatism following toric IOL implantation.
Methods
This single-surgeon, single-site, prospective, non-invasive observational study evaluated the accuracy of toric IOL alignment axes calculated and displayed by the digital guidance system (Cassini Technologies, B.V.) in 100 eyes. The intraoperatively calculated alignment axes were compared to preoperative measurements to assess their accuracy (in degrees). Postoperative outcomes, including residual refractive astigmatism (diopters) and visual acuity (Snellen), were recorded at 1 month postoperatively.
Results
A dedicated validation tool was used by 3 trained reviewers to annotate pre- and intraoperative images using six paired anatomical landmarks to determine the desired intraoperative alignment axis orientation. Results where only considered for digital guidance evaluation when there was less than 6 degrees difference between the annotators (n=25). Mean absolute difference between manual annotators and digital guidance was 2.08° ± 2.44° (median 1.35°). Average time required to initiate surgical guidance was 17.6 seconds (n=35). At 1M post op (n = 13), mean residual refractive cylinder was 0.31 ± 0.34 D. Mean UCDVA was 0.15 ± 0.12 logMAR (~20/29), and mean BCVA was 0.05 ± 0.09 logMAR (~20/22).
Conclusion
Using a dedicated validation tool, the digital guidance system demonstrated strong and reliable toric IOL axis determination with low inter-reviewer variability. One-month outcomes showed low residual refractive cylinder and favorable visual acuity, supporting accurate and effective astigmatism management.
