The use of toric lenses in a general hospital in the Netherlands: is it successful?

Session Details

Session Title: Toric IOLs

Session Date/Time: Sunday 14/09/2014 | 16:30-18:30

Paper Time: 18:03

Venue: Capital Hall B

First Author: : J.Ongkosuwito THE NETHERLANDS

Co Author(s): :    N. Botos   L. Bakker   M. Ronday        

Abstract Details

Purpose:

To evaluate the use of Acrysof toric lenses in a non Academic non Refractive Ophthalmologic Department.

Setting:

General Hospital: Flevoziekenhuis, Almere, The Netherlands, yearly 1200 cataract surgeries performed by four experienced opthalmologists. None with experience in refractive eye surgery.

Methods:

Patients were seen at the clinic, if cataract was diagnosed, patient consented in surgery, and a corneal cylinder of more than 0.75 D was present, patients were sent to an experienced optometrist for biometry. The optometrist performed measurements by IOL master, corneal topography, automated keratometry, when in doubt Javal measurements were performed. The results of all measurements were than viewed by the ophthalmologist. Data were entered in the “Acrysof Toric calculator”. At the moment before cataract surgery the zero axis was marked with a “Nuijts” marker in sitting position, before subthenon injection was performed. During surgery the placement axis was determined by using a Mendez ring. The mean incision was made sclerocorneally with a 2.8mm blade. The day after surgery patients were phoned by a trained nurse, a week after the patients were seen by the optometrist to control the correct placement of the Toric lens. If the location was of axis lens was dialled within 14 days after initial surgery. Visual acuity before surgery, at one week after surgery, at 3 weeks, and if present at 3 months, keratometry, lenstype, target, expected residual astigmatism, expected spherical equivalent were entered in a database.

Results:

A total of 133 Toric lenses were implanted during a period of approximately 3 years (may2010 until July 2013); Acrysof Toric (116) and Acrysof ReSTOR Toric (17). The number of toric lenses implanted had increased to 15% in 2013. Average age of patients was 66 years (range 43-93), Male=63 and Female=70 Before surgery the average spherical power was -1.0 D (range -10.25 to +8.75) and the average diopter used for implanted lenses was 18.5 (range +6 D to +30 D). The average cylinder power was 1.34 D (range 0.75-2.75) in the group T2-T5 (N=118, 88.7%) ; the average corneal cilinder power was 3.4D (range 2.25-6) in the group T6-T9 (N=15, 11.3%). After surgery 85% had residual astigmatism of <0.5 D, 98% <1.0 D and only 2% had > 1 D residual astigmatism. Postoperative one week uncorrected visual acuity was 6/7.5, after 3 weeks visual uncorrected visual acuity was 6/6 in all eyes. Using a toric lens approximately 95% of all patients were spectacle independent for distance, 5% of patients still needed glasses. Out of the 95% of spectacle independent patients; 3 patients used monovision. No patients needed additional refractive laser treatment.

Conclusions:

The outcome of the use of toric lenses in a non refractive setting is successful when preoperative measurements are performed by an experienced optometrist, considering the use of at least two comparable keratometry measurements. This resulting in approximately 95% of spectacle independence (for distance).

Financial Interest:

NONE