Hawaiian Eye and Retina 2024: Toric IOL pearls for correcting lower levels of astigmatism

David Hutton of Ophthalmology Times talks with William Trattler, MD, about his presentation "Toric IOL pearls for Correcting Lower Levels of Astigmatism" at this year's Hawaiian Eye and Retina 2024 Meeting.

Video Transcript

Editor's note - This transcript has been edited for clarity.

David Hutton:

Hi I'm David Hutton of Ophthalmology Times. Hawaiian Eye is being held this year at the Grand Wailea resort in Maui. Joining me today is Dr. William Trattler. His presentation at the event is titled "Toric IOL pearls for Correcting Lower Levels of Astigmatism." Thank you so much for joining us, tell us about your presentation.

William Trattler, MD:

Thank you so much. It's my honor to be here and share some pros for my presentation. I think we all know that if we have a patient that has a lot of astigmatism - 1, 2, or 3 diopter of astigmatism. It's pretty straightforward to plan toric intraocular lens and make patients very, very happy. But the more challenging patients are those that have less astigmatism, they have more or less a half diopter to three quarters of astigmatism. And while we can do Limbal relaxing incisions or arcuate incisions, toric IOLs actually worked really well in these patients. And my presentation was really about how to calculate those patients. And talking about that it's okay to flip the axis if you need to, and really how to best, first of all determine the power of astigmatism, and the axis of the astigmatism, and then plan your astigmatism correction.

So one thing to point out is that while the corneal astigmatism may give you one value, there is a nomogram for adjusting the total astigmatism, so you end up on target. So for example, if you have horizontal astigmatism, and let's say, a it's half a diopter, you have to add another .5 to .6 diopters to get the total corneal astigmatism. And those are built into all the nomograms. You can also have different devices that measure not only the interior curvature or interior astigmatism, but the total corneal astigmatism. And I use two devices at my center, I use a Cassini, I use the IOLMaster700. To further try to help analyze these patients with lower levels of astigmatism.

Now, if you have vertical astigmatism, you actually have to subtract. If you have a doctor, everything's gonna start off with you subtract about .5 to .6 on that when you're doing the nomogram. Or if you measure it, you can use that calculation as well. And then at the end of the day, when you have these patients with lower levels astigmatism, you can look at formulas and try to determine whether a toric lens will make more sense than just a regular lens. And I think one of the key issues is that for awhile we were worried about flipping the axis, but it's really okay. In my practice, I find that my goal is to get to the lowest level of astigmatism. So if I ended up with .25 astigmatism whether it's not flipping the axis or flipping the axis, it really doesn't matter.

Our goal is to get patients with low levels of astigmatism, say at the very best uncorrected visual acuity. And basically, that was the point of my talk is that we can use toric lenses and these lower patients with lower powers of astigmatism, so that we can really end up with even less than astigmatism and better uncorrected visual acuity.