Toric IOLs in abnormal corneas: How the two can work together

 

Take-Home Message: Premium IOLs can be used successfully in patients with corneal pathologies.

 

By Lynda Charters; Reviewed by Christopher E. Starr, MD

New York-Careful patient selection is the foundation for successful outcomes when implanting premium toric IOLs in some cases with corneal pathologies. To obtain the best visual results, other procedures may be required before or after cataract surgery.

“When implanting premium IOLs in patients with abnormal corneas, there is really no right or wrong,” said Christopher E. Starr, MD, associate professor of ophthalmology and director, refractive surgery service, Weill Corneal Medical College, New York Presbyterian Hospital, New York.

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Having said that, Dr. Starr’s personal style when dealing with higher-risk eyes tends toward the more conservative in an area in which the patients have unusually high expectations regarding visual outcomes.

“No cornea is static-all corneas change over time,” he said. “Normal corneas tend to change very slowly and predictably over time-normal corneas have regular astigmatism.”

Dr. Starr cited a study by Koch et al. which noted that normal corneas drift from with-the-rule to against-the-rule astigmatism over time-which required adjusting the toric IOL power accordingly. These eyes do well with premium IOLs.

“On the other hand, abnormal corneas tend to change rapidly and unpredictably and can have substantial irregular astigmatism,” he said. “In these eyes, IOL selection is like shooting at a moving target. IOL selection is less precise and managing expectations in these cases is paramount.”

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