1. Community
  2. Eyes
  3. Cataract

Are patients typically notified of toric lens position?

Posted , 4 users are following.

judith93585
judith93585

My surgeon suggested and I agreed to have toric lenses implanted. I would be interested to know if these lenses have retained their correct positions at subsequent post op appointments but this information has not been forth coming despite my requests.

Does this require special diagnostics or should this be evident at one week or 6 week post op appointments or even whenever the eye has been dialated?

Alternatively is this question not addressed unless the patient has a complaint regarding visual acuity?

I would appreciate any feedback from group members who have toric lenses.

Many thanks.

0 likes, 5 replies

5 Replies

  • trilemma
    trilemma judith93585

    Edited

    Are you asking if a surgeon/team is likely to volunteer the IOL ended rotated from the plan by 15 degrees? I could only speculate. Similarly, is a surgeon/team is likely to volunteer that the lens was placed off-center? I wonder if that happens.

    A refraction now would be informative IMO. If that were to be done now, and compared to the refraction before, and if the astigmatism was due to the cornea, then if the axis stayed about the same or rotated by 90 degrees, then I would expect the lens angle was placed right. My statement is based on thinking on it, and not based on data.

    I would want see what the end result is, and that axis comparison could be something to think about.

    .

This is a quote from a 2013 article:

    “If you’re basing your orientation on really accurate readings, I don’t think an aberrometer will change the axis that much,” says Dr. Davison. “It’s the same for the spherical component. The data I’ve seen says that about 6 percent of intraoperative aberrometry patients still end up with 0.75 D or more or spherical equivalent residual refractive error after surgery. Without using aberrometers, we have 7 percent of our patients with 0.75 D or more of residual spherical equivalent refractive error after surgery.

    Here is another quote that seems relevant:

    To achieve excellent postcataract results with toric intraocular lenses (IOLs), precise axis alignment is essential. “A 3-degree misalignment can lead to a 10 percent loss of cylinder correction,” said Kevin M. Miller, MD, at the University of California, Los Angeles. “With 10 degrees of misalignment, you lose 33 percent of the effect, and with 30 degrees, you lose all of the effect.1Not only that, but the axis of residual astigmatism is at a different angle, often oblique.”

    I would appreciate any feedback from group members who have toric lenses.

    Well, my RxLAL went in as non-toric but got adjusted to toric. That means that the axis did not matter during surgery, so that was one item that could not go wrong.

    • judith93585
      judith93585 trilemma

      Posted

      Thanks trilemma!

      My Rx showed a +0.50 cylinder with -1.75 sphere at 8 weeks. I was just wondering if most surgeons provide the status of toric placement to patients when asked.

      There have been some inconsistencies in the progress notes regarding whether a -1.75D or -1.50D target was used for the calculations. When targeting near-intermediate, I have no way to gauge if my visual acuity following surgery is what would be expected for that target. The reason I'm interested in knowing the status of my toric lens is because I understand the lens can be rotated if necessary. Basically I'd just like to be in the loop!

  • RonAKA
    RonAKA judith93585

    Edited

    They typically mark the eye just before surgery and match the toric lens to the marked position. I am not sure how long the marks lasts on the eye, so it may not be all that easy to determine if the lens has moved or not. But, it really does not matter, as the real outcome is your measured astigmatism. If you have gotten a good reduction in astigmatism (cylinder) and it hold over time then all is good. I suspect most of the rotation is in the first few hours after surgery. The critical check is the one done 24 hours after surgery. If it has moved then they should adjust it. This is possible because the incision has not healed yet.

  • judith93585
    judith93585

    Posted

    Thanks Ron. Now I understand! I was missing that critical piece of information! Thank you so much!!!

  • ka76787
    ka76787 judith93585

    Posted

    based on your new Rx it sounds like you're results are spot on. intermediate is -1D and breast is -2D, and you landed at -1.75D with +0.5D of cylinder (about -1.5)

    When surgically managing astigmatism, an end result at or below 0.5D cylinder is considered a success. Do o you know how much corneal astigmatism you had before surgery? Or what toric iol was used?

Back to top

Report or request deletion

Thanks for your help!

We want the community to be a useful resource for our users but it is important to remember that the community are not moderated or reviewed by doctors and so you should not rely on opinions or advice given by other users in respect of any healthcare matters. Always speak to your doctor before acting and in cases of emergency seek appropriate medical assistance immediately. Use of the community is subject to our Terms of Use and Privacy Policy and steps will be taken to remove posts identified as being in breach of those terms.