1. Alcon AcrySof Toric IOL Con Moshegov Stephen Bambery Australia

2. IOL Design

AcrySof Single piece foldable acrylic

Soft and malleable

Allows easy manipulation while positioning

Axis marks on the posterior surface

IOL placed with marksaligned with the steep axis of the cornea

3.

Blue-light filter

Injector delivery same as conventional SN60AT IOLs

4. Other toric IOLs

Silicone plate haptic: rotation in capsular bag has been an issue

First toricFDA approval

5. AcrySof Single Piece IOL

Adhesive property

Advantage taken to prevent rotation after implantation

Oshika T, et al. Adhesion of lens capsule to intraocular lenses of PMMA, silicon, and acrylic foldable materials: an experimental study.Br. J Ophthalmol , 1998;82:468. 6. IOL Design Rotational Stability

Lens stability is important

Off-axis rotation reduces the corrective cylinder power

7.

For every 1of rotation, 3.3% of the lens cylinder power islost

For30 of rotation there is a complete loss of astigmaticcorrection

Additional astigmatism or visual problems with greaterthan 30 of rotation

8. Error Induced from Cyclotorsional Movements

Residual PSF and Blurred Eye Chart Letters

Real eye: 0.15DS 1.01DC x 0

9. IOL Power Selection Process

Determine the required spherical lens power

10. Select an AcrySof Toric IOL Model

The data are entered into the AcrySof Toric IOL Calculator to determine the optimal model

Calculator

• Considers effect of incision location and surgically induced cylinder to make a more precise calculation

• Determines the correct IOL model and optimal axis placement of the IOL in the capsular bag

11. AcrySof Toric IOL Models

Three AcrySof Toric IOL models available

Cylinder power option is combined with SE power 16 D to25 D in 0.5 D increments

Additional power options will be added in the future toaddress a broader range of astigmatic conditions

12. 13. 14. ASICO instruments 15. Pre-op mark 16. Marking of the Eye Axis Marking 17. AstigmatismSEC Holladay Data Base 0.916 D Average K astig 2.4% >/= 3 D 8.6% >/= 2 D 39% >/= 1 D n = 3538 18. Surgically induced astigmatism

Holladay IOL Consultant

SIA = 0.13 (SD 0.39)

N = 41

2.75 mm (pre implantation) temporal clear corneal wound

OD 180 OS 10

No other incisions

19. Pre op: Toric vs. LRI N=55 N=75 -0.25 -0.25 aim 100% 96% cyl >/= 1 D 32% 21% cyl >/= 2 D 1.84 D 1.75 D Pre-op cyl SN60ATwith LRIs n=55 Acrysof Toric n=75 20. Post op: Toric vs. LRI -0.575 -0.45 Mean SE 0.97 D 0.48 D Post-op refractive cyl 85% 93% >/= 6/12 24% 56% >/= 6/6 SN60AT+ LRIs Acrysof Toric 21. SEC experience

25.5% of cataract patients have a toric IOL

Over half are T3

56% T3 25% T5 19% T4 22. IOL rotation

Follow-up: about a month later

n = 38

Av = 2.66 (0 7.5 )

92% < 5

Direction: equal clockwise and anticlockwise

23. Measuring axis post-op 24. Conclusion

AcrySof Toric IOL

We can confirm that the lens has excellent rotational stability at 1 month

It handles just as easily as any AcrySof single piece lens

More reliable than spherical lens and LRIs in improving uncorrected distance visual acuity