For more than a decade, cataract surgeons have been using corneal relaxing incisions and toric IOLs as the primary methods of astigmatic management during cataract surgery. Recently, both treatments have been improved.
Corneal incisions can now be performed using femtosecond lasers and are precisely configured with respect to depth, length, optical zone, and can even be purely intrastromal. Furthermore, intraoperative aberrometry using ORA (now with Verifeye, [WaveTec Vision]) can provide real-time feedback during the creation of limbal relaxing incisions (LRIs).
On the implant side, two new toric IOLs—the Tecnis (Abbott Medical Optics Inc.) and the Trulign (Crystalens, Bausch + Lomb)—have been recently added to Alcon Laboratories, Inc., toric series and STAAR Surgical’s lens. The lenses’ effects can be further refined by magnitude and axis intraoperatively using ORA. The amount of corneal astigmatism correctable via toric IOLs now ranges from 0.83 D with the Trulign to 4.11 D with the AcrySof T9.
Many surgeons have a go-to method: some love LRIs, others not as much. I am in the latter camp. I have always favored toric IOLs over LRIs every time for better postoperative predictability, long-term refractive stability, and extremely satisfied patients. Now that we have a toric accommodative IOL and will eventually have a toric multifocal lens, I will use LRIs less and less. Currently, I only employ LRIs, either using the laser or manually, for astigmatism less than 1.25 D. Certainly financial considerations play a factor in our and our patients’ decisions.
At the time of cataract surgery, what is your preferred method of correcting 1.00 D of WTR cylinder? How about 2.00 D of ATR cylinder?