touchOPHTHALMOLOGY touchOPHTHALMOLOGY
Corneal and External Disorders, Refractive Surgery
Read Time: 2 mins

Toric Intraocular Lens Implants for Astigmatism

Copy Link
Published Online: May 22nd 2012 European Ophthalmic Review, 2012;6(3):164–8 DOI: http://doi.org/10.17925/EOR.2012.06.03.164
Authors: Irene C Kuo, Victor E Reviglio
Quick Links:
Abstract
Article
Article Information
Abstract:
Overview

Toric intraocular lenses are available in our surgical armamentarium for use in cataract surgery, refractive lens exchange, phakic lens procedures and multifocal lens procedures. These lens implants enjoy a high level of success in terms of post-operative uncorrected visual acuity, astigmatism correction and safety. With time, toric phakic lens implants, not available worldwide, may gain popularity as more surgeons gain comfort and confidence in offering and performing an elective intraocular procedure.

Keywords

Toric, astigmatism, intraocular lens implant, phakic lens implant, toric

Article:

There are many options to treat corneal astigmatism in patients undergoing cataract surgery. This refractive error is found in 15–29 % of prospective cataract patients.1–3 Astigmatic keratotomy at the time of surgery is one option, but although a powerful tool, such corneal relaxing incision has limited predictability and may result in overcorrection – especially in older patients or in patients with lower levels of astigmatism – or undercorrection in younger patients. Limbal relaxing incisions may have better predictability, but wound healing (and concomitant over- or undercorrection) can still be an issue. Another option is to inform patients who choose a monofocal intraocular lens (IOL) that they can undergo excimer laser refractive surgery after cataract surgery in order to correct the anticipated residual corneal astigmatism.

A third option is to consider a toric IOL in patients with pre-operative and anticipated post-operative corneal astigmatism. First described in the ophthalmic peer-review literature in 1994,4 toric IOLs are gaining popularity. The mechanics of small incision cataract extraction are unchanged and toric (monofocal) IOL implantation remains the same except for marking the proper axis on the cornea or limbus and implanting an IOL at that axis. Moreover, toric lens implants are no longer solely the purview of surgeons performing cataract surgery. This article will examine the option of toric IOLs to correct corneal astigmatism during cataract extraction, clear lens extraction, or as a phakic procedure.

History and Overview
One of the first reports in the literature of a toric IOL implant described results obtained with the Nidek NT-98B, a three-piece posterior chamber lens with an oval optic (6.5 x 5.5 mm) and two positioning holes on its major axis.4 It had a toric correction on the concave posterior surface and the axis of cylinder lay on the minor axis of the lens. The anterior surface had a convex surface for implantation in eyes with against-the-rule corneal astigmatism. Therefore, the lens had to bepositioned so that the line linking the positioning holes of the cylinder IOL (the lens axis) lay horizontally. From a review of the literature, this model is no longer available.

To view the full article in PDF or eBook formats, please click on the icons above.

Article Information:
Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Irene C Kuo, Cornea and Refractive Surgery Services, Wilmer Eye Institute, 4924 Campbell Blvd. #100, Baltimore, MD, 21236, US. E: ickuo@jhmi.edu

Support

Supported by an unrestricted grant from Research to Prevent Blindness, New York, US.

Received

2012-01-06

References

  1. Woodcock M, Shah, S, Smith RJ, Recent advances in
    customizing cataract surgery, BMJ, 2004;328:92–6.

  2. Hoffer KH, Biometry of 7,500 cataractous eyes,
    Am J Ophthalmol, 1980;90:360–8; correction 890.

  3. Ninn-Pedersen K, Stenevi U, Ehinger B, Cataract patients in
    a defined Swedish population 1986-1990. 11: Preoperative
    observations, Acta Ophthalmol (Copenh), 1994; 72(1):10–5.

  4. Shimizu K, Misawa A, Suzuki Y, Toric intraocular lenses:
    correcting astigmatism while controlling axis shift,
    J Cataract Refract Surg, 1994;20:523–6.

  5. Gills JP, Treating astigmatism at the time of cataract
    surgery, Curr Opin Ophthalmol, 2002;13:2–6.

  6. Sun X-Y, Vicary D, Montgomery P, Griffiths M, Toric
    intraocular lenses for correcting astigmatism in 130 eyes,
    Ophthalmology, 2000;107:1776–82.

  7. Visser N, Nuijits RM, de Vries NE, Bauer NJC, Visual
    outcomes and patient satisfaction after cataract surgery
    with toric multifocal intraocular lens implantation,
    J Cataract Refract Surg, 2011;47:2034–42.

  8. Navas A, Suárez R, One-year follow-up of toric intraocular
    lens implantation in forme fruste keratoconus,
    J Cataract Refract Surg, 2009;35(11):2024–7.

  9. Kamiya K, Shimizu K, Ando W, et al., Phakic toric
    Implantable Collamer Lens implantation for the correction
    of high myopic astigmatism in eyes with keratoconus,
    J Refract Surg, 2008;24(8):840–2.

  10. Alfonso JF, Fernández-Vega L, Lisa C, et al., Collagen copolymer
    toric posterior chamber phakic intraocular lens in eyes with
    keratoconus, J Cataract Refract Surg, 2010;36(6):906–16.

  11. Kamiya K, Shimizu K, Kobashi H, et al., Clinical outcomes of
    posterior chamber toric phakic intraocular lens implantation
    for the correction of high myopic astigmatism in eyes with
    keratoconus: 6-month follow-up, Graefes Arch Clin Exp
    Ophthalmol, 2011;249(7):1073–80.

  12. Sedaghat M, Ansari-Astaneh MR, Zarei-Ghanavati M, et al.,
    Artisan iris-supported phakic IOL implantation in patients
    with keratoconus: a review of 16 eyes, J Refract Surg,
    2011;27(7):489–93.

  13. Visser N, Gast ST, Bauer NJ, Nuijts RM, Cataract surgery
    with toric intraocular lens implantation in keratoconus: a
    case report, Cornea, 2011;30(6):720–3.

  14. Jaimes M, Xacur-García F, Alvarez-Melloni D, et al.,
    Refractive lens exchange with toric intraocular lenses in
    keratoconus, J Refract Surg, 2011;27(9):658–64.

  15. Luck J, Customized ultra-high-power toric intraocular lens
    implantation for pellucid marginal degeneration and
    cataract, J Cataract Refract Surg, 2010;36:1235–8.

  16. Guell JL, Morral M, Kook D, Kohnen T, Phakic intraocular
    lenses. Part 1: Historical overview, current models,
    selection criteria, and surgical techniques,
    J Cataract Refract Surg, 2010;36:1976–93.

  17. Carey PJ, Leccisotti A, McGilligan VE, et al., Assessment of
    toric intraocular lens alignment by a refractive
    power/corneal analyzer system and slitlamp observation,
    J Cataract Refract Surg, 2010;36(2):222–9.

  18. Cha D, Kang SY, Kim SH, et al., New axis-marking method
    for a toric intraocular lens: mapping method, J Refract Surg,
    2011;27(5):375–9.

  19. Naeser K, Hjortdal J, Polar value analysis of refractive data,
    J Cataract Refract Surg, 2001;27:86–94.

  20. Chang DF, Comparative rotational stability of single-piece
    open-loop acrylic and plate-haptic silicone toric intraocular
    lenses, J Cataract Refract Surg, 2008;34(11):1842–7.

  21. Chang DF, Early rotational stability of the longer Staar
    toric intraocular lens: fifty consecutive cases,
    J Cataract Refract Surg, 2003;29(5):935–40.

  22. Lee SY, Kwon HJ, Ahn HS, et al., Comparison of patient
    outcomes after implantation of Visian toric implantable
    collamer lens and iris-fixated toric phakic intraocular lens,
    Eye, 2011;23:1409–17.

  23. Novis C, Astigmatism and toric intraocular lenses,
    Curr Opin Ophthalmol, 2000;11:47–50.

  24. Ma JJK, Tseng SS, Simple method for accurate alignment of
    toric phakic and aphakic intraocular lens implantation,
    J Cataract Refract Surg, 2008; 34:1631–6.

  25. Till JS, Yoder PR, Wilcox TK, Spielman JL, Toric
    intraocular lens implantation: 100 consecutive
    cases, J Cataract Refract Surg, 2002;28:295–301.

Further Resources

Share this Article
Related Content In Refractive Surgery
  • Copied to clipboard!
    accredited arrow-down-editablearrow-downarrow_leftarrow-right-bluearrow-right-dark-bluearrow-right-greenarrow-right-greyarrow-right-orangearrow-right-whitearrow-right-bluearrow-up-orangeavatarcalendarchevron-down consultant-pathologist-nurseconsultant-pathologistcrosscrossdownloademailexclaimationfeedbackfiltergraph-arrowinterviewslinkmdt_iconmenumore_dots nurse-consultantpadlock patient-advocate-pathologistpatient-consultantpatientperson pharmacist-nurseplay_buttonplay-colour-tmcplay-colourAsset 1podcastprinter scenerysearch share single-doctor social_facebooksocial_googleplussocial_instagramsocial_linkedin_altsocial_linkedin_altsocial_pinterestlogo-twitter-glyph-32social_youtubeshape-star (1)tick-bluetick-orangetick-red tick-whiteticktimetranscriptup-arrowwebinar Sponsored Department Location NEW TMM Corporate Services Icons-07NEW TMM Corporate Services Icons-08NEW TMM Corporate Services Icons-09NEW TMM Corporate Services Icons-10NEW TMM Corporate Services Icons-11NEW TMM Corporate Services Icons-12Salary £ TMM-Corp-Site-Icons-01TMM-Corp-Site-Icons-02TMM-Corp-Site-Icons-03TMM-Corp-Site-Icons-04TMM-Corp-Site-Icons-05TMM-Corp-Site-Icons-06TMM-Corp-Site-Icons-07TMM-Corp-Site-Icons-08TMM-Corp-Site-Icons-09TMM-Corp-Site-Icons-10TMM-Corp-Site-Icons-11TMM-Corp-Site-Icons-12TMM-Corp-Site-Icons-13TMM-Corp-Site-Icons-14TMM-Corp-Site-Icons-15TMM-Corp-Site-Icons-16TMM-Corp-Site-Icons-17TMM-Corp-Site-Icons-18TMM-Corp-Site-Icons-19TMM-Corp-Site-Icons-20TMM-Corp-Site-Icons-21TMM-Corp-Site-Icons-22TMM-Corp-Site-Icons-23TMM-Corp-Site-Icons-24TMM-Corp-Site-Icons-25TMM-Corp-Site-Icons-26TMM-Corp-Site-Icons-27TMM-Corp-Site-Icons-28TMM-Corp-Site-Icons-29TMM-Corp-Site-Icons-30TMM-Corp-Site-Icons-31TMM-Corp-Site-Icons-32TMM-Corp-Site-Icons-33TMM-Corp-Site-Icons-34TMM-Corp-Site-Icons-35TMM-Corp-Site-Icons-36TMM-Corp-Site-Icons-37TMM-Corp-Site-Icons-38TMM-Corp-Site-Icons-39TMM-Corp-Site-Icons-40TMM-Corp-Site-Icons-41TMM-Corp-Site-Icons-42TMM-Corp-Site-Icons-43TMM-Corp-Site-Icons-44TMM-Corp-Site-Icons-45TMM-Corp-Site-Icons-46TMM-Corp-Site-Icons-47TMM-Corp-Site-Icons-48TMM-Corp-Site-Icons-49TMM-Corp-Site-Icons-50TMM-Corp-Site-Icons-51TMM-Corp-Site-Icons-52TMM-Corp-Site-Icons-53TMM-Corp-Site-Icons-54TMM-Corp-Site-Icons-55TMM-Corp-Site-Icons-56TMM-Corp-Site-Icons-57TMM-Corp-Site-Icons-58TMM-Corp-Site-Icons-59TMM-Corp-Site-Icons-60TMM-Corp-Site-Icons-61TMM-Corp-Site-Icons-62TMM-Corp-Site-Icons-63TMM-Corp-Site-Icons-64TMM-Corp-Site-Icons-65TMM-Corp-Site-Icons-66TMM-Corp-Site-Icons-67TMM-Corp-Site-Icons-68TMM-Corp-Site-Icons-69TMM-Corp-Site-Icons-70TMM-Corp-Site-Icons-71TMM-Corp-Site-Icons-72