Introduction of a Toric Intraocular Lens to a Non-Refractive Cataract Practice: Challenges and Outcomes Clare Kirwan 1,2,3,* , John M Nolan 3 , Jim Stack 3 , Ian Dooley 4 , Johnny Moore 1 , Tara CB Moore 1 , and Stephen Beatty 2,3 1 Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland 2 Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland 3 Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland 4 University College Hospital Limerick, Ireland Abstract Aim—To identify challenges inherent in introducing a toric intraocular lens (IOL) to a non- refractive cataract practice, and evaluate residual astigmatism achieved and its impact on patient satisfaction. Methods—Following introduction of a toric IOL to a cataract practice with all procedures undertaken by a single, non-refractive, surgeon (SB), pre-operative, intra-operative and post- operative data was analysed. Attenuation of anticipated post-operative astigmatism was examined, and subjectively perceived visual functioning was assessed using validated questionnaires. Results—Median difference vector (DV, the induced astigmatic change [by magnitude and axis] that would enable the initial surgery to achieve intended target) was 0.93D; median anticipated DV with a non-toric IOL was 2.38D. One eye exhibited 0.75D residual astigmatism, compared to 3.8D anticipated residual astigmatism with a non-toric IOL. 100% of respondents reported satisfaction of ≥ 6/10, with 37.84% of respondents entirely satisfied (10/10). 17 patients (38.63%) reported no symptoms of dysphotopsia (dysphoptosia score 0/10), only 3 respondents (6.8%) reported a clinically meaningful level of dysphotopsia (≥ 4/10). Mean post-operative NEI VF-11 score was 0.54 (+/-0.83; scale 0 – 4). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. * Corresponding author: Clare Kirwan, Macular Pigment Research Group, Carriganore House, Waterford Institute of Technology, Waterford, Ireland, Tel: 00353879197351, [email protected]. Conflict of Interest Statement All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Ethical Statement This study adhered to the tenets of the Declaration of Helsinki, and the local ethics committee (Research Ethics Committee, Health Service Executive, South Eastern Area, Ireland) gave approval as it represents clinical audit and, therefore, best clinical practice. Europe PMC Funders Group Author Manuscript Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07. Published in final edited form as: Int J Ophthalmol Clin Res. ; 3(2): . Europe PMC Funders Author Manuscripts Europe PMC Funders Author Manuscripts
19
Embed
Introduction of a Toric Intraocular Lens to a Non-Refractive …€¦ · · 2017-02-27Cataract Practice: Challenges and Outcomes Clare ... Macular Pigment Research Group, Carriganore
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Introduction of a Toric Intraocular Lens to a Non-Refractive Cataract Practice: Challenges and Outcomes
Clare Kirwan1,2,3,*, John M Nolan3, Jim Stack3, Ian Dooley4, Johnny Moore1, Tara CB Moore1, and Stephen Beatty2,3
1Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland 2Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland 3Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland 4University College Hospital Limerick, Ireland
Abstract
Aim—To identify challenges inherent in introducing a toric intraocular lens (IOL) to a non-
refractive cataract practice, and evaluate residual astigmatism achieved and its impact on patient
satisfaction.
Methods—Following introduction of a toric IOL to a cataract practice with all procedures
undertaken by a single, non-refractive, surgeon (SB), pre-operative, intra-operative and post-
operative data was analysed. Attenuation of anticipated post-operative astigmatism was examined,
and subjectively perceived visual functioning was assessed using validated questionnaires.
Results—Median difference vector (DV, the induced astigmatic change [by magnitude and axis]
that would enable the initial surgery to achieve intended target) was 0.93D; median anticipated DV
with a non-toric IOL was 2.38D. One eye exhibited 0.75D residual astigmatism, compared to 3.8D
anticipated residual astigmatism with a non-toric IOL. 100% of respondents reported satisfaction
of ≥ 6/10, with 37.84% of respondents entirely satisfied (10/10). 17 patients (38.63%) reported no
symptoms of dysphotopsia (dysphoptosia score 0/10), only 3 respondents (6.8%) reported a
clinically meaningful level of dysphotopsia (≥ 4/10). Mean post-operative NEI VF-11 score was
0.54 (+/-0.83; scale 0 – 4).
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.*Corresponding author: Clare Kirwan, Macular Pigment Research Group, Carriganore House, Waterford Institute of Technology, Waterford, Ireland, Tel: 00353879197351, [email protected].
Conflict of Interest StatementAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.
Ethical StatementThis study adhered to the tenets of the Declaration of Helsinki, and the local ethics committee (Research Ethics Committee, Health Service Executive, South Eastern Area, Ireland) gave approval as it represents clinical audit and, therefore, best clinical practice.
Europe PMC Funders GroupAuthor ManuscriptInt J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Published in final edited form as:Int J Ophthalmol Clin Res. ; 3(2): .
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Conclusion—Use of a toric IOL to manage astigmatism during cataract surgery results in less
post-operative astigmatism than a non-toric IOL, resulting in avoidance of unacceptable post-
lamp estimation of the axis of alignment by rotating a slit beam and aligning with a graticule
is a simple and time-efficient technique, but is prone to error. Alignment can be analysed
using vector analysis of post-operative refraction and keratometry readings, anterior segment
optical coherence tomography, wavefront aberrometry or various digital overlays [28].
Figure 3 outlines some key points in optimal toric IOL implantation.
Conclusion
Toric IOLs are an excellent means for a non-refractive surgeon to avoid unacceptable post-
operative astigmatism, resulting in substantial reduction in post-operative astigmatism
relative to that which would occur were a toric IOL not implanted. Toric IOLs can be
introduced safely to a non-refractive practice with minimal effort, provided certain pitfalls
are avoided.
Acknowledgements
This study was funded by Abbott Medical Optics, Germany.
References
1. Dell S. Screening and evaluating presbyopic patients. Cataract Refract Surg Today. 2007:81–82.
2. Williams KM, Verhoeven VJ, Cumberland P, Bertelsen G, Wolfram C, et al. Prevalence of refractive error in Europe: the European Eye Epidemiology (E(3)) Consortium. Eur J Epidemiol. 2015; 30:305–315. [PubMed: 25784363]
3. Ferrer-Blasco T, Montés-Micó R, Peixoto-de-Matos SC, González-Méijome JM, Cerviño A. Prevalence of corneal astigmatism before cataract surgery. J Cataract Refract Surg. 2009; 35:70–75. [PubMed: 19101427]
4. Lee, Soo Han; Chang, Ji Woong. The Relationship between Higher-order Aberrations and Amblyopia Treatment in Hyperopic Anisometropic Amblyopia. Korean J Ophthalmol. 2014; 28:66–75. [PubMed: 24505201]
5. Dooley I, Charalampidou S, Malik A, Ormonde G, Loughman J, et al. Surgically induced astigmatism after phacoemulsification with and without correction for posture-related ocular cyclotorsion: randomized controlled study. J Cataract Refract Surg. 2010; 36:413–417. [PubMed: 20202538]
Kirwan et al. Page 10
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
6. Saeed A, Guerin M, Khan I, Keane P, Stack J, et al. Deferral of first review after uneventful phacoemulsification cataract surgery until 2 weeks: randomized controlled study. J Cataract Refract Surg. 2007; 33:1591–1596. [PubMed: 17720075]
7. Kirwan C, Nolan JM, Stack J, Moore TC, Beatty S. Determinants of patient satisfaction and function related to vision following cataract surgery in eyes with no visually consequential ocular co-morbidity. Graefes Arch Clin Exp Ophthalmol. 2015; 253:1735–1744. [PubMed: 25968132]
8. Kinard K, Jarstad A, Olson RJ. Correlation of visual quality with satisfaction and function in a normal cohort of pseudophakic patients. J Cataract Refract Surg. 2013; 39:590–597. [PubMed: 23395326]
9. Bailey IL, Lovie-Kitchin JE. Visual acuity testing. From the laboratory to the clinic. Vision Res. 2013; 90:2–9. [PubMed: 23685164]
10. Alpins N. Astigmatism analysis by the Alpins method. J Cataract Refract Surg. 2001; 27:31–49. [PubMed: 11165856]
11. Visser N, Berendschot TT, Bauer NJ, Nuijts RM. Vector analysis of corneal and refractive astigmatism changes following toric pseudophakic and toric phakic IOL implantation. Invest Ophthalmol Vis Sci. 2012; 53:1865–1873. [PubMed: 22408012]
12. Novis C. Astigmatism and toric intraocular lenses. Curr Opin Ophthalmol. 2000; 11:47–50. [PubMed: 10724827]
13. Charalampidou S, Dooley I, Molloy L, Beatty S. Value of dual biometry in the detection and investigation of error in the preoperative prediction of refractive status following cataract surgery. Clin Experiment Ophthalmol. 2010; 38:255–265. [PubMed: 20447121]
14. Dean CB, Nielsen JD. Generalized linear mixed models: a review and some extensions. Lifetime Data Anal. 2007; 13:497–512. [PubMed: 18000755]
15. Waltz KL, Featherstone K, Tsai L, Trentacost D. Clinical Outcomes of TECNIS Toric Intraocular Lens Implantation after Cataract Removal in Patients with Corneal Astigmatism. Ophthalmology. 2014; 122:39–47. [PubMed: 25444352]
16. Sheppard AL, Wolffsohn JS, Bhatt U, Hoffmann PC, Scheider A, et al. Clinical outcomes after implantation of a new hydrophobic acrylic toric IOL during routine cataract surgery. J Cataract Refract Surg. 2013; 39:41–47. [PubMed: 23158681]
17. Mendicute J, Irigoyen C, Aramberri J, Ondarra A, Montés-Micó R. Foldable toric intraocular lens for astigmatism correction in cataract patients. J Cataract Refract Surg. 2008; 34:601–607. [PubMed: 18361982]
18. Gale RP, Saldana M, Johnston RL, Zuberbuhler B, McKibbin M. Benchmark standards for refractive outcomes after NHS cataract surgery. Eye (Lond). 2009; 23:149–152. [PubMed: 17721503]
19. Mazzini C. Visual and refractive outcomes after cataract surgery with implantation of a new toric intraocular lens. Case Rep Ophthalmol. 2013; 4:48–56. [PubMed: 23898293]
20. Hirnschall N, Maedel S, Weber M, Findl O. Rotational stability of a single-piece toric acrylic intraocular lens: a pilot study. Am J Ophthalmol. 2014; 157:405–411. [PubMed: 24332372]
21. Popp N, Hirnschall N, Maedel S, Findl O. Evaluation of 4 corneal astigmatic marking methods. J Cataract Refract Surg. 2012; 38:2094–2099. [PubMed: 23098629]
22. Visser N, Berendschot TT, Bauer NJ, Jurich J, Kersting O, et al. Accuracy of toric intraocular lens implantation in cataract and refractive surgery. J Cataract Refract Surg. 2011; 37:1394–1402. [PubMed: 21782085]
23. Viestenz A, Seitz B, Langenbucher A. Evaluating the eye’s rotational stability during standard photography: effect on determining the axial orientation of toric intraocular lenses. J Cataract Refract Surg. 2005; 31:557–561. [PubMed: 15811745]
25. Miyake T, Kamiya K, Amano R, Iida Y, Tsunehiro S, et al. Long-term clinical outcomes of toric intraocular lens implantation in cataract cases with preexisting astigmatism. J Cataract Refract Surg. 2014; 40:1654–1660. [PubMed: 25149554]
Kirwan et al. Page 11
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
26. Goggin M, Moore S, Esterman A. Toric intraocular lens outcome using the manufacturer’s prediction of corneal plane equivalent intraocular lens cylinder power. Arch Ophthalmol. 2011; 129:1004–1008. [PubMed: 21825184]
27. Sanders DR, Sarver EJ, Cooke DL. Accuracy and precision of a new system for measuring toric intraocular lens axis rotation. J Cataract Refract Surg. 2013; 39:1190–1195. [PubMed: 23889866]
28. Teichman JC, Baig K, Ahmed II. Simple technique to measure toric intraocular lens alignment and stability using a smartphone. J Cataract Refract Surg. 2014; 40:1949–1952. [PubMed: 25316617]
29. Patel CK, Ormonde S, Rosen PH, Bron AJ. Postoperative intra-ocular lens rotation: a randomized comparison of plate and loop haptic implants. Ophthalmology. 1999; 106:2190–2195. [PubMed: 10571358]
Kirwan et al. Page 12
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
induced astigmatism (TIA), (f) difference vector (DV) and (g) difference vector no toric
(DVNT) for 77 eyes in this series.
Kirwan et al. Page 13
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Figure 2. Points to consider before introducing a toric IOL to a non-refractive cataract practice.
Kirwan et al. Page 14
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Figure 3. Implantation of a toric IOL, 8 simple steps.
Kirwan et al. Page 15
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Kirwan et al. Page 16
Table 1(a)
Measures of post-operative visual acuity, and change with respect to respective pre-operative measures of
visual acuity.
Measure n % Mean StDev AvChange p
Group 1
UAVA 34 47.2 86.65 13.16 1.18 0.326
PHVA 5 6.9 86.4 13.1 -2.08 0.276
BCVA 12 16.7 91.18 6.69 3.2 0.216
OptVA 72 100 90.48 11.24 11 0
Group 2
UAVA 43 51.8 93.07 7.25 11.58 0
PHVA 7 8.4 95.08 5.44 4.28 0.267
BCVA 13 15.6 95.08 9.24 5 0.03
OptVA 82 100 95.18 5.18 4.01 0
Group 3
UAVA 4 28.5 96.5 4.35 12.5 0.328
PHVA* - - - - - -
BCVA 3 21.4 98.3 6.65 0 -
OptVA 14 100 92.7 9.99 2.14 0.155
Mean: mean post-operative visual acuity, StDev: Standard deviation, AvChange: Average change in acuity as a result of cataract surgery, UAVA: Unaided visual acuity, PHVA: Pinhole visual acuity, BCVA: Best corrected visual acuity, OptVA: Best measure of visual acuity recorded, p: p value, Group 1: Eyes with pre-operatively observed visually consequential ocular co-morbidity, Group 2: Eyes with no pre-operatively observed visually consequential co-morbidity; Group 3, operated eyes which experienced a post-operative complication
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Kirwan et al. Page 17
Table 1(b)
Measures of post-operative visual acuity, and change with respect to respective pre-operative measures of
visual acuity for eyes with no pre-operative ocular co-morbidity, and who completed the questionnaires.
Measure n % Mean StDev AvChange p
UAVA 20 47.6 94.3 6.01 7.45 0.016
PHVA 5 11.9 94.2 6.38 1.8 0.588
BCVA 5 11.9 94.4 3.71 5.2 0.171
OptVA 42 100 95.61 3.31 3.01 0.003
Mean: Mean post-operative visual acuity, StDev: Standard Deviation, AvChange: Average Change in Acuity as a Result of the Procedure, UAVA: Unaided visual acuity, PHVA: Pinhole visual acuity, BCVA: Best Corrected Visual Acuity, OptVA: Best Visual Acuity Measure Recorded, p: p value from paired samples t-test comparing pre-operative and post-operative acuity
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Kirwan et al. Page 18
Table 2
Categories of dysphotopsia scores, and mean satisfaction score within each category.
Score range Category n % Satisfaction St Dev Range
0-3.99 Sub-clinical 34 91.9 8.74 1.26 6-10
4-5.99 Mild 0 - - - -
6-7.99 Moderate 1 2.7 10 0 10-10
8-10 Severe 2 5.4 8 0 8-8
Total 37 100 8.81 1.25 6-10
Score range: PDQ score range, Category: Clinical Classification of Dysphotopsia, %: Percentage of Respondents with Pseudophakic Dysphotopsia Scores within the Stated Range, Satisfaction: Corresponding Mean Satisfaction Score, StDev: Standard Deviation
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.
Europe PM
C Funders A
uthor Manuscripts
Europe PM
C Funders A
uthor Manuscripts
Kirwan et al. Page 19
Table 3
Summary of vector analysis post toric intraocular lens implantation.
TIA: target induced astigmatic vector, mag: magnitude, SIA: surgically induced astigmatic vector, DV: difference vector, CI: correction index (ideal value 1), ME: magnitude of error (ideal value 0), AE: angle of error (ideal value 0), IOS: index of success (ideal value 0), DVNT: difference vector, no toric - the vector that describes the difference between the actual post-operative result and that predicted by the Alcon calculation (i.e., the astigmatism which would have to be induced to undo the toric IOL component), DVR: the difference vector ratio (the ratio of DVNT magnitude to DV magnitude)
Int J Ophthalmol Clin Res. Author manuscript; available in PMC 2016 November 07.