Toric IOLs routine or exception?

For many years, the surgical technique of cataract removal, phacoemulsification or FLACS, has been discussed at various international conferences, but mainly the functional results that can be achieved on the patient.
Thus, a clinical and instrumental diagnostic pathway is produced that is absolutely indispensable and fundamental for performing refractive surgery of the crystalline lens, which thus becomes to all intents and purposes vision rehabilitation.
On the basis of this philosophy, 'l'Oculista Italiano' wanted to produce a simple but practical brochure, which clearly and competently addresses the issues that arise during this process.
The opinion of qualified international leaders well known to the general public, both European and Italian, is the way to offer a broad, elegant and impeccable overview.
Having clear Fundamental concepts for choosing the ideal patient and targeting toric IOL surgery is the abc to start with.
This pre-operative phase is the subject of the interview with the Professor José Guellwhose scientific and professional curriculum is well known to us all. Suffice it to say that he was President of the ESCRS a few years ago. His qualified and objective opinion will help the still uncertain surgeon to cross that border between addressing to a toric IOL surgery or to exclude.
But, of course, the toric lens must be chosen, calculated, even before being implanted in the operating room. That is why we sought the opinion and advice of the Professor Noel Alpins, an Australian ophthalmologist who has for many years devoted his studies and research to the development of mathematical systems for the calculation of IOLs.
His experience and ingenuity allowed him to create, in a short time, an online calculator dedicated to SIFI Med Tech's brand new Mini Toric lens, which has already enabled numerous Colleges in Italy to successfully carry out the first implants, with functional results that have delighted the surgeon and even more so the patients.
Everything about the post-operative step management was entrusted to the experience of Professor Gerd U. Auffarth who, on the basis of his extensive clinical case history and his important clinical and surgical contributions, could only be the ideal host of this international panel.
From him, practical advice both on the final choices, immediately close to the surgical act, and on solving those small problems that may occur in the immediate post-operative period. His anatomo-pathological expertise also led us to ask him for an opinion on the stability of toric lenses in the sac.
Finally, at the Professor Ozana Moraru who has participated in numerous congresses in Italy, has been entrusted with the task of answering some questions concerning toric IOL surgery, due to his surgical experience and extensive case histories of simple and complex cases, filtered through his critical power.
This special edition of 'l'Oculista Italiano' comes out on the occasion of the XXXIV ESCRS Congress is thus intended to be a small but juicy sign of how a company with decades of tradition behind it has instead, and already has for some time, set its sights on the future.
The production of a complete line of intraocular lenses, of high quality and with excellent functional results, is now a market reality.
The pre-loaded Mini Ready lenses, the Mini Well lens with EDOF optical technology, and since a few months the new Mini Toric, are the different solutions available to us.
It is the clinical situation and the surgeon's experience that will produce the best choice and thus the best result.

Vittorio Picardo
Scientific coordinator

E-mail: eyeboss@vittoriopicardo.191.it

Read this article in English

TORIC IOLS: ROUTINE OR EXCEPTION IN CATARACT SURGERY?
It has been a long time since cataract surgery has evolved into a refractive procedure for the crystalline lens surgery.
The removal of the lens, which can be more or less clouded, and the implant of an IOL aims at the correction of the pre-operative refractive error providing a postsurgical ametropia that improves quality and quantity of the patient's visual acuity.
In order to achieve this target the range of the IOLs available on the market has been widened with the addition of IOLs for the simultaneous correction of presbyopia, with some models of Extended Depth Of Focus (EDOF) IOLs and other kinds of simpler IOLs for the correction of corneal astigmatism: toric IOLs.
Recent international studies report around 20% patients suffering both from cataract and corneal astigmatism, higher than 1.5 D and 30% at least with astigmatism values lower than 1 D.
All of this shows that the problem of the astigmatic patient undergoing cataract surgery is a statistically significant conditionwith immediate practical effects.
For many years we have been discussing at international Congresses not only about the surgical technique of cataract removal, phacoemulsification or FLACS, but mainly the functional outcomes that can be achieved for the patient.
The result is a protocol of clinical procedure and instrumental diagnostics which is absolutely compulsory and essential for a refractive surgery of the crystalline lens, which becomes rehabilitating for the visual function.
According with this behavioral philosophy 'l'Oculista italiano' chose to edit a simple but practical paper, dealing with clearness and expertise of the problems that may arise during these clinical and diagnostic procedures.
The opinions of highly qualified international leaders who are well known to the Italian and European public are the way we would like to provide a wide review that is smart, complete and irreproachable.
Full mastering of some basic concepts to select the ideal patient and address him or her to cataract surgery with toric IOL is the starting point to begin with.
This pre-operative phase is the subject of an interview with Professor José L Güell whose scientific and professional CV is well known to everybody.
Let's mention that a few years ago he was President of the ESCRS.
His qualified and objective opinion will help the eye surgeon who is still uncertain whether to cross the border which separates the choice of surgery with or without toric IOLs. Of course the lens must be chosen and calculated just before being implanted in our patient.
For this reason we have asked opinion and advice to Professor Noel Alpins, Australian ophthalmologist, who has dedicated, his studies and research to the development of mathematical system for IOL power calculation for many years.
Experience and invention allowed him to implement, in a short time, an online Calculator customised for the latest Mini Toric Ready IOL by SIFI Medtech, which was very useful for many Colleagues in Italy to realise the first successful implants, with functional outcomes that have arisen the enthusiasm of the surgeon and even more of the patients.
Everything concerning the management of the post-operative step is entrusted to the expertise of Professor Gerd U. Auffarth who is the ideal guest of this international panel for his huge clinical records and his important clinical and surgical studies.
He provides us with practical advice both concerning the final choices, immediately close to the surgical operation, and the solution of the small problems which can occur in the immediate post-operative phase.
His patho-anatomical expertise is the reason we asked just his opinion about the stability of the toric IOLs inside the sac.
At the end, Professor Ozana Moraru, who has been speaker at many meetings in Italy, is committed to the task of answering some questions concerning the surgery with toric IOLs, for her wide experience and high records of simple and complex cases, filtered by her critical knowledge.
This special edition of 'l'Oculista Italiano', published on the occasion of XXXIV Congress of the ESCRS, is a small but thorough mark of where the Company with a longtime legacy has, for some time, placed itsfuture goals.
The production of a complete line of high-quality intraocular lenses with excellent functional results is now a market reality.
Pre-loaded Mini Ready IOLs , Mini Well EDOF IOL optic technology, and recently the new Mini Toric Ready, are the new solutions available for us.
It will be the clinical condition and the surgeon's experience to bear the best choice and therefore the best outcome.

Vittorio Picardo
Scientific coordinator