Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice Pattern

Toric intraocular lenses (IOLs) have been a game-changer for addressing patients with cataract and significant preexisting corneal astigmatism. With increasing demands and expectations of the patients, there is now a greater responsibility on part of anterior segment surgeons to offer a postoperativ...

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Main Authors: Sanjay Chaudhary, Alka Pandey, Anju Sharma, Rahil Chaudhary, Hema Mehra, Nishtha Khurana, Divya Vermani, Ritu Nagpal
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2023-01-01
Series:Delhi Journal of Ophthalmology
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Online Access:https://journals.lww.com/10.4103/DLJO.DLJO_14_23
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author Sanjay Chaudhary
Alka Pandey
Anju Sharma
Rahil Chaudhary
Hema Mehra
Nishtha Khurana
Divya Vermani
Ritu Nagpal
author_facet Sanjay Chaudhary
Alka Pandey
Anju Sharma
Rahil Chaudhary
Hema Mehra
Nishtha Khurana
Divya Vermani
Ritu Nagpal
author_sort Sanjay Chaudhary
collection DOAJ
description Toric intraocular lenses (IOLs) have been a game-changer for addressing patients with cataract and significant preexisting corneal astigmatism. With increasing demands and expectations of the patients, there is now a greater responsibility on part of anterior segment surgeons to offer a postoperative uncorrected visual acuity of 6/6. At present, majority of surgeons rely on the “measured” values of anterior corneal astigmatism and “predicted” values of posterior corneal astigmatism to calculate the final IOL power and the axis of the toric IOL. Such a practice, at times, has been shown to result in unexpected postoperative refractive outcomes. We have had situations where the anterior corneal curvature values suggested using a spherical IOL, while the measured total corneal astigmatism values suggested implanting a toric IOL to minimize the postoperative residual astigmatism. Not only this, we also encountered situations where the axis of the anterior corneal curvature is not in concordance with that of the total corneal power. Differences as high as 8° have been witnessed. Implanting a toric IOL solely based on the magnitude and axis of the anterior corneal astigmatism would have resulted in residual astigmatic errors. In this article we intend to elaborate on the available literature regarding the contribution of the posterior corneal surface toward the total corneal power. We would also provide some of our clinical scenarios which changed our practice pattern for IOL calculations and discuss future applications of this information.
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spelling doaj-art-76566e366bb54d4b9886380c7db8bb232025-08-20T03:11:14ZengWolters Kluwer Medknow PublicationsDelhi Journal of Ophthalmology0972-02002454-27842023-01-01331656910.4103/DLJO.DLJO_14_23Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice PatternSanjay ChaudharyAlka PandeyAnju SharmaRahil ChaudharyHema MehraNishtha KhuranaDivya VermaniRitu NagpalToric intraocular lenses (IOLs) have been a game-changer for addressing patients with cataract and significant preexisting corneal astigmatism. With increasing demands and expectations of the patients, there is now a greater responsibility on part of anterior segment surgeons to offer a postoperative uncorrected visual acuity of 6/6. At present, majority of surgeons rely on the “measured” values of anterior corneal astigmatism and “predicted” values of posterior corneal astigmatism to calculate the final IOL power and the axis of the toric IOL. Such a practice, at times, has been shown to result in unexpected postoperative refractive outcomes. We have had situations where the anterior corneal curvature values suggested using a spherical IOL, while the measured total corneal astigmatism values suggested implanting a toric IOL to minimize the postoperative residual astigmatism. Not only this, we also encountered situations where the axis of the anterior corneal curvature is not in concordance with that of the total corneal power. Differences as high as 8° have been witnessed. Implanting a toric IOL solely based on the magnitude and axis of the anterior corneal astigmatism would have resulted in residual astigmatic errors. In this article we intend to elaborate on the available literature regarding the contribution of the posterior corneal surface toward the total corneal power. We would also provide some of our clinical scenarios which changed our practice pattern for IOL calculations and discuss future applications of this information.https://journals.lww.com/10.4103/DLJO.DLJO_14_23posterior corneal astigmatismtoric intraocular lenstotal corneal astigmatism
spellingShingle Sanjay Chaudhary
Alka Pandey
Anju Sharma
Rahil Chaudhary
Hema Mehra
Nishtha Khurana
Divya Vermani
Ritu Nagpal
Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice Pattern
Delhi Journal of Ophthalmology
posterior corneal astigmatism
toric intraocular lens
total corneal astigmatism
title Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice Pattern
title_full Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice Pattern
title_fullStr Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice Pattern
title_full_unstemmed Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice Pattern
title_short Calculating the Power of Toric Intraocular Lens using Total Corneal Astigmatism Measured by a Swept-Source Optical Coherence Tomography-Based Device: An Observation which Changed our Practice Pattern
title_sort calculating the power of toric intraocular lens using total corneal astigmatism measured by a swept source optical coherence tomography based device an observation which changed our practice pattern
topic posterior corneal astigmatism
toric intraocular lens
total corneal astigmatism
url https://journals.lww.com/10.4103/DLJO.DLJO_14_23
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