EW SHOW DAILY
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Biometry and lens constant optimi-
zation resources can help minimize
SIA, keeping in mind that the ante-
rior corneal vector has both magni-
tude and direction. Astigmatism is
measured manually, with the use of
autorefractometers, Placido images
(critical), and biometry. Posterior
corneal astigmatism is essentially a
minus lens acting like against-the-
rule astigmatism. If eye surgeons
only use anterior corneal measure-
ments, their calculations will be
off, she explained. Posterior corneal
astigmatism must be incorporated
using, for instance, the Baylor no-
mogram or the Barrett toric calcula-
tor. Anterior and posterior corneal
astigmatism can be measured using
Scheimpflug devices, horizontal slit
lamp beam, dual Scheimpflug, LED,
and anterior segment OCT.
John Hovanesian, MD, Laguna
Hills, California, went on to discuss
the important issue of postoperative
management of toric IOL patients.
"Most patients' fears do not revolve
around losing their sight, only un-
der 10%. They fear needing glasses
or having blurry vision," he said,
highlighting patients' demand for
excellent vision. A patient's satis-
faction increases with decreasing
A
ttendees made their way
to West Hall B early Mon-
day morning for the Eye-
World CME Event "Pairing
Astigmatism Patients
with the Optimal Technology: What
Would You Do?"
Astigmatism management im-
pacts patient satisfaction, premium
IOL eligibility, and quality of vision,
according to Nicole Fram, MD, Los
Angeles, which is why she urges
cataract and refractive surgeons to
watch the ocular surface, use at least
three different tools to calculate
toric power, and understand the
implications of posterior corneal
astigmatism.
Dr. Fram said that the key to
toric IOL success involves achieving
as close to target cylinder as possi-
ble. Anything over 0.5 D of residual
cylinder leaves patients symptom-
atic. The assumption, of course,
is that the cornea is measureable.
Ocular surface disease, including
dysfunctional tear syndrome, epithe-
lial basement membrane dystrophy
(EBMD), pterygium, nodules, upper
eye lid chalazion, and corneal ecta-
sia affect keratometry, can radically
affect outcomes, and require treat-
ment and renewed biometry prior to
IOL power calculations.
Surgeons need to keep an eye on
surgically induced astigmatism (SIA).
by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer
Torics and astigmatism:
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Dr. Fram explains the complexities of astigmatism management.
continued on page 58
