![]() These systems use preoperative images and intraoperative reference points to guide orientation of the lens. Image-guided systems allow the surgeon to skip marking the axis preoperatively. IMAGE-GUIDED TOOLS WITH MANUAL TECHNIQUES The tips are available in visible-spectrum or infrared formulas, the latter of which is helpful for marking prior to use of a femtosecond laser. The marks themselves are small, helping to avoid the bleeding of ink that can occur if the surface is moist or a large pen tip is used. The device ensures that the surgeon is not creating error by tilting the marking pen. The self-leveling component of the marker is a dual pendular weight system, and the marks are made by single-use, sterile-tip fins with a dry-marking formula. The fixation light helps to replicate the position of the patient’s eye that was identified when the astigmatism was measured preoperatively. The Robomarker (Surgilum) is a self-leveling corneal marker with pre-inked, sterile, disposable tips and an integrated fixation light. Also, one can rotate the slit beam on the slit lamp to the meridian of interest and mark it there. Several types of markers are available, including bubble markers, pendular markers, tonometer markers, and so on. Weighted markers can assist in ensuring that the marks are as accurate as possible. Important tips include ensuring that the patient is sitting upright and staring at a distance target while the surgeon makes small, accurate marks. Excellent results can be achieved when care is taken to properly mark the eye. MANUAL TOOLSĭespite an array of tools to determine axial alignment, many surgeons still utilize manual marking. However, newer tools and technologies are now available to ensure proper alignment of the toric IOL. Traditionally, the surgeon’s only option was to manually mark the eye with a marking pen while the patient was sitting upright. 3 Therefore, it is important to mark the axis prior to surgery. ![]() Studies have shown that eyes may undergo as much as 2º to 10º of cyclotorsion when patients lie flat. 2 There are two independent but equally critical steps to ensure optimal toric IOL alignment: intraoperative measurement to ensure that the steep meridian has been accurately determined and accurate alignment of the toric IOL once the steep meridian has been verified. Therefore, if a toric lens is 30º off its intended axis, the toric effect is completely neutralized. Each degree of toric misalignment causes approximately 3% of the toric power of the IOL to be lost. One important step is to ensure that the IOL lines up correctly with the target axis. This article examines those steps and the tools needed to accomplish them. 1 Toric IOLs can provide excellent correction for regular astigmatism in the setting of cataract extraction or refractive lens exchange, but key steps must be considered. Astigmatism of 0.75 D or greater will frequently compromise patients’ distance visual acuity, and therefore astigmatic correction should be incorporated as an essential part of any refractive cataract surgery procedure. To optimize refractive outcomes after cataract extraction, surgeons must address astigmatism. The Xen Gel Stent in Pseudophakic Refractory Glaucoma Patients I Found an IOL Likely To Result in Fewer IOL Exchanges The Family of AcrySof IQ IOLs Helps Us Customize the Approach to Vision Correction I Waited Until I Found the Right Technology to Offer my Patients I Wanted to Have a Presbyopia Correcting Option to Offer Post-LASIK Patients I Was Searching for an IOL Designed to Reduce the Potential for Dysphotopsias I Wanted an IOL That Offered Uncompromised Distance and Excellent Contrast Sensitivity High-Volume DUOVISC XL OVD Ideal for Intraoperative Aberrometry ![]() The Right Patients, The Right Device: A MIGS Case Study The Contrasts Between Managing and Leading Strategies That Can Bring in New BusinessĬRST Readers Comment on Encounters With Dangerous Patients Incentivizing Your Staff to Exceed Expectations Government Boosting Efforts to Recover Funds Lost to Fraud and AbuseĬybersecurity for the Ophthalmic Practice Optimize the Ocular Surface to Determine Precise IOL Power Eye Pain and Strain That Masquerade as Dry Eye
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