AcrySof IQ ReStor +2.50 D (Alcon) features the company’s ActiveFocus optical design with seven diffractive steps. It has a distance center with a large peripheral zone that allows more light to the distance focal point as the pupil diameter increases and an apodized diffractive multifocal zone. This IOL is designed for individuals with an active lifestyle wanting distance and intermediate vision.2
If the patient has 1.00 D or more of corneal cylinder, we opt for toric IOL instead of a standard implant.
AcrySof IQ Toric (Alcon) IOL is a biconvex toric with aspheric design and ranges from +6.0 to +34.0 with seven cylinder powers. I use the company’s online calculator (acrysoftoriccalculator.com) to calculate the toric power and axis placement.
I also use an online visual simulator which shows patients simulated visual results with an IOL for activities including golfing, gardening, shopping, and night driving. Enter the patient’s astigmatism, level of cataract development, and IOL option to demonstrate the visual outcome. Obviously, results may vary, but it is a great way to demonstrate a patient’s expected visual results with various IOL options.
We also implement the ORA System with VerifEye+ technology. It offers real-time intraoperative IOL sphere, cylinder, and alignment suggestions. This is especially useful in the operating room for patients with a history of refractive surgery, including LASIK, PRK, and RK procedures. It helps to account for both anterior and posterior corneal astigmatism. The goal is to reduce the incidence of unintended residual postoperative astigmatism.2
After the surgery
Complications associated with cataract surgery are rare. Cataract surgery is one of the most successful procedures performed in the United States.8 However, it can include bleeding, retinal detachment, and infection. I assure patients that they will be using antibiotics to prevent infection. Bleeding is usually limited to the conjunctiva and will resolve in one to two weeks.
We let our patients know there are no restrictions. I tell them they can bend, lift, shower, shampoo, and do all their usual activities. We ask them to avoid swimming or hot tubs for a week. Patients can usually drive after the one-day postoperative appointment as long as pupil dilation is resolving and they feel comfortable driving. Always check the visual acuity of both eyes. It is common courtesy to send a short postoperative report to the surgeon.
1. Carl Zeiss. Zeiss presents the new IOLMaster 700 for better predictability and optimized workflows in cataract surgery. Available at: https://www.zeiss.com/meditec/int/media-news/press-releases/iolmaster-700-with-swept-source-biometry.html. Accessed 3/15/17.
2. Alcon. The AcrySof Advantage. Available at: https://www.myalcon.com/products/surgical/acrysof-iq-cataract-iols/index.shtml. Accessed 3/15/17.
3. Marco. OPD-SCAN III Wavefront Aberrometer. Available at: https://marco.com/products/wavefront-aberrometry/opd-scan-iii-wavefront-aberrometer/. Accessed 3/15/17.
4. Nagy ZZ, Kránitz K, Takacs AI, Miháltz K, Kovács I, Knorz MC. Comparison of intraocular lens decentration parameters after femtosecond and manual capsulotomies J Refract Surg. 2011 Aug;27(8):564-9.
5. Moshirfar M, Hoggan RN, Muthappan V. Angle Kappa and its importance in refractive surgery. Oman J Ophthalmol. 2013 Sep;6(3):151-8.
6. Gordon-Shaag A, Millodot M, Ifrah R, Shneor E. Aberrations and topography in normal, keratoconus-suspect, and keratoconic eyes. Optom Vis Sci. 2012 Apr;89(4):411-8.
7. Seok Song I, Hoon Park J, Hyoung Park H, Young Moon S, Yong Kim J, Joon Kim M, Tchah H. Corneal coma and trefoil changes associated with incision location in cataract surgery. J Cataract Refract Surg. 2015 Oct;41(10):2145-2151.
8. Torpy JM, Lynm C, Glass RM. Cataracts. JAMA. 2003;290(2):286.