Demand for corrective surgery for astigmatism cleared for takeoff

As the number of premium IOLs grows, along with the demand for cataract surgeries and the population of patients in their mid-50s and 60s, optometrists are poised to take an essential role in preparing patients and performing preoperative testing, according to Douglas K. Devries, OD.

IOLs and LRIs used in tandem

Premium IOLs, including toric lenses, make up 10% to 15% of the market, but that number will grow, according to Dr. Devries. As it does, optometrists will increasingly be the key source of information about these IOLs, he said. Currently, two types of toric lenses are on the market: the STAAR Surgical toric and the Alcon AcrySof IQ toric. The STAAR toric comes in 2.00 D and 3.50 D. Alcon's lens has a greater range of power, 1.50 D to 6.00 D.

The pre-op work-up

The preoperative care before astigmatism correction with an LRI or IOL begins with a comprehensive exam, including accurate refraction, manual keratotomy, corneal evaluation (look for presence of guttata, deficient tear syndrome, or blepharitis or meibomian gland disease), and dilated fundus exam.

Pachymetry is also an essential part of the evaluation. It helps ensure that a correction can be made with the excimer laser if the initial procedure doesn't produce the desired outcome, Dr. Devries said. Corneal topography is especially useful on a patient who has an ectatic disorder which, if not identified before surgery, could affect the outcome.

The work-up for a toric IOL should also include a manifest refraction or a history of refraction, including both the amount and axis of cylinder. Also look for pseudoexfoliation; these patients may not be ideal candidates for a toric IOL. Finally, discuss the method of surgery with the patient as well as his or her expectations.

"Patients need to know, at this point, that it's not a perfected science, but in the vast majority of cases, they will get a better visual outcome," Dr. Devries said.