Introduction of a Toric Intraocular Lens to a Non-Refractive Cataract Practice: Challenges and Outcomes.
OBJECTIVE
To identify challenges inherent in introducing a toric intraocular lens (IOL) to a non-refractive cataract practice, and evaluate residual astigmatism achieved and its impact on patient satisfaction.


METHODS
Following introduction of a toric IOL to a cataract practice with all procedures undertaken by a single, non-refractive, surgeon (SB), pre-operative, intra-operative and post-operative data was analysed. Attenuation of anticipated post-operative astigmatism was examined, and subjectively perceived visual functioning was assessed using validated questionnaires.


RESULTS
Median difference vector (DV, the induced astigmatic change [by magnitude and axis] that would enable the initial surgery to achieve intended target) was 0.93D; median anticipated DV with a non-toric IOL was 2.38D. One eye exhibited 0.75D residual astigmatism, compared to 3.8D anticipated residual astigmatism with a non-toric IOL. 100% of respondents reported satisfaction of ≥ 6/10, with 37.84% of respondents entirely satisfied (10/10). 17 patients (38.63%) reported no symptoms of dysphotopsia (dysphoptosia score 0/10), only 3 respondents (6.8%) reported a clinically meaningful level of dysphotopsia (≥ 4/10). Mean post-operative NEI VF-11 score was 0.54 (+/-0.83; scale 0 - 4).


CONCLUSIONS
Use of a toric IOL to manage astigmatism during cataract surgery results in less post-operative astigmatism than a non-toric IOL, resulting in avoidance of unacceptable post-operative astigmatism.
Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland; Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland; Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland.
Clare
C
Kirwan
Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland.
John M
JM
Nolan
Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland.
Jim
J
Stack
University College Hospital Limerick, Ireland.
Ian
I
Dooley
Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland.
Johnny
J
Moore
Biomedical Science Research Institute, University of Ulster, Coleraine, Northern Ireland.
Tara Cb
TC
Moore
Institute of Eye Surgery, and Institute of Vision Research, Whitfield Clinic, Cork Road, Waterford, Ireland; Macular Pigment Research Group, Waterford Institute of Technology, Waterford, Ireland.
Stephen
S
Beatty
Astigmatism reduction; Cataract surgery; Dysphotopsia; Non-refractive surgeon; Refractive outcomes; Rotational stability; Satisfaction; Surgical outcomes; Tecnis® toric intraocular lens; Visual outcomes