The need for toric intra‐ocular lens implantation in public ophthalmology departments
2014; Wiley; Volume: 93; Issue: 5 Linguagem: Inglês
10.1111/aos.12584
ISSN1755-3768
AutoresChristoffer Ostri, Lotte Falck, Gøril Boberg‐Ans, Line Kessel,
Tópico(s)Intraocular Surgery and Lenses
ResumoActa OphthalmologicaVolume 93, Issue 5 p. e396-e397 Letter to the EditorFree Access The need for toric intra-ocular lens implantation in public ophthalmology departments Christoffer Ostri, Corresponding Author Christoffer Ostri Department of Ophthalmology, Glostrup University Hospital, Copenhagen, Denmark Correspondence: Christoffer Ostri, MD, PhD Department of Ophthalmology Glostrup University Hospital Nordre Ringvej 57 2600 Glostrup Copenhagen, Denmark Tel: +45 27 12 16 16 Fax: +45 38 63 46 99 Email: c@ostri.dkSearch for more papers by this authorLotte Falck, Lotte Falck Department of Ophthalmology, Glostrup University Hospital, Copenhagen, DenmarkSearch for more papers by this authorGøril Boberg-Ans, Gøril Boberg-Ans Department of Ophthalmology, Glostrup University Hospital, Copenhagen, DenmarkSearch for more papers by this authorLine Kessel, Line Kessel Department of Ophthalmology, Glostrup University Hospital, Copenhagen, DenmarkSearch for more papers by this author Christoffer Ostri, Corresponding Author Christoffer Ostri Department of Ophthalmology, Glostrup University Hospital, Copenhagen, Denmark Correspondence: Christoffer Ostri, MD, PhD Department of Ophthalmology Glostrup University Hospital Nordre Ringvej 57 2600 Glostrup Copenhagen, Denmark Tel: +45 27 12 16 16 Fax: +45 38 63 46 99 Email: c@ostri.dkSearch for more papers by this authorLotte Falck, Lotte Falck Department of Ophthalmology, Glostrup University Hospital, Copenhagen, DenmarkSearch for more papers by this authorGøril Boberg-Ans, Gøril Boberg-Ans Department of Ophthalmology, Glostrup University Hospital, Copenhagen, DenmarkSearch for more papers by this authorLine Kessel, Line Kessel Department of Ophthalmology, Glostrup University Hospital, Copenhagen, DenmarkSearch for more papers by this author First published: 07 November 2014 https://doi.org/10.1111/aos.12584Citations: 13AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Editor, Astigmatism is often present in patients undergoing cataract surgery. Implanting toric intra-ocular lenses (IOL) is a safe way to increase the chance of spectacle independence after cataract surgery (Holland et al. 2010); however, toric IOL′s cost more than conventional IOL′s, and in many public ophthalmology departments, toric IOL′s are simply not offered to patients, unless the preoperative corneal astigmatism (PCA) is very high. We experience an increasing patient demand for surgical astigmatism correction in the setting of an upcoming cataract surgery, in particular among younger patients. In this letter, we set out to estimate the need for toric IOL implantation in public ophthalmology departments by analysing the preoperative keratometry values in a large population of cataract operated patients. We conducted a retrospective, cross-sectional survey of the electronic surgical charts from the Department of Ophthalmology at Glostrup University Hospital between 1 January 2002 and 31 December 2013 (12 years). All consecutive, non-paediatric cataract operated patients were included. PCA in dioptre (D) was measured by the IOLMaster (Carl Zeiss Meditec AG, Jena, Germany), Retinomax (Nikon Corp., Tokyo, Japan) or Lenstar device (Haag-Streit AG, Koeniz, Switzerland). Under current Danish law, register studies of this nature do not require approval from The Danish National Committee on Biomedical Research Ethics. In the surveyed period, 14 071 patients (21 524 eyes) were cataract operated, 5558 (39%) men and 8513 (61%) women. Mean age at time of surgery was 72 years (standard deviation (SD) = 12 years). Preoperative, mean power of the flat meridian was 43.19 D (SD = 1.67 D) and mean power of the steep meridian was 44.25 D (SD = 1.72 D). Mean PCA was 1.06 D (SD = 0.90 D). The distribution of PCA in different age groups is seen in Table 1. In 721 (3%) eyes, PCA was 3.00 D or more due to corneal dystrophy/scar(s) (13%), previous vitreoretinal surgery (11%), previous corneal transplantation/keratoconus (5%) or other known causes (7%). The cause was unknown/idiopathic in the remaining eyes (64%). Table 1. Preoperative corneal astigmatism in cataract operated eyes (non-paediatric patients) Astigmatism dioptres Patient age All ages (%) Cumulative, % <60 years (%) Cumulative, % 60-79 years (%) Cumulative, % ≥80 years (%) Cumulative, % ≥3.00 721 (3.3) 3.3 164 (6.5) 6.5 364 (2.9) 2.9 193 (3.1) 3.1 2.50–2.99 515 (2.4) 5.7 77 (3.0) 9.5 250 (2.0) 4.8 188 (3.0) 6.0 2.00–2.49 1064 (4.9) 10.7 164 (6.5) 16.0 498 (3.9) 8.8 402 (6.4) 12.4 1.50–1.99 2030 (9.4) 20.1 281 (11.1) 27.1 1007 (7.9) 16.7 742 (11.8) 24.2 1.00–1.49 4437 (20.6) 40.7 518 (20.5) 47.6 2533 (20.0) 36.7 1386 (22.0) 46.1 0.50–0.99 7627 (35.4) 76.2 787 (31.1) 78.8 4726 (37.2) 73.9 2114 (33.5) 79.7 <0.50 5130 (23.8) 100 536 (21.2) 100 3311 (26.1) 100 1283 (20.3) 100 Total eyes 21 524 (100) 2527 (100) 12 689 (100) 6308 (100) The beneficial effect of toric IOL implantation has been documented for eyes with PCA of 1.50 D or more (Visser et al. 2013). In the present study, 20% of all cataract operated eyes had PCA of 1.50 D or more. For comparison, 16% had a PCA of 1.50 D or more in a large study from a German private eye surgery centre (Hoffmann & Hütz 2010). As seen in Table 1, changing the level of PCA where toric IOL implantation should be considered has a major impact on the number of potential candidates. It is important to remember, though, that all eyes would require cataract surgery with IOL implantation anyway. The number of candidates is also moderated by the contraindications for toric IOL implantation, for example large amounts of irregular astigmatism, presumed capsular instability or eyes that might need keratoplasty in the future. In addition, the proportion of eyes with a high degree of PCA was higher in the 80 years or more age group, which most likely is a result of the increasing corneal astigmatism with age (Gudmundsdottir et al. 2005). It is possible that older patients find spectacle freedom for distance vision less important than younger patients and therefore are less interested in toric IOL implantation. Our results show that there is a large need for toric IOL implantation in public ophthalmology departments. In effect, many patients with cataract could enjoy the benefit of spectacle freedom for distance vision after surgery. Whether the healthcare system in a particular region or country is willing to reimburse toric IOL lenses is another question. References Gudmundsdottir E, Arnarsson A & Jonasson F (2005): Five-year refractive changes in an adult population: Reykjavik Eye Study. Ophthalmology 112: 672– 677. CrossrefPubMedWeb of Science®Google Scholar Hoffmann PC & Hütz WW (2010): Analysis of biometry and prevalence data for corneal astigmatism in 23,239 eyes. J Cataract Refract Surg 36: 1479– 1485. CrossrefPubMedWeb of Science®Google Scholar Holland E, Lane S, Horn JD, Ernest P, Arleo R & Miller KM (2010): The AcrySof Toric intraocular lens in subjects with cataracts and corneal astigmatism: a randomized, subject-masked, parallel-group, 1-year study. Ophthalmology 117: 2104– 2111. CrossrefPubMedWeb of Science®Google Scholar Visser N, Bauer NJ & Nuijts RM (2013): Toric intraocular lenses: historical overview, patient selection, IOL calculation, surgical techniques, clinical outcomes, and complications. J Cataract Refract Surg 39: 624– 637. CrossrefPubMedWeb of Science®Google Scholar Citing Literature Volume93, Issue5August 2015Pages e396-e397 ReferencesRelatedInformation
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