Ten pearls to help surgeons achieve successful toric IOL placements

Toric IOLs currently represent 7% of all cataract surgeries being performed in the U.S. Because corneal astigmatism is corrected close to the nodal point of the eye, patients have generally been pleased with the outcome. However, it is imperative that the IOL be placed in the correct axis to ensure optimal results. We present several pearls in this article that have helped us have success with our toric IOL placements.It is imperative to ensure that the preoperative keratometry values used for IOL calculations are accurate. In addition to the keratometry values obtained with an optical biometer, it is important to validate these values with some form of topography, such as with the Oculus Pentacam, the Zeiss Atlas, the i-Optics Cassini or the Haag-Streit Lenstar T-Cone. This helps ensure that the keratometry values are consistent and that there is no irregular astigmatism. If there is significant irregular astigmatism, a toric IOL will not result in “crisp” postoperative vision.