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Jay Mashouf,1 Keith Wan,1 Brad Hall2 1Scripps Optometric Group, San Diego, CA, USA; 2Sengi, Penniac, NB, CanadaCorrespondence: Jay Mashouf, Scripps Optometric Group, 10549 Scripps Poway Pkwy, Ste. G, San Diego, CA, 92131, USA, Tel +1-858-530-2800, Email jaymashouf@gmail.comPurpose: To evaluate the subjective wearing experience of lehfilcon A toric lenses among subjects who were already satisfied with their comfilcon A toric lenses.Methods: This was an open-label, single arm study of currently satisfied comfilcon A soft toric contact lens (Biofinity Toric, CooperVision, Pleasanton, CA) wearers that were refit with lehfilcon A soft toric lenses (Total30® for Astigmatism; Alcon Vision LLC, Fort Worth, TX). Subjects were administered a questionnaire about satisfaction with comfort, visual performance, end of day comfort, and ease of handling with lehfilcon A toric lenses.Results: A total of 40 subjects completed the study. After one month of wear the median and interquartile range (IQR) was 8 (2) for overall satisfaction with lehfilcon A comfort, 8 (1.25) for visual performance, 7 (3.25) for end of day comfort, 9 (2) for ease of handling, and finally 8 (2) for overall satisfaction.Conclusion: A high proportion of subjects were satisfied with the subjective wearing experience with lehfilcon A toric lenses, including satisfaction with comfort, visual performance, end of day comfort, and ease of handling.Plain Language Summary: There are many different types of contact lens materials and replacement schedules for patients to suit individual needs. Despite the diversity of options, contact lens dropout continues to be high, likely influenced by discomfort and poor vision. A new frequent replacement toric contact lens is available that may offer good subjective comfort for patients. However, there is minimal data on the performance of this lens. The purpose of this study was to evaluate the subjective wearing experience with the new contact lens among patients who were already satisfied with their current toric contact lenses. The results of this study suggest that a high proportion of patients were satisfied with the subjective wearing experience with the new toric contact lens, including satisfaction with comfort, visual performance, end of day comfort, and ease of handling.Keywords: comfort, toric, contact lens, lehfilcon A, Total30 for Astigmatism

Takayuki Akahoshi Cataract and Refractive Surgery Department, Nihonbashi Cataract Clinic, Tokyo, JapanCorrespondence: Takayuki Akahoshi, Cataract and Refractive Surgery Department, Nihonbashi Cataract Clinic, 2-4-1, Nihonbashi Muromachi, Chuoku, Tokyo, Japan, Email eye@phaco.expertPurpose: To analyze the refractive and visual outcomes following cataract surgery and implantation of a new hydrophobic trifocal toric intraocular lens (IOL) in Japanese eyes with different degrees of corneal astigmatism.Methods: A total of 66 eyes from 39 patients implanted with a FineVision HP Toric IOL (Beaver-Visitec International Inc) were analyzed retrospectively. The main outcome measures considered were refraction, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40 cm. Eyes were evaluated at three months post-surgery.Results: Sixty-five eyes (98.48%) were within ± 0.50D of spherical equivalent, and all were within ± 1.00D (mean: 0.00± 0.21D). Moreover, 63 eyes (95.45%) had ≤ 0.50D of residual astigmatism, and all had ≤ 1.00D (mean: – 0.08± 0.23D). Similarly, 58 (87.88%) and 60 eyes (90.91%) had ≥ 20/20 UDVA and CDVA, respectively, with 65 (98.48%) and 66 eyes (100%) achieving ≥ 20/25 UDVA and CDVA, respectively. In addition, 28 (42.42%) and 23 eyes (34.85%) had ≥ 20/25 DCIVA at 80 and 66 cm, respectively, with 49 (74.24%) and 52 eyes (78.79%) achieving ≥ 20/32 DCIVA at 80 and 66 cm, respectively. Finally, 39 (59.09%) and 40 eyes (60.61%) had ≥ 20/20 UNVA and DCNVA, respectively, with 58 (87.88%) and 59 eyes (89.39%) achieving ≥ 20/25 UNVA and DCNVA, respectively.Conclusion: Our study shows that implantation of the new hydrophobic FineVision HP Toric IOL results in accurate refractive outcomes, with good visual acuity at different distances, in Japanese eyes.Keywords: astigmatism, trifocal, toric, intraocular lens, cataract

Francisco Pastor-Pascual,1 Paz Orts-Vila,2 Pedro Tañá-Sanz,2 Santiago Tañá-Sanz,2 Pedro Tañá-Rivero2 1Cataract and Refractive Surgery Department, Oftalvist Valencia, Valencia, Spain; 2Cataract and Refractive Surgery Department, Oftalvist Alicante, Alicante, SpainCorrespondence: Pedro Tañá-Rivero, Oftalvist Alicante, Avda. Dénia 76, Alicante, 03013, Spain, Tel +34 965 14 15 00, Email rdi@oftalvist.esPurpose: To assess the refractive and visual outcomes at different distances following cataract surgery with implantation of an omnidirectional aberration-free diffractive trifocal toric intraocular lens (IOL).Methods: A total of 24 patients who underwent bilateral implantation with the TrivaT-aAY IOL were analyzed at 3– 4 months post-surgery. Refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, monocular and binocular defocus curve and rotational stability were measured. Patients also completed the Catquest-9SF questionnaire at the last postoperative visit.Results: The postoperative mean values of binocular logMAR CDVA, CDIVA and CDNVA were − 0.06± 0.06, 0.05± 0.07 and 0.07± 0.08, respectively. One hundred percent of patients showed a cumulative binocular CDVA ≥ 20/25, and 95.83% of patients showed a cumulative binocular CDIVA and CDNVA ≥ 20/32. The mean postoperative spherical equivalent was 0.07± 0.26D and 100% and 97.92% eyes were within ± 1.00D and ± 0.50D, respectively. The mean postoperative refractive cylinder was − 0.22± 0.29D and 100% and 89.58% eyes showed a value ≤ 1.00D and ≤ 0.50D, respectively. The defocus curves showed a wide range of useful vision, with visual acuity values > 0.2 logMAR. Mean absolute IOL rotation was 2.19± 2.17 degrees and all eyes had a rotation < 10 degrees. For the questionnaire, 95.83% of patients reported being quite satisfied to very satisfied with their vision and about 79.17% did not report any difficulty with their vision in their everyday life. Between 83.33% and 95.83% of patients reported no difficulty performing different tasks. No intra- and postoperative complications were reported during the follow-up.Conclusion: Our study shows that the TrivaT-aAY IOL provides good visual acuities at all distances and refractive outcomes with excellent rotational stability and with high satisfaction among our patients after its implantation.Keywords: astigmatism, toric, diffractive, trifocal, intraocular lens, cataract

Introduction: This study is a retrospective case series to compare the accuracy of the Barrett toric calculator using predicted posterior corneal astigmatism (PCA) and PCA measurements using swept-source optical coherence tomography (SS-OCT) and a Scheimpflug camera. This evaluation was conducted across different types of anterior and posterior astigmatism. Methods: A total of 146 eyes from 146 patients implanted with toric intraocular lenses were included. Mean absolute prediction error, standard deviation of prediction error, and the percentage of eyes with prediction errors within ±0.50 diopters (D) were calculated using vector analysis. Biometric measurements were conducted using the IOLMaster 700 and Pentacam HR. A subgroup analysis was conducted based on the orientation of both anterior and posterior corneal astigmatism. Results: The Barrett toric calculator with predicted PCA yielded the best results, with 78.1% having a prediction error ≤ 0.50 D, which was a significantly higher percentage than the Barrett formula with the two versions of measured PCA (P < 0.05). In the subgroup with a horizontally steep meridian PCA using the IOLMaster 700, the Barrett formula with predicted PCA yielded the best results, with 78.3% of cases having a prediction error of less than 0.5 D. This percentage was significantly higher than the other two measured PCA subgroups (P < 0.05). Conclusion: The Barrett toric formula with predicted PCA demonstrated a statistically significantly higher proportion of cases with a prediction error ≤ 0.5 D compared to the two measured PCA formulas (from the IOLMaster 700 or Pentacam). This trend persisted even when the posterior corneal astigmatism was horizontally steep. [ABSTRACT FROM AUTHOR]

We investigate a definition of Cohen–Macaulay modules over the Weyl algebra D and give a sufficient condition for a GKZ A-hypergeometric D-module to be Cohen–Macaulay. [ABSTRACT FROM AUTHOR]

Abstract Introduction This study is a retrospective case series to compare the accuracy of the Barrett toric calculator using predicted posterior corneal astigmatism (PCA) and PCA measurements using swept-source optical coherence tomography (SS-OCT) and a Scheimpflug camera. This evaluation was conducted across different types of anterior and posterior astigmatism. Methods A total of 146 eyes from 146 patients implanted with toric intraocular lenses were included. Mean absolute prediction error, standard deviation of prediction error, and the percentage of eyes with prediction errors within ±0.50 diopters (D) were calculated using vector analysis. Biometric measurements were conducted using the IOLMaster 700 and Pentacam HR. A subgroup analysis was conducted based on the orientation of both anterior and posterior corneal astigmatism. Results The Barrett toric calculator with predicted PCA yielded the best results, with 78.1% having a prediction error ≤ 0.50 D, which was a significantly higher percentage than the Barrett formula with the two versions of measured PCA (P

Abstract Background To assess clinical outcomes after implanting toric, extended-depth-of-focus intraocular lenses (IOLs) to correct low corneal astigmatism in eyes with cataracts. Methods 47 eyes were implanted with the AcrySof IQ Vivity Toric DFT215 IOL. Main outcome measures were refractive error, monocular uncorrected and corrected distance (UDVA/CDVA), uncorrected and distance-corrected intermediate (UIVA/DCIVA), and uncorrected near and distance-corrected near (UNVA/DCNVA) visual acuities, monocular defocus curve, rotational stability, and IOLSAT and QUVID questionnaires. Patients were assessed at 3 months postsurgery. Results All eyes had a postoperative spherical equivalent (SE) within ± 0.50 D and 97.87% (n = 46) had a refractive cylinder ≤ 0.50 D. The mean SE and refractive cylinder were − 0.10 ± 0.17 D and − 0.16 ± 0.24 D, respectively. The CDVA was ≥ 20/25 and ≥ 20/32 in 95.74% (n = 45) and 97.87% (n = 46) of eyes, respectively. The DCIVA was ≥ 20/32 in 85.11% (n = 40) of eyes and the DCNVA was ≥ 20/40 in 74.47% (n = 35). The mean values of CDVA, DCIVA, and DCNVA were − 0.02 ± 0.08, 0.14 ± 0.09, and 0.23 ± 0.12 logMAR, respectively. The defocus curve revealed good visual acuity at far and intermediate distances with a depth-of-focus of about 1.75 D. IOL rotation was 0.74 ± 1.13 degrees and all eyes had a rotation of less than 5 degrees. Patients reported either good or very good postoperative vision without eyeglasses under bright-light-conditions at distance (87.80%, 36/41) and intermediate distance (92.68%, 38/41). Between about 63.83%–72.34% (30–34) of patients reported no starburst, halos, or glare, or if experienced, were not bothersome. Conclusions The Vivity toric IOL implanted in eyes with low-astigmatism provides accurate refractive outcomes, good visual acuity at different distances and excellent rotational stability. Trial Registration The study was registered with the German Clinical Trials Register (DRKS00030579)

Sheraz Daya, Marcela Espinosa Lagana Centre for Sight, East Grinstead, West Sussex, UKCorrespondence: Sheraz Daya, Centre for Sight, East Grinstead, West Sussex, RH19 4RH, UK, Email sdaya@centreforsight.comPurpose: To evaluate the visual outcomes and efficacy of astigmatism correction using a new hydrophobic trifocal toric intraocular lens (IOL).Methods: This study involved 62 eyes implanted with the FineVision HP Toric IOL. The visual and refractive outcomes were assessed preoperatively and 6 weeks after the surgery. Specifically, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA) at 80 and 60 cm and uncorrected near visual acuity at (UNVA) at 40 cm were evaluated. The rotational stability of the lens was also assessed.Results: Sixty-one eyes (98.39%) were within ± 1.00D and 55 eyes (88.71%) were within ± 0.50 D of spherical equivalent, with a mean value of 0.09± 0.39 D. 51 (82.26%) and 61 (98.39%) eyes had a UDVA of ≥ 20/20 and ≥ 20/25, respectively, and for CDVA these values were as follows: 59 (95.16%) and 62 eyes (100%), respectively. The mean UDVA and CDVA were 0.01± 0.06 and − 0.01± 0.04logMAR, respectively. Greater than or equal to unaided 20/20 vision was achieved at 40 cm in 42 (67.74%), UIVA at 60 cm in 42 (67.74%) and 50 eyes (80.65%) at 80 cm. Those achieving ≥ 20/25 were 56 (90.32%, 40 cm), 59 (95.16%, 60 cm), and 62 eyes (100%, 80 cm). Postoperative mean values were 0.04± 0.07, 0.03± 0.07, and 0.00± 0.07logMAR for UCNVA, UIVA at 60 cm, and UIVA at 80 cm, respectively. The mean rotation of the IOL was 5.8 degrees.Conclusion: This hydrophobic trifocal toric IOL provides good refractive outcomes with excellent visual acuity across multiple distances, providing a full range of focus.Keywords: astigmatism, trifocal, toric, multifocal, cataract

To review the published literature evaluating the visual and refractive outcomes and rotational stability of eyes implanted with toric monofocal intraocular lenses (IOLs) for the correction of keratometric astigmatism during cataract surgery and to compare those outcomes with outcomes of eyes implanted with nontoric monofocal IOLs and other astigmatism management methods performed during cataract surgery. This assessment was restricted to the toric IOLs available in the United States. A literature search of English-language publications in the PubMed database was last conducted in July 2022. The search identified 906 potentially relevant citations, and after review of the abstracts, 63 were selected for full-text review. Twenty-one studies ultimately were determined to be relevant to the assessment criteria and were selected for inclusion. The panel methodologist assigned each a level of evidence rating; 12 studies were rated level I and 9 studies were rated level II. Eyes implanted with toric IOLs showed excellent postoperative uncorrected distance visual acuity (UCDVA), reduction of postoperative refractive astigmatism, and good rotational stability. Uncorrected distance visual acuity was better and postoperative cylinder was lower with toric IOLs, regardless of manufacturer, when compared with nontoric monofocal IOLs. Correcting pre-existing astigmatism with toric IOLs was more effective and predictable than using corneal relaxing incisions (CRIs), especially in the presence of higher magnitudes of astigmatism. Toric monofocal IOLs are effective in neutralizing pre-existing corneal astigmatism at the time of cataract surgery and result in better UCDVA and significant reductions in postoperative refractive astigmatism compared with nontoric monofocal IOLs. Toric IOLs result in better astigmatic correction than CRIs, particularly at high magnitudes of astigmatism. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

To compare 5-year outcomes of toric intraocular lens (tIOL) or peripheral corneal relaxing incision (PCRI) for correction of keratometric astigmatism (KA) between 0.75 and 2.5 diopters (D). Setting: University Hospital. Design: Randomized clinical trial. Eighty eyes (80 participants) received either tIOL or PCRI. Patients were assessed preoperatively, 1-month, 1, and 5 years. Primary outcomes were uncorrected (UDVA) and best-corrected distance logMAR visual acuity (CDVA). Secondary outcomes were a manifest refractive sphere, refractive astigmatism (Ra), spherical equivalent (SEQ), KA & mean keratometry (KM), and Quality-of-Life Impact of Refractive Correction (QIRC) scores. There was no difference between the two groups in UDVA, CDVA, refractive sphere, KM, RA, and SEQ. KA reduced after 1 month in the PCRI group and remained stable until 5 years. From 1 to 5 years, the number of eyes with distance emmetropia (within ±0.13D) changed from 59% (20/34 eyes) to 32% (6/19 eyes) for tIOLs and from 43% (15/36 eyes) to 20% (4/21 eyes) for PCRIs with 32% (6/19 eyes) and 20% (4/21 eyes) showing >0.5D change in SEQ at 5-years respectively. Compared to 1-year, Ra significantly increased at 5 years in both groups with no difference between the groups. Mean overall QIRC scores were not different between the groups (tIOL: 49.88 ± 7.47; PCRI: 52.09 ± 7.02; p =.18). Although there was no difference between the overall visual and vision-related quality of life outcomes between tIOLs and PCRIs, an increase in refractive astigmatism and reduction in distance emmetropia with time was noted in both groups. [ABSTRACT FROM AUTHOR]

We classify all 4-dimensional toric scalar-flat Kähler instanton metrics under a simple closure condition. This is done by reducing M 4 to its 2-dimensional metric polygon (Σ 2 , g Σ) , where a synthetic zero scalar curvature condition allows a purely analytic classification, based on solutions of a pair of boundary-degenerate elliptic functions. The proof uses a Liouville theorem for these boundary-degenerate elliptic equations, and we create a Dirichlet boundary-specification theorem for these equations. [ABSTRACT FROM AUTHOR]

Keith Wan,1 Jay Mashouf,1 Brad Hall2 1Scripps Optometric Group, San Diego, CA, USA; 2Sengi, Penniac, NB, CanadaCorrespondence: Keith Wan, Scripps Optometric Group, 10549 Scripps Poway Pkwy Ste, San Diego, CA, 92131, USA, Tel +1 858-530-2800, Email keithmwan@gmail.comPurpose: To subjectively evaluate comfort with a daily disposable (delefilcon A for astigmatism) contact lens compared to other common weekly/monthly soft toric contact lenses in symptomatic wearers.Methods: This open-label, single arm study enrolled current reusable soft toric lens wearers with minimum score of 12 on the contact lens dry eye (CLDEQ-8) questionnaire. Subjects were also administered the CLDEQ-8 after 1 replacement schedule of their optimized habitual toric lenses (2 to 4 weeks), and after 2 weeks of wear with delefilcon A toric daily disposable lenses (Dailies Total1 for Astigmatism; Alcon Vision LLC, Fort Worth, Texas).Results: A total of 85 subjects completed the study. Mean total CLDEQ-8 score was 16.8 ± 8.1 for subjects refit with their optimized habitual toric lenses and 12.4 ± 7.5 for subjects refit with delefilcon A toric lenses, a difference of 4.3 ± 10.4 (p < 0.001). With delefilcon A toric lenses, 78.9% of subjects reported little to no intensity of eye discomfort, compared to 51.7% for the habitual toric lenses (p = 0.005). In addition, 77.7% of subjects reported little to no intensity of dryness for delefilcon A toric lenses, compared to 50.6% for the habitual toric lenses (p = 0.001).Conclusion: The subjective comfort in symptomatic habitual reusable toric contact lens wearers was improved by refitting with delefilcon A toric lenses.Plain Language Summary: Discomfort while wearing contact lenses is often a reason why patients decide to stop wearing their lenses. There are many different contact lens materials to choose from, and each may affect discomfort differently. The replacement schedule of a contact lens may also be a factor for discomfort, with lenses replaced daily (daily disposables) offering advantages over those replaced weekly or monthly (frequent replacement). The purpose of this study was to subjectively evaluate comfort with a new daily disposable toric contact lens. The results of this study suggest that subjective comfort in symptomatic habitual reusable toric contact lens wearers was improved by refitting with a new daily disposable toric lens.Keywords: comfort, toric, contact lens, delefilcon A, Dailies Total1 for Astigmatism

AIM: To compare the control effects between toric-designed orthokeratology and spherical orthokeratology on adolescents with moderate-to-low myopia.METHODS: The clinical data of 169 adolescents(290 eyes)with moderate-to-low myopia in Jiayuan Outpatient Department of Shanghai Demu Ophthalmology from July 2020 to June 2021 were analyzed retrospectively. The patients were divided into toric group and spherical group according to the type of orthokeratology, with 81 cases(135 eyes)and 88 cases(155 eyes)respectively. The changes of visual acuity and ocular axis before and after treatment were recorded to evaluate the therapeutic effect.RESULTS: The uncorrected visual acuity of both groups significantly improved at 1a after treatment(P0.05).CONCLUSION: Both toric-designed orthokeratology and spherical orthokeratology can improve the uncorrected visual acuity of adolescents with low-to-moderate myopia, and there is no significant difference in controlling effect on myopia.

Abstract Introduction Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. Methods A retrospective case–control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. Results The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was − 0.29 ± 0.43 vs. − 0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85 D@93° ± 2.42° vs. 0.23 D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1 D vs. 2.28 ± 1.03 D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24 D@28° ± 0.57° vs. 0.03 D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31 D vs. 0.42 ± 0.31 D, respectively (P = 0.44) (D diopters). Conclusion The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52 D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs.

Purpose: To compare the visual outcomes and residual astigmatism following implantation of Eyecryl toric versus Alcon AcrySof IQ toric intra-ocular lenses (IOLs). Methods: This retrospective, observational study included 143 eyes of 141 patients who underwent phaco-emulsification, followed by implantation of Eyecryl toric IOL (n = 83 eyes) or Alcon toric IOL (n = 60 eyes) in an eye hospital in South India from 2018 to 2021. At 1 month post-op, the uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), and residual astigmatism of the toric IOL were compared and analyzed. Results: The mean pre-op corneal astigmatism was 2.02 ± 0.81 D and 1.70 ± 0.68 D in the Alcon and Eyecryl groups, respectively (P = 0.005). The mean post-op corneal astigmatism at 1 month was 0.50 ± 0.51 D and 0.36 ± 0.42 D in the Alcon and Eyecryl groups, respectively, with no statistically significant difference between them (P = 0.87). The mean post-op UCVA in logarithm of minimum angle of resolution (logMAR) at 1 month was similar between the groups at 0.17 ± 0.18 and 0.17 ± 0.16 in the Alcon and Eyecryl groups, respectively (P = 0.98). The mean post-op BCVA in logMAR at 1 month was 0.06 ± 0.09 and 0.03 ± 0.10 in the Alcon and Eyecryl groups, respectively (P = 0.02). Conclusion: Both Eyecryl toric and Alcon AcrySof IQ toric IOLs showed comparable post-operative outcomes in terms of UCVA and residual astigmatism. The post-op BCVA was clinically similar between groups but statistically better in the Eyecryl toric group. [ABSTRACT FROM AUTHOR]

In this paper, formulas for aspherical, sphero-cylindrical, toroidal, and ellipsoidal surfaces with astigmatic axes are derived. Based on this, four types of curved surfaces were designed to correct astigmatism with axis, and, subsequently, the lenses were simulated, fabricated, and measured. A total of ten spectacle lenses in two groups were designed. Those in the first group used identical optical parameters. The spherical and cylindrical powers and maximum and minimum edge thicknesses of aspherical, sphero-cylindrical, and ellipsoidal surfaces were compared. The results indicated that the power of the lens constructed using the toroidal surface was more accurate than those of the other three lenses. Moreover, the minimum edge thickness of the toroidal surface was 1.2%, 4.98%, and 4.87% lower than those of the aspherical, sphero-cylindrical, and ellipsoidal surfaces, respectively. The powers and edge thicknesses of toroidal surfaces with different diopters were compared in the second group. The minimum and maximum edge thicknesses were observed to be reduced by 8.97% and 6.05%, respectively, corresponding to the conic constants obtained via ray tracing. The conclusion will be significant for clinical ophthalmology and optical design for the patients with astigmatism. [ABSTRACT FROM AUTHOR]

Introduction: Implantation of toric intraocular lenses (IOLs) in patients with Fuchs endothelial corneal dystrophy (FECD) is still considered relatively contraindicated, without sufficient clinical evidence. Therefore, this study was designed to evaluate the results of toric IOL implantation in patients with FECD. Methods: A retrospective case–control study of 28 eyes of FECD patients and 84 eyes of healthy control patients who received toric IOLs during routine cataract surgery was performed. The outcome measures were uncorrected and corrected distance visual acuity, spherical equivalent, and refractive residual astigmatism. Results: The mean postoperative uncorrected and corrected distance visual acuity in the FECD eyes compared to the control eyes were 0.15 ± 0.14 vs. 0.13 ± 0.17, respectively (P = 0.32), and 0.05 ± 0.08 vs. 0.06 ± 0.10, respectively (P = 0.95). The spherical equivalent in the FECD eyes compared to the control eyes was − 0.29 ± 0.43 vs. − 0.21 ± 0.50, respectively (P = 0.19). The preoperative corneal centroid astigmatism in the FECD eyes compared to the control eyes was 0.85 D@93° ± 2.42° vs. 0.23 D@68° ± 2.50°, respectively (P = 0.43), and the mean preoperative corneal astigmatism magnitude was 2.26 ± 1.1 D vs. 2.28 ± 1.03 D, respectively (P = 0.82). A trend toward higher postoperative refractive centroid astigmatism was found in the FECD eyes compared with the control eyes: 0.24 D@28° ± 0.57° vs. 0.03 D@127° ± 0.53°, respectively (P = 0.09). However, the mean refractive astigmatism magnitude was similar in FECD eyes and the healthy control eyes: 0.52 ± 0.31 D vs. 0.42 ± 0.31 D, respectively (P = 0.44) (D diopters). Conclusion: The postoperative refractive astigmatism (both centroid astigmatism and mean magnitude astigmatism) was no higher than 0.52 D in both groups. Therefore, FECD patients without corneal edema can be considered for toric IOLs. [ABSTRACT FROM AUTHOR]

Purpose: To compare the visual outcomes and residual astigmatism following implantation of Eyecryl toric versus Alcon AcrySof IQ toric intra-ocular lenses (IOLs). Methods: This retrospective, observational study included 143 eyes of 141 patients who underwent phaco-emulsification, followed by implantation of Eyecryl toric IOL (n = 83 eyes) or Alcon toric IOL (n = 60 eyes) in an eye hospital in South India from 2018 to 2021. At 1 month post-op, the uncorrected distance visual acuity (UCVA), best corrected distance visual acuity (BCVA), and residual astigmatism of the toric IOL were compared and analyzed. Results: The mean pre-op corneal astigmatism was 2.02 ± 0.81 D and 1.70 ± 0.68 D in the Alcon and Eyecryl groups, respectively (P = 0.005). The mean post-op corneal astigmatism at 1 month was 0.50 ± 0.51 D and 0.36 ± 0.42 D in the Alcon and Eyecryl groups, respectively, with no statistically significant difference between them (P = 0.87). The mean post-op UCVA in logarithm of minimum angle of resolution (logMAR) at 1 month was similar between the groups at 0.17 ± 0.18 and 0.17 ± 0.16 in the Alcon and Eyecryl groups, respectively (P = 0.98). The mean post-op BCVA in logMAR at 1 month was 0.06 ± 0.09 and 0.03 ± 0.10 in the Alcon and Eyecryl groups, respectively (P = 0.02). Conclusion: Both Eyecryl toric and Alcon AcrySof IQ toric IOLs showed comparable post-operative outcomes in terms of UCVA and residual astigmatism. The post-op BCVA was clinically similar between groups but statistically better in the Eyecryl toric group.

Phillip J Buckhurst,1 George Lau,2 Jon I Williams,2 Mark Packer3 1School of Health Professions, University of Plymouth, Plymouth, UK; 2Bausch and Lomb Surgical, Bausch and Lomb Bridgewater, New Jersey, NJ, USA; 3Mark Packer Consulting, Boulder, CO, USACorrespondence: Phillip J Buckhurst, School of Health Professions, University of Plymouth, Plymouth, UK, Tel +44 1752 588884, Email Phillip.buckhurst@plymouth.ac.ukPurpose: To assess the refractive outcomes, intraocular centration and rotational stability of the enVista toric intraocular lens (IOL).Patients and Methods: This study was a prospective, multi-centre, double-masked, partially randomized and partially controlled clinical trial. A total of 191 participants were implanted with toric IOL (1.25, 2.00, or 2.75D) or non-toric IOL (control). The lowest range of corneal astigmatic eyes were randomized to 1.25D toric or control. Higher astigmatic powers were allocated to the treatment arm. Subjects were assessed immediately postoperatively, 1– 2 (V1), 7– 14 (V2), 30– 60 (V3) and 120– 180 (V4) days postoperatively. Unaided (UDVA) and distance corrected visual acuity (CDVA), manifest refraction and corneal curvature were assessed. Vector analysis was used to calculate surgically induced refractive correction (SIRC), correction ratio (CR), error magnitude (EM) and error vector (EV). Slit-lamp photography was used to measure centration and rotational stability.Results: UDVA was better in the low toric IOL group in comparison with the control group at V4 (p< 0.001). There was an undercorrection in the control group, whereas the average CR for all toric subjects was 1.00 ± 0.32: V2, 0.98 ± 0.34: V3 and 0.98 ± 0.35: V4. The absolute IOL rotational stability in comparison to the position of the IOL at V1 was 1.35° ± 0.97°: V2, 1.35° ± 1.07°: V3 and 1.38° ± 1.25°: V4. Decentration was generally inferior (V1: 0.04 ± 0.22mm, V2: 0.05± 0.20mm, V3: 0.08 ± 0.22mm, V4: 0.04 ± 0.21mm) and nasal (V1: 0.19 ± 0.23mm, V2: 0.20 ± 0.20mm, V3: 0.20 ± 0.21mm, V4: 0.17 ± 0.22mm).Conclusion: Participants with low levels of corneal astigmatism achieved superior vision and refractive outcomes in the low toric group over the control. Moderate and high levels of astigmatism achieved excellent refractive outcomes. The toric IOL demonstrated high levels of both rotational and centrational stability.Keywords: IOL, astigmatism, cataract, enVista, toric

Astigmatism management is a frequently encountered challenge in the world of modern cataract surgery. This review article investigates the importance of astigmatic correction and seeks to uncover the critical components of preoperative evaluation. With the rapid growth of new technologies and techniques, this article aims to also catalogue and clarify the multitude of astigmatism treatment options available for the cataract surgeon.

There have been significant advancements in toric soft contact lens design and manufacturing technology, and increased product availability, over the past half a century. The purpose of this work is to update earlier surveys by describing international trends in toric soft lens fitting between 2000 and 2023, inclusive. An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000 and 2023, inclusive. Data relating to 220,934 standard soft daily wear single vision lens fits undertaken in 20 countries returning reliable longitudinal data were analysed in respect of toric soft lens fitting. Overall, toric soft lens prescribing almost doubled over the time-course of this survey, from 24.4 % of standard soft daily wear single vision lens fits in 2000 to 46.2 % in 2023 (p < 0.0001). There were significant differences between countries in toric soft lens prescribing (p < 0.0001). Of all standard soft daily wear single vision contact lenses prescribed to males, 32.0 % were toric soft lenses, compared with 28.7 % for females (p < 0.0001). The mean age of toric soft lens wearers was 30.5 ± 12.5 years, compared to 27.9. ± 12.1 years for spherical soft lens wearers (p < 0.0001). Analysis of 13,582 recent toric soft lens fits (2019–2023, inclusive), in terms of material type and replacement frequency, revealed the following proportions: reusable silicone hydrogel – 51 %; daily disposable silicone hydrogel – 27 %; daily disposable hydrogel – 12 %; and reusable hydrogel – 10 %. There has been a substantial increase in toric soft lens fitting throughout the 24 years of this survey, to a point whereby almost all clinically significant astigmatism is being corrected among those wearing standard soft daily wear single vision lenses. [ABSTRACT FROM AUTHOR]

Seth M Pantanelli,1 Ashley Sun,1 Neal Kansara,2 Gerard Smits3 1Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA; 2Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA; 3Computer and Statistical Consultants Incorporated, Santa Barbara, CA, USACorrespondence: Seth M PantanelliDepartment of Ophthalmology, Penn State College of Medicine, 500 University Drive, HU19, Hershey, PA, 17033-0850, USA, Tel +1 717-531-5690, Fax +1 717-531-5009, Email spantanelli@pennstatehealth.psu.eduPurpose: The purpose of this study was to compare the Barrett (BTC) and Emmetropia Verifying Optical (EVO) Toric Calculators’ performance with regards to prediction of residual post-operative astigmatism after cataract surgery.Methods: This was a secondary analysis of de-identified data that was collected as part of a prospective multicenter clinical trial in which 109 eyes from 109 patients were implanted with a monofocal toric intraocular lens (IOL). Post-operative biometry was used to calculate the predicted post-operative residual astigmatism for each eye using the two different calculators. The vector difference between the actual and predicted residual astigmatism was calculated.Results: The mean absolute astigmatism prediction errors were 0.59 ± 0.38 D and 0.59 ± 0.36 D for the BTC and EVO calculators, respectively (p = 0.98). The centroid of the prediction errors were 0.18 D @ 89° ± 0.68 D and 0.20 D @ 89° ± 0.66 D, respectively (p = 0.21). The proportion of eyes in which the astigmatism prediction error was ≤ 0.5 D was 50% for BTC and 46% for EVO (p = 0.28). The proportion of eyes in which the post-operative astigmatism orientation was correctly predicted as being against-the-rule, with-the-rule, or oblique was 81% for BTC and 77% for EVO (p = 0.15).Conclusion: The Barrett and Emmetropia Verifying Optical Toric Calculators had similar performance with regards to their astigmatism prediction accuracy.Keywords: Barrett, EVO, astigmatism, toric, cataract, residual astigmatism

The current investigation evaluates the efficiency of the trifocal toric Liberty 677MTY intraocular lens (IOL) in correcting preoperative corneal astigmatism in cataract patients demanding spectacle independence. The retrospective evaluation included 28 eyes of 15 patients with preoperative corneal astigmatism of at least 1.0 Dioptre (D). All patients were followed up for one year postoperatively. Residual refractive errors and visual acuities at multiple distances were measured. Binocular visual acuity and contrast sensitivity defocus curves were plotted. Visual functions and patient satisfaction were assessed. The efficiency of astigmatism correction was determined using the vector analysis method. The mean spherical equivalent refraction (SEQ) improved from 2.72 ± 1.62 D to 0.10 ± 0.48 D. The cylindric refraction decreased from 1.18 ± 0.45 D to 0.16 ± 0.31 D. Vector analysis proved efficient astigmatism correction with a centroid of 0.10 ± 0.34 D at 161°. Ninety-two percent of eyes resulted within 0.5 D from the target refraction. Visual acuities were 0.1 logMAR or better from +1.0 to −3.5 D defocus values. Visual tasks could be performed without major difficulties. Our patients were highly satisfied. Refractive and visual outcomes with the investigated presbyopia-correcting toric IOL are predictable and the lens provides excellent trifocal vision. [ABSTRACT FROM AUTHOR]

Uncorrected refractive astigmatism degrades visual acuity. Spherical intraocular lenses (IOLs) leave astigmatic errors resident in the cornea manifest in refractive astigmatism. Toric IOLs, correcting for this corneal astigmatism, contribute to spectacle‐free vision in the pseudophakic eye. This review provides information to assist surgeons in a rational choice of eyes suitable for toric IOL implantation, methods of IOL cylinder power calculation, surgical techniques for toric IOLs and management of complications. With appropriate application of this information, correction of visually detrimental astigmatism can be achieved routinely. [ABSTRACT FROM AUTHOR]

Matthew S Ward,1 Andrew C Hou,2 David A Murphy,2 Mason A Schmutz,3 Kamran M Riaz2 1Riverwoods Eye Center, Provo, UT, USA; 2Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, OK, USA; 3Excel Eye Center, Saratoga Springs, UT, USACorrespondence: Kamran M RiazDean McGee Eye Institute, University of Oklahoma, 608 Stanton L Young Blvd, Suite 313, Oklahoma City, OK, 73104, USATel +1 405-271-1095Fax +1 405-271-3680Email Kamran-Riaz@dmei.orgPurpose: To describe surgical technique and report short-term visual outcomes after suture-fixation of a single-piece eyelet-toric (SET) intraocular lens (IOL) for treatment of concurrent aphakia and astigmatism.Design: Retrospective, noncomparative, and non-consecutive case series.Methods: This was a case series of eleven eyes who underwent successful SET. Eligible eyes had loss of capsular support or aphakia with a minimum of symmetric corneal astigmatism 1.75 diopters (D). Outcome measures included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), magnitude of residual refractive cylinder, and complications resulting from the SET procedure.Results: Preoperative UDVA and CDVA in logMAR scale were 1.46 and 0.45, respectively. Mean preoperative keratometric and refractive cylinder were 3.67 D and 2.52D, respectively. Postoperative UDVA and CDVA were 0.51 and 0.27, respectively, three months after surgery (POM3). Residual refractive cylinder at POM3 was 0.93 D.Conclusion: SET technique reduced refractive cylinder and improved UDVA and CDVA. SET may be adapted by surgeons using a readily available IOL and familiar scleral-fixation maneuvers.Keywords: aphakia, toric, suture fixation, secondary lens, astigmatism

Contact lens prescribing data serve as a benchmark for eye care clinicians in assessing their own prescribing patterns and provide useful contextual information for researchers and the contact lens industry. To document global trends in contact lens prescribing during the first two decades of this century. A longitudinal survey of contact lens prescribing was conducted by asking contact lens practitioners to provide 11 items of information from 10 consecutive contact lens fits between January and March each year from 1996 to 2020, inclusive. Data relating to 406,859 contact lens fits were collected from 71 countries between 1996 and 2020, generating 4.5 million data points. Demographic analysis for 61 nations returning ≥100 fits demonstrated that a majority of lenses (65–70%) were fitted to females. The average age of lens wearers was 30.8 ± 13.9 years for males and 32.5 ± 14.3 years for females. Trend analysis of 20 countries returning prescribing data for ≥13 years between 2000 and 2020 revealed the following: increase in the age of lens wearers; dramatic rise in the extent of fitting silicone hydrogel and daily disposable lenses; increased fitting of soft toric and multifocal lenses; increasing proportion of rigid lens fits in specialist (non-spherical) designs; incomplete provision of near contact lens corrections for contact lens wearing presbyopes; ongoing low levels of extended wear fits; and almost exclusive use of multi-purpose care systems. Daily disposable lenses were used for both full-time and part-time wear, whereas rigid and soft reusable lenses were primarily worn full time. The evolution of international contact lens fitting over the first two decades of this century is documented. The data presented here may assist all stakeholders in advancing contact lens clinical practice, informing contact lens research, and guiding contact lens manufacturers. [ABSTRACT FROM AUTHOR]

To evaluate the visual outcomes, refractive outcomes and rotational stability of a toric piggyback intraocular lens (1stQ AddOn, GmbH, Mannheim, Germany) for astigmatic refractive error in pseudophakic eyes. Visual and refractive outcomes were assessed based on the standard graphs for reporting refractive surgery outcomes. Rotational stability was assessed according to the Intraocular Lens (IOL) standards of the International Organisation for Standards. Twenty-two eyes of 17 patients (age: 65.1 ± 9.3 years) underwent toric piggyback IOL insertion. After a minimum follow-up of 3 months, 18 eyes (82%) achieved an uncorrected distance visual acuity (UDVA) of 0.00 logMAR (20/20) or better and all eyes achieved 0.1 logMAR (20/25). Mean UDVA improved from 0.27 ± 0.03 to 0.12 ± 0.03 and 0.04 ± 0.04 at one and 3 months (all p <.05). Nineteen eyes (86%) achieved an UDVA at least equal to the pre-operative corrected distance visual acuity (CDVA). No eyes lost more than one line of CDVA. All eyes achieved within 0.5D of target spherical equivalent (SE). In 18 eyes (82%), the residual astigmatism magnitude was 0.5D or less. The mean absolute difference between the target axis and the achieved axis 1 and 3 months postoperatively was 2.5° ± 2.7° and 3.2° ± 3.3°, respectively. The final IOL orientation was within 10 degrees of target axis in 19 of 22 (86.4%) eyes, within 20 degrees in 21 of 22 (95.2%) eyes and within 30 degrees in 22 of 22 (100%) eyes. IOL rotational repositioning was required in two eyes (9.1%). In this cohort of patients, the 1stQ AddOn toric monofocal piggyback IOL resulted in very good visual and refractive outcomes and showed reasonable rotational stability. This IOL appears to be an effective treatment option for residual astigmatic refractive error in pseudophakic eyes. [ABSTRACT FROM AUTHOR]

Pedro Manuel Baptista,1,2 Sílvia Monteiro,1 Ana Carolina Abreu,1 João Poças,1 Diana José,1 Miguel Lume,1 Maria do Céu Pinto1 1Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; 2Instituto de Ciências Biomédicas Abel Salazar, Porto, PortugalCorrespondence: Pedro Manuel BaptistaCentro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, Porto 4099-001, PortugalTel +351 917868372Email pedroyybaptista@gmail.comPurpose: To analyze and compare the mid-term objective and subjective performance of two phakic intraocular lenses (PIOLs) – Visian® ICL™ V4c and Artiflex® and to correlate those results with anatomical parameters.Patients and Methods: Observational retrospective study including thirty patients (15 for each PIOL) randomly selected from those who underwent bilateral implantation of one of the PIOLs (60 eyes were analysed). Uncorrected and corrected distance visual acuities (UDVA and CDVA), anterior chamber structural parameters, and corneal endothelial cells density and morphology were evaluated. Quality of vision was assessed both subjectively with a questionnaire, and objectively using a double-pass technology optical quality analysis system.Results: At the end of follow-up the Artiflex® group showed better UDVA (0.95± 0.11 vs 0.99± 0.05, p=0.027) and higher proportion of eyes reaching at least 20/20 (28/30 vs 18/30, p=0.005). Excellent and similar objective scatter index (1.79± 0.9 vs 2.14± 1.6, p=0.306) and modular transfer function cutoff frequency (26.91± 9.2 vs 26.51± 11.9, p=0.784) results were achieved in the HD Analyzer® and the questionnaire showed comparable high Satisfaction (55.7± 3.5 vs 54.3± 5.4, p=0.386) and low Dysphotopsia Scores (3.1± 1.8 vs 2.1± 2.2, p=0.213). The ICL group showed inferior anterior chamber volume (p< 0.001), and angle (p< 0.001) and superior pupillary diameter (p=0.007). Minimum follow-up was 24 months.Conclusion: Both the Visian® ICLV4c™ and the Artiflex® showed excellent optical performance through the HD AnalyzerTM technology, translated in high patient satisfaction. Overall, both PIOLs showed similar safety, predictability, stability and effectiveness of for the reduction of high sphero-cylindrical refractive errors, despite better UDVA results with the Artiflex®.Keywords: astigmatism, Artiflex®, dysphotopsia, glare, halos, HD AnalyzerTM, high myopia, phakic intraocular lens, spheric, toric, Visian® ICLV4c™

The use of specially designed reverse geometry lenses, known as orthokeratology (ortho-K) lenses, has gained popularity recently. There are various names to this technique: corneal reshaping therapy, corneal refractive therapy, overnight corneal reshaping, corneal molding system, Vision Shaping Treatment, and many more. The advantage of applying this technique is that it results in a temporary reduction of the refractive error by flattening the central cornea with overnight wear of the specially designed lens. Ortho-K lenses are also widely used as a modality for slowing myopia progression in children. With advances in technology and lens design, high refractive errors and astigmatism are now possible to correct. This case presentation summarizes a successful fitting of toric ortho-K lenses to reshape a toric cornea with high myopia and astigmatism. [ABSTRACT FROM AUTHOR]

Purpose: To assess refractive and visual outcomes following phacoemulsification with femtosecond laser-assisted cataract surgery (FLACS) using intraoperative aberrometry and implantation of a toric intraocular lens (IOL) in eyes with different degrees of astigmatism. Methods: One hundred two eyes of 70 patients who underwent implantation of the transitional toric 565 Precizon IOL (Ophtec BV) were enrolled. FLACS, capsular tension ring insertion, and intraoperative aberrometry were performed. Main outcome measures were refractive error, uncorrected- and corrected distance snellen decimal visual acuity values (UDVA and CDVA, respectively), and IOL rotation. Specifically, a vector analysis was carried out with J0 and J45 evaluation. Eyes were evaluated 1-year after surgery. Results: Overall, 94.12% (96 eyes) and 100% (102 eyes) of the eyes showed a spherical equivalent (SE) within ± 0.50D and ± 1.00D, respectively. The mean SE and refractive cylinder were − 0.06 ± 0.29D and − 0.23 ± 0.37D, respectively. Vector analysis revealed that 100% of the eyes were within ± 0.50D for the J0 and J45 cylindrical components. The mean toric axis rotation was 1.10 ± 1.71° (from 0° to 5°), 77% (79 eyes), and 100% (102 eyes) of the eyes showed UDVA and CDVA of 20/25, respectively. The postoperative mean values of monocular UDVA and CDVA were 0.88 ± 0.17 and 0.96 ± 0.07 (about 20/20), respectively. No patient required IOL realignment during the postoperative follow-up. Conclusions: The present study suggests that the use of the Precizon IOL after FLACS, using intraoperative aberrometry in patients with different amounts of astigmatism, provides good visual acuity, accurate refractive outcomes, and excellent rotational stability. [ABSTRACT FROM AUTHOR]

Seth M Pantanelli,1 Neal Kansara,1 Gerard Smits2 1Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, USA; 2Computer and Statistical Consultants Incorporated, Santa Barbara, CA, USACorrespondence: Seth M PantanelliDepartment of Ophthalmology, Penn State College of Medicine, 500 University Drive; HU19, Hershey, PA 17033-0850, USATel +1 717-531-5690Fax +1 717-531-5009Email spantanelli@pennstatehealth.psu.eduPurpose: To compare predictability of postoperative refractive astigmatism (RA) using the Emmetropic Verifying Optical (EVO) Toric Formula v2.0 to one that accounts only for anterior corneal astigmatism.Methods: This is a secondary analysis of de-identified data from a clinical trial including 9 sites across the United States. Preoperative biometry was used to predict postoperative RA with the implanted toric IOL using legacy enVista and EVO online calculators. The RA prediction error was computed between back-calculated postoperative RA and predicted residual RA. Outcome measures included vector (centroid) and arithmetic mean RA prediction error.Results: Comparison of calculators was based on 109 eyes, 97 (89%) of which were implanted with a toric IOL with an effective astigmatism power of 1.4 D or less. Centroid of the RA prediction errors was 0.37 D @ 178 and 0.17 D @ 090 for the legacy and EVO calculators, respectively (p < 0.0001). The proportion of eyes with an absolute RA prediction error ≤ 0.5 was 47.3% and 49.1% (p = 0.78), while the proportion of eyes ≤ 1.0 D was 82.7% and 89.1% (p = 0.03). Differences in the proportions ≤ 0.5 D existed for WTR (p = 0.015) but not ATR (p = 0.75) eyes. The proportion in which orientation of the predicted RA (ATR, WTR, or oblique) matched the actual RA was 62% and 78% for legacy and EVO calculators, respectively (p = 0.0029).Conclusion: The EVO Toric Formula v2.0 out-performed the legacy calculator with regards to predictions in eyes with low astigmatism.Keywords: cataract, toric, intraocular lens power, astigmatism, calculators, EVO

AIM: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a trifocal toric intraocular lens (IOL) in eyes with low degrees of corneal astigmatism. METHODS: Twenty-six eyes of 22 patients who underwent implantation a trifocal toric IOL (FineVision PODFT, PhysIOL s.a., Liege, Belgium) were enrolled. Phacoemulsification with femtosecond laser, capsular tension ring insertion and intraoperative aberrometry were performed in all cases. All IOLs used showed a cylinder power of 1.00 D. Main outcome measures were refractive error and corrected-distance visual acuity (CDVA) and uncorrected-distance visual acuity (UDVA) values. Eyes were evaluated at 4mo post-surgery. RESULTS: Totally 50% of eyes showed a spherical equivalent (SE) within ±0.13 D and all of them within ±0.50 D. The mean SE and refractive cylinder were -0.02±0.23 and -0.16±0.22 D, respectively. Vector analysis revealed that 100% of eyes were within ±0.50 D for the SE and cylindrical components (J0 and J45). Refractive changes were not correlated with keratometric changes (P>0.05) showing that the reduction in astigmatism comes from the trifocal toric IOL. Of 81% and 96% of eyes showed UDVA and CDVA of 20/20, respectively. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.97±0.05 and 0.99±0.02 (about 20/20), respectively. CONCLUSION: Our study suggests that the use of this trifocal toric IOL in patients with low amount of astigmatism provides accurate refractive outcomes and enables them to achieve excellent visual acuity.

Purpose: To compare the accuracy of isolated manual marking and smartphone-assisted manual marking with the Verion image-guided system for toric intraocular lens (IOL) implantation. Methods: In this prospective observational study, 42 eyes of 36 patients planned for phacoemulsification with toric IOL implantation with corneal astigmatism >1D as measured on Lenstar LS 900 optical biometer were included. Patients were preoperatively registered and photographed on the Verion image-guided system. In the operating room, the patient's eye was manually marked at the 6 o′ clock limbus (Manual axis-90°) on slit-lamp in sitting position. Next, using the smartphone android app—iToric Patwardhan, the exact mark axis was confirmed (Smartphone axis). Following this, the patient was taken on the operation table where the mark axis was confirmed with Verion digital overlay on an external screen (Verion axis). The absolute angular deviation of manual axis from Verion was compared with the absolute angular deviation of the smartphone axis from Verion as the primary outcome measure. Results: The mean absolute angular deviation between the smartphone axis and the Verion axis was 2.62°, which was significantly lower (P < 0.05) than that between the manual axis and Verion axis (4.60°). Moreover, the intraclass correlation coefficient between the smartphone axis and Verion axis was 0.88 indicating a strong agreement between the two. Conclusion: Smartphone-assisted manual marking significantly improves the accuracy of manual marking alone when comparing with the Verion Digital Marker system for toric IOL implantation.

J Sha,1 C Fedtke,1,2 D Tilia,1,2 N Yeotikar,1 M Jong,1,2 J Diec,1 V Thomas,1 RC Bakaraju1,2 1Brien Holden Vision Institute, Sydney, NSW, Australia; 2School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia Purpose: To ascertain the impact of altering cylinder (cyl) power and axis on vision in astigmatism. Methods: In a prospective, randomized, participant-masked, crossover clinical trial, 28 astigmatic participants were tested for the following conditions on different days: full sphero-cyl correction and undercorrection by 0.25, 0.50, and 0.75 DC while maintaining spherical equivalence. Axis was also misaligned between –30° and +30°, in 10° steps. For each configuration, monocular high- and low-contrast visual acuities (HCVA, LCVA) were measured at 6 m, and participants rated vision clarity (1–10), vision satisfaction (1–10), and vision acceptability (yes/no). Linear mixed models were used to compare visual performance in the overall group and in low, medium, and high cyl subgroups. Results: Undercorrecting cyl power affected all groups equally (P≥0.073). Undercorrection by 0.75 DC was significantly different to full cyl power for all variables (P≤0.007), while 0.25 DC undercorrection did not cause any significant decreases (P>0.05). Undercorrection by 0.50 DC was significantly different to full cyl power for HCVA (P=0.006, however not clinically significant) and vision acceptability (P=0.034). Axis misalignment affected the cyl groups differently (P

Jill Saxon, Marjorie J Rah, William T Reindel Vision Care, Bausch & Lomb Incorporated, Rochester, NY, USA Purpose: The purpose of this evaluation was to compare the experience of habitual contact lens wearers with that of nonwearers when fitted with a novel toric nesofilcon A contact lens (Biotrue ONEday for Astigmatism lens; Bausch & Lomb Incorporated, Rochester, NY, USA), for wearer comfort, vision, and satisfaction in a real-world setting.Materials and methods: Participating eye care practitioners (ECPs) prescribed toric nesofilcon A lenses to their astigmatic patients as part of their routine clinical practices. Accordingly, 1,253 patients successfully completed the evaluation; of these, 51% wore contact lenses habitually, 41% wore eyeglasses, and 8% had no prior vision correction. All wore the lenses for at least 4 days, and 74% wore them for an average of 9 hours or more per day. After at least 4 days of wear, each patient completed an online survey to evaluate his or her level of satisfaction regarding comfort and vision. As this postmarket evaluation was observational, data were analyzed to determine whether more patients than not agreed with individual statements regarding lens performance, and whether there was any difference in response between habitual contact lens wearers and nonwearers.Results: As a measure of general satisfaction, 96% of patients indicated that their overall opinion of the toric nesofilcon A lens was good to excellent. Further, more patients than not agreed that the lens performed well with regard to all aspects of vision and comfort queried (P

Purpose: To analyze and compare the mid-term objective and subjective performance of two phakic intraocular lenses (PIOLs) – Visian® ICL™ V4c and Artiflex® and to correlate those results with anatomical parameters. Patients and Methods: Observational retrospective study including thirty patients (15 for each PIOL) randomly selected from those who underwent bilateral implantation of one of the PIOLs (60 eyes were analysed). Uncorrected and corrected distance visual acuities (UDVA and CDVA), anterior chamber structural parameters, and corneal endothelial cells density and morphology were evaluated. Quality of vision was assessed both subjectively with a questionnaire, and objectively using a double-pass technology optical quality analysis system. Results: At the end of follow-up the Artiflex® group showed better UDVA (0.95± 0.11 vs 0.99± 0.05, p=0.027) and higher proportion of eyes reaching at least 20/20 (28/30 vs 18/30, p=0.005). Excellent and similar objective scatter index (1.79± 0.9 vs 2.14± 1.6, p=0.306) and modular transfer function cutoff frequency (26.91± 9.2 vs 26.51± 11.9, p=0.784) results were achieved in the HD Analyzer® and the questionnaire showed comparable high Satisfaction (55.7± 3.5 vs 54.3± 5.4, p=0.386) and low Dysphotopsia Scores (3.1± 1.8 vs 2.1± 2.2, p=0.213). The ICL group showed inferior anterior chamber volume (p< 0.001), and angle (p< 0.001) and superior pupillary diameter (p=0.007). Minimum follow-up was 24 months. Conclusion: Both the Visian® ICLV4c™ and the Artiflex® showed excellent optical performance through the HD AnalyzerTM technology, translated in high patient satisfaction. Overall, both PIOLs showed similar safety, predictability, stability and effectiveness of for the reduction of high sphero-cylindrical refractive errors, despite better UDVA results with the Artiflex®. [ABSTRACT FROM AUTHOR]

Smartphone apps are becoming increasingly popular in ophthalmology, one specific area of their application being toric intraocular lens (IOL) surgery for astigmatism correction. Our objective was to identify, review and objectively score smartphone apps applicable to toric IOL calculation and/or axis alignment. This review was divided into three phases. A review was conducted on four major app databases (phase I): National Health Service (NHS) Apps Library, Google Play Store, Apple App Store and Amazon Appstore. A systematic literature review (phase II) was conducted to identify studies for included apps in phase I of our study. Keywords used in both searches included: “toric lens”, “toric IOL”, “refraction”, “astigmatism”, “ophthalmology”, “eye calculator”, “ophthalmology calculator” and “refractive calculator”. Included apps were objectively scored (phase III) by three independent reviewers using the mobile app rating scale (MARS), a validated tool that ranks the quality of mobile health apps using a calculated mean app quality (MAQ) score. Phase I of our study screened 2428 smartphone apps, of which six apps for toric IOL calculation and four apps for axis marking were eligible and were selected for quantitative analysis. Phase II of our study screened 477 studies from PubMed, Medline and Google Scholar. Three studies validating two apps (toriCAM, iToric Patwardhan) in a clinical setting as adjunct tools for preoperative axis marking were identified. Phase III ranked Toric Calculator for iPhone (Apple iOS, MAQ 4.13; average MAQ 3.34 ± 0.54) as the highest-scoring toric IOL calculator, and iToric Patwardhan (Android OS, MAQ 4.13; average MAQ 3.41 ± 0.44) was the highest-scoring axis marker in our study. Our review identified and objectively scored ten smartphone apps available for toric IOL surgery adjuncts. Toric Calculator for iPhone and iToric Patwardhan were the highest-scoring toric IOL calculator and axis marker, respectively. Current literature, though limited, suggests that axis marking smartphone apps can achieve similar levels of misalignment reduction when compared to digital systems.

Abstract Background To compare the clinical outcome of Precizon toric intraocular lens (IOL) (Ophtec Inc.) to that of Tecnis toric IOL (Abbott Medical Optics Inc.). Methods This randomized comparative study included 40 eyes (Precizon, 20 eyes; Tecnis, 20 eyes) of 40 patients with visually significant cataract and corneal astigmatism who underwent cataract surgery. Changes in uncorrected distant visual acuity (UCDVA), best corrected distant visual acuity (BCDVA), uncorrected intermediate visual acuity (UCIVA), refraction, residual astigmatism, rotation of the IOL axis, and higher order aberrations at 3 months postoperatively were evaluated. Vector analysis was performed using the Alpins method. Results Both groups showed significant reduction in refractive astigmatism after the surgery (Precizon: − 1.06 ± 0.94 Diopter (D) to − 0.31 ± 0.29 D, p = 0.042; Tecnis: − 1.83 ± 1.29 D to − 0.41 ± 0.33 D, p = 0.015). There was no significant (p > 0.05) difference in postoperative UCDVA, BCDVA, or residual astigmatism between the two groups, although a tendency of better UCIVA was observed in the Precizon group. Vector analysis parameters showed no statistically significant difference beween groups(P > 0.05). Significant difference in rotation of toric IOL axis was found between the two groups (Precizon: 1.50° ± 0.84, Tecnis: 2.56° ± 0.68, p = 0.010). Spherical aberration in the Precizon group was significantly (p = 0.005) lower than that in the Tecnis group. Conclusions The Precizon toric IOL group had better rotational stability at 3-month postoperatively. Both Precizon toric IOL and Tecnis toric IOL could be effectively used by cataract surgeons to correct preexisting corneal astigmatism through cataract surgery. Trial registration http://clinicaltrials.gov, NCT03085901, retrospectively registered on 21 March 2017.

AIM: To compare clinical results between toric and spherical periphery design orthokeratology (ortho-k) in myopic children with moderate-to-high corneal astigmatism. METHODS: This retrospective study enrolled 62 eyes of 62 subjects using toric ortho-k lenses. These subjects were assigned to the toric group. Based on the one-to-one match principle (same age, proximate spherical equivalence and corneal astigmatism), 62 eyes of 62 subjects were enrolled and included in the spherical group. At one-year follow-up visit, visual acuity, corneal astigmatism, treatment zone decentration, axial elongation and adverse reaction were compared between these two groups. RESULTS: At the one-year visit, corneal astigmatism was significantly lower in the toric group (1.22±0.76 D) than in the spherical group (2.05±0.85 D) (P=0.012). The mean magnitude of the treatment zone decentration was 0.62±0.42 mm in the toric group and 1.07±0.40 mm in the spherical group (P=0.004). Axial elongation was significantly slower in the toric group (0.04±0.13 mm) than in the spherical group (0.09±0.13 mm) (P=0.001). The one-year axial elongation was significantly correlated with initial age (r=-0.487, P

Purpose: To assess a single site's initial experience with SMILE for the treatment of myopic astigmatism and compare outcomes and vector analysis results with the US Food and Drug Administration (FDA) results and published literature. Patients and Methods: Forty-eight eyes (29 patients) with mean preoperative sphere of − 5.11 ± 1.31 diopters (D) and cylinder of − 1.12 ± 0.60 D underwent SMILE. Visual acuity, refractive, and vector analysis outcomes as well as subjective measures were reported at three and twelve months postoperatively and compared with FDA results and the published literature between 2014 and 2020 involving treatment of patients with mean cylinders of >− 0.50 to ≤− 3.00 D. Results: At three and twelve months, 43 and 32 eyes were evaluated, respectively. At twelve months, mean cylinder power was reduced to − 0.38 ± 0.38 D with 78.1% achieving ≤± 0.50 D. Uncorrected distance visual acuity (UDVA) ≥ 20/20 was achieved in 77.4% of eyes by twelve months with 100% achieving ≥ 20/30 UDVA. No loss of corrected distance visual acuity was observed in eyes seen at twelve months. Correction index (CI) at twelve months was 0.90 indicating overall undercorrection of 10%. Twelve-month CI was 0.96, 0.90, and 0.83 in eyes with preoperative cylinders of <− 1.00 D, ≥− 1.00 to <− 2.00 D, and ≥− 2.00 D, respectively. Mean angle of error was − 1.58 ± 11.61° ranging from − 24.22° to 37.75°. Conclusion: We found SMILE to be an effective and safe means of achieving spectacle independence and improving visual acuity in patients with myopic astigmatism. SMILE has the potential for improved clinical outcomes with better nomogram guidance and advancements in technique. However, surgeons must be aware of the potential for undercorrection in with-the-rule astigmatism and at higher preoperative cylinders and as well as the potential for overcorrection in against-the-rule and lower preoperative cylinder astigmatism. [ABSTRACT FROM AUTHOR]

Purpose: To compare the accuracy of isolated manual marking and smartphone-assisted manual marking with the Verion image-guided system for toric intraocular lens (IOL) implantation.Methods: In this prospective observational study, 42 eyes of 36 patients planned for phacoemulsification with toric IOL implantation with corneal astigmatism >1D as measured on Lenstar LS 900 optical biometer were included. Patients were preoperatively registered and photographed on the Verion image-guided system. In the operating room, the patient's eye was manually marked at the 6 o' clock limbus (Manual axis-90°) on slit-lamp in sitting position. Next, using the smartphone android app-iToric Patwardhan, the exact mark axis was confirmed (Smartphone axis). Following this, the patient was taken on the operation table where the mark axis was confirmed with Verion digital overlay on an external screen (Verion axis). The absolute angular deviation of manual axis from Verion was compared with the absolute angular deviation of the smartphone axis from Verion as the primary outcome measure.Results: The mean absolute angular deviation between the smartphone axis and the Verion axis was 2.62°, which was significantly lower (P < 0.05) than that between the manual axis and Verion axis (4.60°). Moreover, the intraclass correlation coefficient between the smartphone axis and Verion axis was 0.88 indicating a strong agreement between the two.Conclusion: Smartphone-assisted manual marking significantly improves the accuracy of manual marking alone when comparing with the Verion Digital Marker system for toric IOL implantation. [ABSTRACT FROM AUTHOR]

Purpose: To determine the refractive astigmatism following toric intraocular lens (tIOL) implantation without consideration of posterior keratometric astigmatism with a conventional tIOL calculator for eyes with low keratometric astigmatism (0.75D to 2.5D) and to theoretically compare the outcomes with predicted refractive astigmatism using a calculator with Barrett's formula. Methods: 34 eyes (34 patients) were assessed with Scheimpflug imaging and underwent tIOL implantation employing conventional tIOL calculator. Eyes were grouped on preoperative keratometric astigmatism as against-the-rule (ATR), with-the-rule (WTR), and oblique (OB). The refractive astigmatism was assessed at 1, 3, 6 and 12 months postoperatively and was classified as ATR, WTR, and OB. Theoretical refractive astigmatism calculations were performed for the same eyes using Barrett's formula. Results: Preoperatively keratometric astigamtism was ATR, WTR, and OB in 32%, 53% and 15% of eyes. At 12 months, in ATR, WTR and OB groups, 45.5%, 16.7% and 60% had ATR refractive astigmatism; 16.7%, 0%, and 20% had WTR refractive astigmatism; 55.6%, 54.5% and 20% were emmetropic (no sphere and cylinder) respectively. There was a significant difference between the theoretical predicted postoperative refractive astigmatism using conventional tIOL calculator and Barrett's formula (P <.05). Postoperative refractive astigmatism was not significantly different from the theoretical predicted refractive astigmatism with Barrett's formula but it was significantly higher than that with a conventional tIOL calculator. Conclusions: At 12 months, with a conventional tIOL calculator, postoperative emmetropia is achieved in half, two third and one-fifth of eyes with preoperatively ATR, WTR, and OB keratometric astigamtism respectively. Around 1/4th WTR keratometric astigamtism eyes preoperatively were overcorrected to ATR refractive astigmatism whereas ½ATR remained undercorrected at 12 months Outcomes achieved were dissimilar to predicted outcomes with a conventional tIOL calculator but similar to those with Barrett's formula. [ABSTRACT FROM AUTHOR]