The ability to position toric IOLs in real time and validate astigmatic accuracy intraoperatively may yield more precise lens positioning and, thus, optimal refractive results. This compilation presents an overview of several tools with intraoperative capabilities for toric IOL alignment.
The Holos IntraOp wavefront aberrometer (Clarity Medical Systems) provides streaming video of intraoperative wavefront data to assess real-time refractive changes during cataract surgery. According to company literature,1 the device displays qualitative and quantitative refractive data in real time, providing immediate feedback on how adjustments affect refraction during rotational alignment of a toric IOL.
1. Holos IntraOp Wavefront Aberrometer. Clarity Medical Systems. http://www.claritymsi.com/us/downloads/HOLOSBrochure_2013.pdf. Accessed April 20, 2015.
ORA System With VerifEye+
The ORA System with VerifEye+ technology (Alcon WaveTec) is an intraoperative wavefront aberrometer that provides realtime lens power, sphere, cylinder, and axis recommendations and provides real-time data validation. According to company literature, 1 the ORA System can enhance toric IOL outcomes by helping to determine the cylindrical magnitude and axis in real time, accounting for both anterior and posterior corneal astigmatism and reducing the incidence of unintended residual postoperative astigmatism.
1. ORA System with VerifEye+ Technology. Alcon. https://www.myalcon.com/products/surgical/ora-system/index.shtml. Accessed April 20, 2015.
Powered by TrueVision Smart 3D (TrueVision 3D Surgical), TrueGuide is a computer guidance software application designed to improve patient outcomes during cataract and refractive surgery, according to company literature.1 TrueGuide generates templates on the live surgical field of view to aid in IOL alignment and incision creation. At-the-microscope touchscreen capability enables surgeons to change in real time toric IOL alignment, incision parameters, and targeted astigmatic outcomes.
1. Efficient surgical workflow and real-time updates with next generation TrueGuide astigmatic correction application [news release]. TrueVision 3D Surgical. http://www.truevisionsys.com/announcement64.html. Accessed April 20, 2015.
Available on the Callisto eye system (Carl Zeiss Meditec), Z Align is an eye-tracking technology that overlays a previously captured image over the live microscope image, according to company literature.1 Once Callisto eye has taken the images and relayed them to the Z Align module, the surgeon, looking at the touchscreen, can use the images to achieve IOL placement on the target axis for markerless alignment.
1. Carl Zeiss Meditec. http://www.zeiss.info/41256808003BC74D/EmbedTitelIntern/brochure_eng_zeiss-toric-solution/$File/brochure_eng_zeiss-toric-solution.pdf. Accessed April 20, 2015.
SMARTPHONE APPS FOR TORIC IOL ALIGNMENT
• Developed by José Miguel Varas, MD; and Evandro Souza
• Available at https://itunes.apple.com/au/app/axis-assistant/id843536178?mt=8 (iPhone)
Toraxis and Toreasy
• Developed by Damien Gatinel, MD
• Available at https://itunes.apple.com/fr/app/toraxis/id936713092?l=en&mt=8 (iPhone) and https://play.google.com/store/apps/details?id=com.campion.toreasyunlimited&hl=en (Android)