Enhance Your Toric IOL Workflow

2 July 2024
Image of Douglas Koch, MD
About the expert Douglas Koch, MD Dr. Koch practices at the Baylor College of Medicine in Houston, Texas

As a surgeon who obsessively reviews IOL calculations in patients with mild to moderate astigmatism, I used to find myself pouring over piles of paperwork of printed and handwritten notes and bouncing between various formula calculators to arrive at the most precise calculations possible. Obviously, I performed this time-consuming process to optimize patient outcomes.

This changed when I integrated ZEISS VERACITY Surgery Planner into my clinical and surgical routine. Rather than manually aggregate the data from presurgical workups and estimate the postsurgical refraction, I now have all data in a single, unified repository that performs instantaneous calculations, thereby giving me the information I need to discuss options and educate my patients.

When working with patients with slight astigmatism who present at my office for a cataract consultation, ZEISS VERACITY Surgery Planner offers the following advantages:

  • Immediate collation of preoperative examination data. I often gather two biometry and up to three topography reports in patients with astigmatism, as I feel that, the more data I have on hand, the more precisely I can verify the quality of the data and therefore more accurately select IOL power and correct all levels of astigmatism. VERACITY pulls these data directly from the imaging technologies housed in my clinic, saving me the time of inputting data in myself, and, very importantly, eliminating the risk of transcription errors.
  • Immediate lens calculations leveraging different formula calculators. Given how particular I am about choosing the right toric IOL for a particular patient, I like to look at multiple astigmatism values and run at least two formulas before making a recommendation. I rely on the Abulafia-Koch and the Barrett formulas. In pre-VERACITY days, I had to go to different calculators and (in some situations) manually input data into each one to get a calculation. Now, with ZEISS VERACITY Surgery Planner, I can toggle between the outputs of each formula to see which approach will result in the best outcome for my patient.
  • Rapid understanding of the relationship between toric technology and postoperative astigmatism. Once I have selected a lens—say, a monofocal non-toric lens—the toric formulas in VERACITY calculate the predicted postoperative refraction. If, as is sometimes the case with many borderline astigmatism patients, the predicted postoperative refraction shows higher-than-expected degrees of astigmatism, I can quickly see how switching to a toric IOL will affect postoperative refraction. If toric technology can address immediate or future astigmatism-related quality of vision, then I educate the patient about these options.
            o The result is that my use of toric IOLs has significantly increased, as has patient satisfaction.
  • More quality face time with patients. Before VERACITY, there were times when it was a challenge to suggest the optimal lens choice while interacting with the patient. Now that I use ZEISS VERACITY Surgery Planner, I make these calculations in real time in front of the patient with just a few taps, which facilitates greatly improved communication with patients. This also enhances clinic flow, enabling me to see more patients.
  • Data analysis. When integrated with an EMR (Epic, in my case), ZEISS VERACITY Surgery Planner uses powerful analytical software to pull postoperative refractive data and automatically analyze the accuracy of IOL spherical and toric calculations. What used to consumed hours of time is now accomplished automatically—and continuously.
  • I get home earlier! Thanks to ZEISS VERACITY Surgery Planner, I do a better job and in less time. What a concept!
Real-world Example:

Figure 1. The patient’s predicted final refraction using the Barrett Integrated-K formula showed likely postoperative astigmatism when a non-toric IOL was selected.

Clinical Example - Non-toric IOL

A recent example from my clinic illustrates the power of ZEISS VERACITY Surgery Planner to unlock predicted postoperative refractions that can guide patient education in patients with borderline astigmatism.

A 66-year-old physically active man presented to the clinic for a cataract evaluation. His stated goals were mini-monovision and some intermediate vision. The patient sat for various preoperative measurements, data from which were fed into ZEISS VERACITY Surgery Planner for collation. After toggling through my preferred formulas, I settled on the Barrett Integrated-K, which I felt offered the best postoperative outcome for my patient (Figure 1). After selecting a non-toric IOL, I found that the predicted postoperative refraction showed excessive residual astigmatism that would interfere with the patient’s postoperative goals—and would leave the patient with against-the-rule astigmatism that would only worsen with time (on average, 3/8 D per decade1).

Real-world Example

Figure 2. After switching to a toric IOL, the patient’s predicted final refraction using the Barrett Integrated-K formula showed that astigmatism would be addressed adequately.

Clinical Example - Toric IOL

Using ZEISS VERACITY’s nearly instantaneous recalculations, I toggled to a toric IOL to see how it might affect predicted postoperative refraction using the same formula. As expected, the predicted final refraction showed that the toric lens accommodated the patient’s astigmatism (Figure 2).

Armed with this knowledge, the patient elected for toric technology. I targeted this eye for -0.50—and got a perfect result, with uncorrected vision of 20/20-2, J2 and postoperative refraction of -0.75 + 0.50 x 75o. This astigmatic outcome will serve him well for at least 2 decades.

ZEISS VERACITY Surgery Planner Refines Your Toric Workflow

My life in the pre-VERACITY era required cumbersome and time-consuming manual calculations, often taking me well into the evening to select my IOLs.

Now that I have integrated ZEISS VERACITY Surgery Planner into my clinic, I run multiple formulas with multiple lenses to calculate the most ideal postoperative refraction. Because of immediate access to my data and toric calculations, I can better educate my patients about why toric technology is right for them, and my patients leave with the sense that they received personalized care—which, after all, is what they expect and deserve.

Overall, I have improved refractive accuracy and astigmatic outcomes by connecting ZEISS VERACITY Surgery Planner to my busy practice. I recommend it to any surgeon seeking to improve their clinic in this capacity.

The statements of the author reflect only his personal opinions and do not necessarily reflect the opinions of any institution with whom he is affiliated.
The author has a contractual or other financial relationship with Carl Zeiss Meditec, Inc. and has received financial support.

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  • 1

    Hayashi K, Ogawa S, Manabe S-I, Hirata A. Influence of Patient Age at Surgery on Long-Term Corneal Astigmatic Change Subsequent to Cataract Surgery. Am J Ophthalmol. 2015;160(1):171-178.