Toric intraocular lens (IOL) technology has expanded to include multifocal capabilities and serves specialized patient populations including keratoconus cases, driving both patient satisfaction and clinical differentiation. Here, Ophthalmology Management board member Alanna Nattis, DO, FAAO, joins the publication’s 30th anniversary celebration of innovation with a discussion of how toric IOLs have enhanced both patient outcomes and practice value. The below transcript was edited for clarity.

Hi, my name is Dr. Alanna Nattis. I'm a cornea, cataract, and refractive surgeon as well as director of clinical research at SightMD on Long Island in New York. I want to discuss the value that toric IOLs have brought to my practice, both as a cataract and refractive surgeon and also as a cornea specialist. Toric IOLs have been around for quite some time. They've given our patients a lot of freedom in terms of spectacle independence, even if it's just for distance vision after cataract surgery. We can correct about 1.5 to 6 diopters of astigmatism at the IOL plane, which equates to about 1 to 4 diopters at the corneal plane depending on the IOL that you're using. And it's very important—that I've found in my practice for patients who are candidates for toric IOLs—that you get accurate K readings before the surgery to make sure that you know exactly the correct power of the sphere, the cylinder, and the axis of astigmatism before doing cataract surgery. This may sometimes mean doing a corneal screening before surgery if some patients have corneal dystrophies like anterior basement membrane dystrophy.

As the IOL technology has evolved, we can also give toric IOLs to our patients who desire multifocality. So patients who are also interested in extended-depth-of-focus lenses or trifocal lenses or multifocal lenses are also candidates for toric lenses as well if they have a decent amount of astigmatism in their prescription. As a cornea specialist, they've been valuable to me too for helping my keratoconus patients. Many of the keratoconus patients that I have end up needing some form of scleral contact lens or sometimes even a corneal transplant after they've had cross-linking. But there are some keratoconus patients with mild astigmatism that has been stable for quite some time and those patients can do incredibly well with these toric IOLs also with cataract surgery. And that's a very gratifying thing for these patients that have had to suffer with such poor vision most of their lives.

One thing that I've certainly learned through my training and also in practice is that toric lenses, they have to be stable in their rotation aspects. So you don't want to put these in patients that have zonular instability, patients where there may have been a complication during the surgery, maybe the capsule isn't very stable. Even in patients that have very long axial lens, you have to be careful for IOL rotation postoperatively. So I do keep an eye on that as well if the vision isn't quite where I think it should be in the post-op period. But overall, these toric lenses have contributed a great amount to my practice, a lot of patient satisfaction, and of course satisfaction for me too, to be able to give my patients better vision after cataract surgery.