Regional EuroTimes
Date Posted 13/09/2009
Iris fingerprinting for toric IOLs
Iris “fingerprinting” offers new alternative for optimising toric IOL outcomes
Iris fingerprinting is an effective new technique for improving the precision of toric IOL orientation, said Robert H Osher MD, at the XXVII Congress of the ESCRS.
The concept is based on the fact that every iris contains unique structures (eg., crypts, nevi, holes, ridges, stromal patterns, Brushfields spots) that when imaged preoperatively, provide landmarks for accurate toric IOL alignment in the operating room.
“Almost five years ago I predicted that toric IOLs would become the new standard of care in refractive cataract surgery, and the enormous growth of this implant technology in the international market confirms we are heading in that direction. However, conventional techniques used by cataract surgeons for identifying the visual axis are barbaric,” said Dr Osher, professor of ophthalmology, College of Medicine, University of Cincinnati, and medical director emeritus of the Cincinnati Eye Institute, Cincinnati, Ohio, US.
“I believe iris fingerprinting represents a significant step forward in the evolution of refractive cataract surgery.”
Dr Osher said that the pitfalls of current methods of axis identification using a marking pen are highlighted by a study he performed showing that he personally was off axis routinely by at least 10 degrees.
“These marks may be off initially and then can diffuse and even disappear,” he explained.
Originally Dr Osher used hand drawings of iris landmarks as an aide to guide toric IOL orientation. Now proprietary iris fingerprinting software is available from several companies.
The technique begins by obtaining a detailed, high magnification image of the iris during a routine dilated preoperative slit-lamp exam. A first button press overlays the iris image with a grid showing the major meridia. With a second press of a button, an adjustable goal line appears, and with one more button press, the exact location of any iris landmark can be determined. The image can be printed out as a hard copy or electronically transferred to the OR.
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