Kirandeep Kaur1, Bharat Gurnani2. 1. Consultant Pediatric Ophthalmology and Strabismus Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India. 2. Consultant Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India.
Dear Editor,As we all are aware that with the advancement in technology and introduction of newer generation premium intraocular lenses (IOLs), the patient’s demand and expectations have increased tremendously.[1] Modern-day cataract surgery has transformed into refractive surgery.[2] The postoperative outcomes after toric IOL implantation are influenced by various factors such as preoperative patient selection and investigations to accurate intraoperative axis alignment and postoperative care with counseling.[3] Postoperative toric IOL rotation is the major factor responsible for suboptimal visual outcomes after toric IOL implantation. Toric IOL realignment is needed in 0.65% to 3.3% cases, with more than 10° of rotation from the target axis.[4] We read the article by Patil et al.[5] and we congratulate the authors for bringing out this interesting study. However, we have a few important observations and suggestions to make.Firstly, it would be interesting to know that the authors used which method of keratometry to rule out corneal astigmatism? This is vital since it can interfere with postoperative outcomes. At our center, we use Pentacam for all patients willing for toric IOL implantation.Secondly, the authors mention that around 32 (80%) patients have IOL rotation at postop 1 and 3 months, and 8 (20%) rotations between 6° and 10° on all follow-ups, which is slightly higher than expected. What can be the reason for the same? Can the authors throw some light on this for the benefit of the readers?Thirdly, three patients had very large axis rotation, which was eventually realigned. It would be interesting to know what the final residual astigmatism was for these patients since patient’s expectations are very high post premium-IOL implantation. Can the authors enlighten us over this?Finally, how did the authors ensure patient satisfaction post IOL implantation? Did they use any particular questionnaire? Once again, we would like to congratulate the authors for bringing out this important analysis on premium IOLs.