Evaluation of Two Different Axis Marking Methods in Cataract SurgeryFirst Author: C. Kakoulidis SLOVAKIACo Author(s): P. Papadopoulos, M. Cernak, A. Cernak

Electronic Toric Marker Clinical Update 2013

Pandelis A. Papadopoulos, MDGreece

The authors have no financial interest in the products mentioned in the study

Reference 2013 Winter ESCRS, Warsaw Free Papers

“The Electronic Toric Marker (ETM) saves me a lot of time, enabling me to mark the axis accurately in the OR. We found that the ETM, had an average of 1.3 ° (STD : ±1.3 °) difference from the reference axis. The direct focusing on the eye, in com-bination with the colored LEDs and the sound alert, makes it a very useful tool for toric IOL implantation.”

2

AE-2930 - ONE STEP ELECTRONIC TORIC MARKER

• All in one Marker and gauge• Marks axis directly in one step• 12.5mm outer diameter; Ideal for all eyes, including those with small orbits• 5.0mm non marking optic zone formaximum visibility

To evaluate the accuracy and efficacy of two different hand-held devices in marking the axis of astigmatism before cataract surgery

01 Study Purpose

1-Ophthalmology Clinic, Slovak Medical University in Bratislava, Slovakia 2-Ophthalmology Department, Metropolitan Hospital. Athens, Hellas

02 Setting

03 MethodsThe horizontal axis was marked in 28 eyes (14 left and 14 right), using one of the two hand-held devices: A) Electronic Toric One Step Marker, AE-2930,Asico, held frontally and B) Pre-op Toric Axis Marker, AE-2791BL, ASICO, held temporally. Device A has five leds indicating the horizontal plane and device B has bubble level. The eyes were photographed at the slit lamp with a very narrow horizontal slit, used as the reference axis. The difference from the reference axis was calculated from the enlarged photographs.

04 ResultsThe electronic toric marker (A group) had a difference of 1.3o (STD:1.3o) from the reference axis. Eyes marked with Pre-op Toric Axis Marker (B Group) had a difference of 4.1o (STD:1.6o). (p<0.001). No statistically significant difference was found in group A between marking of right and left eye (P>0.2). In group B, the marks of the right eyes had a positive angle (>0, CCW turn) of deviation, in contrast to the left eyes, that had a negative angle of deviation (<0, CW turn),(p>0.001).

05 ConclusionsBoth devices could mark the axis within 5o of intended. Astigmatism axis marking was more precise with the Electronic One Step Marker. The temporally held Pre-op Toric Axis Marker showed significant difference in marking, between the right and left eye. Takayuki Akahoshi, MD

Japan

“The Electronic Toric Marker uses my sense of SIGHT and HEARING to help me easily and accurately pinpoint the horizontal axis and stay focused on my patient.”

Dr. Takayuki Akahoshi is the inventor of the Electronic Toric Marker

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Evaluation of Two Different Axis Marking Instruments in

Clinical Practice

Electronic Toric One Step Marker, AE-2930, ASICO

Pre-op Toric Reference Marker, AE-2791BL, ASICO

PurposeDesigned to Maximize Outcome

NEW TECHNOLOGY

SYSTEM

AE-2930ASICO ElectronicOne Step Toric Marker

4

• 28 eyes (right: 14 - left: 14)• Each eye was marked with one of the devices• All eyes photographed at the slit lamp with a narrow slit beam (reference axis)• The difference in degrees between the reference axis and the marks was calculated from the enlarged photographs.

www.asico.com

Patients - MethodsStudy Methodology

Difference in o R-L eye Remarks

1.3o (STD:±1.3o) p>0.2

4.1o (STD:±1.6 o) p=0.01

Right Eyes: + angle CCW turn

Left Eyes: - angle CW turn

Significance p<0.001

Results3x more Accurate

Study shown Electronic Toric Marker AE-2930 to be at 1.3o

(STD:±1.3o )

which is about 3 times more accurate than reference marker with bubble level at 4.1o

(STD:±1.6o

).

Degree Rotation

20x more Consistant

Under Hypothesis that Mark on Right equal to Left eye. Electronic Toric Marker AE-2930 proven to be more consistency than than the Preop Toric Reference Marker with bubble.

Right & Left Eye

Ergonomis Redefined

“Handling of the Preop Toric Reference Marker with bubble was somehow difficult and showed differences between the right and left eye, mainly because the surgeon can not look simultaneously at the eye and at the bubble of the instrument.”

Ease of Use

“Both devices have the advantage of marking the axis without requiring a slit lamp. The difference in accuracy is related to the led assistance and the coaxial angle of view in the Electronic One Step Marker”

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• 10o-30o misalignment: severe reduction of astigmatic correction and require realignment of the IOL • >30o misalignment: increase of preop astig-matism

DISCUSSION: IMPORTANCE OF CORRECT AXIS MARKINGFOR EVERY 1o MISALIGNMENT, APPROXIMATELY 3.3% OF THE CYLINDER POWER IS REDUCED

6

0.0

10.0

20.0

30.0

40.0

50.0

<.5 <1 <1.5 <2 <2.5 <3 <3.5 >3.5

Medium1.0 – 2.0D

25%

High >2.0 D

10%

N = 10,411

% o

f Pat

ient

s

Cylinder D ( < ) Prevalence of Corneal Astigmatism

CONCLUSIONASTIGMATISM AXIS MARKING WAS MORE PRECISE WITH THE ELECTRONIC MARKER.

7

STUDY CONCLUSION

• Both devices could mark the axis within 5o of intended axis.

• Astigmatism axis marking was more precise with the Electronic One Step Marker.

• The temporally-held Pre-op Toric Reference Marker with Bubble showed significant difference in marking be-tween the right and left eye.

75%

AccuracyMaximum Ergonomic

Ease of Use

95%

Consistance Outcome

25%

Chance of Rotation 5%

Pre-op Toric Reference Marker with Bubble

Pre-op Toric Reference Marker with Bubble

Electronic Toric Marker

Electronic Toric Marker

Figure 1. Show different performance between Electronic Toric Marker and Pre-op Toric Reference Marker with Bubble.

ASICO’s Ophthalmic Instruments

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Ph. +1 630-986-8032 Toll Free. +1 800-628-2879

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email: info@asico.com www.asico.com

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