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SIA CALCULATION AND

ITS IMPORTANCE
DR MITA JOSHI
DR SACHDEV EYE HOSPITAL
SURAT
SURGICALLY INDUCED
ASTIGMATISM

SITE OF INSICION
SIZE OF INSICION
CAUTERIZATION
SUTURING OF INSICION
CHANGES INDUCED BY SURGERY
CORNEAL STEEPENING
TIGHT SUTURE
WOUND EDEMA
VERTICAL MISALIGNMENT
EXCESSIVE CAUTERY
CORNEAL FLATENNING
WOUND GAPE
LOOSE SUTURES
SUPERFICIAL SUTURES
CENTRAL OVERRIDING
CLEAR CORNEAL INCISION
2.7 – 4 MM
MINIMAL OR NO EFFECT ON
ASTIGMATISM 0.25 - 0.5 D
MULTIPLANAR INCISION
BEVELLED BIPLANAR SELF SEALING
INCISION
PSEUDOPHAKIC ASTIGMATISM
TORIC IOLS
CYLINDER POWER
INCORPORATED IN THE IOL , ACTS
AT THE CORNEAL PLANE
MEASURING ASTIGMATISM

TOPOGRAPHY

MANUAL KERATOMETRY

MANIFEST REFRACTION

WAVEFRONT REFRACTION
IMPLANTATION OF TORICIOL
CONSIDER REF AND
KERATOMETRIC ASTIGMATISM
IMPLANTED ACC TO KERATOMETRIC
ASTIGMATISM
CORRECT FOR DISTANCE FROM
NODAL POINT
SURPRISE ELEMENT
SURGICALLY INDUCED
ASTIGMATISM
INSICION PLAYS A MOJOR ROLE
SITE AND SIZE
Effect of surgically induced astigmatism
Why is there almost always a difference?

The problem
045°
Q: Why is it that the astigmatic
power correction and axis
are often different than
expected following toric
IOL implantation?

A: We have not been taking


into account a second
important influencing
45.50 D factor.
Effect of surgically induced astigmatism
Astigmatism is a vector quantity

Because corneal astigmatism has


both a magnitude and a direction, it
is a vector quantity.

Multiple vectors in the same plane


can be combined.

The sum of multiple vectors will


result in a new magnitude and a
new direction.
Effect of surgically induced astigmatism
Astigmatism is a vector quantity

Airplane flying to Las Vegas


120 knots to the Northeast (036°) Planned
036° at 120 knots
Effect of surgically induced astigmatism
Astigmatism is a vector quantity

Airplane flying to Las Vegas


120 knots to the Northeast (036°) Planned
036° at 120 knots

Wind
22 knots out of the Northwest
(160°)

Wind 160° at 22 knots


Effect of surgically induced astigmatism
Addition of two vectors = third vector

Airplane flying to Las Vegas


120 knots to the Northeast (036°) Planned
036° at 120 knots

Wind
22 knots out of the Northwest
(160°) Actual
046° at 110 knots
Without making a
No wind 120 knots at 036° correction

With wind 110 knots at 046°


Wind 160° at 22 knots

Actual = Sum of flight vector & wind vector


Effect of surgically induced astigmatism
Addition of two vectors = third vector

Airplane flying to Las Vegas


120 knots to the Northeast (036°)
Planned
036° at 120 knots
Wind
22 knots out of the Northwest
(160°) Correction
Actual
046° at 110 knots
No wind 120 knots at 036° Without making a
correction
With wind 110 knots at 046°

Wind 160° at 22 knots


The sum of the two vectors results
in the need for a change in
direction combined with an
increase in power to maintain Actual = Sum of flight vector & wind vector
same direction & speed.
Effect of surgically induced astigmatism
Calculating the new axis of astigmatism
42.25 flat

Steep K 43.50 x 135°


Flat K 42.25 x 045°

43.50 steep
Effect of surgically induced astigmatism
Calculating the new axis of astigmatism

Steep K 43.50 x 135° Original


Flat K 42.25 x 045° axis

Incision 3.0 mm 180°


Induced cyl 0.50 x 090°

Right
eye
OCULAR RESIDUAL ASTIG
SIA OD <3MM
LOCATION SIA (D) NO OF PT
TEMPORAL 1.82 1
NASAL 1.17 2
SUPERIOR 0.0 0
INFERIOR 0.0 0
SUP TEMP 0.31 2
INF TEMP 0.0 0
OVERALL SIA 0.96 5
SIA OS <3 MM
LOCATION SIA(D) NO OF PTS
TEMPORAL 0.5 5
NASAL 0.0 0
SUPERIOR 0.0 0
INFERIOR 0.0 0
SUP TEMP 0.3 1
INF TEMP 0.0 0
OVERALL SIA 0.47 6