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The TRULIGN Toric (Bausch & Lomb) is a premium IOL that can treat cataracts and astigmatism, providing improved near, intermediate and distance vision, and potentially less dependence on glasses.

TRULIGN is an accommodative IOL that is an optic on a hinge, with haptics that are very stable within the capsular bag. The rotational stability of the Trulign product is exceptional. It works by utilizing the natural accommodative mechanism of the eye to flex and provide an extended range of vision.


For patients who have more than a diopter and a half of astigmatism—the limit of what can be corrected with a limbal relaxing incision—there have been no other options for an extended range of vision. Trulign is the one product that now fulfills this niche.

At my practice on Florida’s West Coast, whenever I had a patient with a higher level of astigmatism than I’m comfortable correcting with a limbal relaxing incision, I used to say, “Well, really, your options are for both eyes to be maximized for distance vision, or we can go for a monovision result, where one eye is for distance while the other is for near vision.”


While that works for many patients, it wasn’t a great tool for giving patients the independence they want from glasses in the extended range. Trulign has enabled me to say, “Hey, we now have something else that will give you excellent distance vision, great intermediate computer distance vision and functional near vision.”

That’s a slam-dunk for patients who have a higher level of astigmatism because you’re maximizing their distance vision while giving them a natural range of vision. Those are very happy patients.


Trulign is also great for another type of patient, one with early signs of a progressive ocular disease, such as early endothelial dysfunction or endothelial disease. I’m not comfortable putting a multi-focal IOL in those patients because I know that as their disease progresses, their quality of vision is going to decline.

For patients with early glaucomatous damage that may not be well controlled in the future, or patients with early evidence of retinopathy, a multi-focal might not be a lifetime solution. But Trulign is a wonderful option because it gives them that extended range of vision without the potential future complication of degrading their quality of vision.


The biggest challenge with the Trulign (and Crystalens) platform is that intraoperative techniques must be meticulously followed. You have to make sure you have an appropriately sized and centered capsularexis, and that you’re very meticulous in removing lens epithelial cells to minimize capsular contraction.

One tool that really helps is the femtosecond laser because it lets me know exactly the centration and sizing of the capsularexis. This gives me the confidence to know that my lens will be exactly where I want it to be and it’s reproducible every time.

Another challenge is making sure you’re very meticulous with cortical removal and endothelial cell removal. So there are a few steps that you have to be attentive to during the procedure and even in the postoperative period, to have consistent, favorable results.


I highly recommend the Trulign because it benefits those patients who fall into the two categories I described. Either they have a bit more astigmatism than is easily corrected with a corneal procedure or they have other signs that may interfere with their ability to have success with a multi-focal lens.