The Buzard Eye Institute for Corneal and Refractive Surgery

There are three basic incisional astigmatism nomograms presented here. Again the specific parameters and uses of these nomograms are extremely important. These nomograms are published in three basic locations, "Surgical Management of Astigmatism", Buzard KA: Medical Cornea--Corneal and Refractive Surgery, edited by Richard E. Selser, Jr., Kugler Publications,(New Orleans Academy of Ophthalmology; February 26-28, 1993), pp 87-99, "Clinical results of arcuate incisions to correct astigmatism"; Buzard, Laranjeira and Fundingsland in The Journal of Cataract and Refractive Surgery, vol22, #8, p1062 Oct 1996 and in the book on Astigmatism written by Dr Buzard and Troutman, "Corneal Astigmatism: Etiology, Prevention, and Management", CV Mosby, published 1992, Richard Troutman, M.D., Kurt Buzard, M.D. Two basic paradigms are presented. The T-cut nomograms use short (2-2.5mm) incisions and vary the optical zone to obtain different effects. The arcuate nomograms use a constant 7mm optical zone and vary the length to obtain different effects. All astigmatic incisions are made shallow with 80% depth incisions. The first nomogram is to be used specifically with RK and one can see that for a given optical zone, more effect will be obtained in a cornea with an RK than for T-cuts performed in a cornea without RK as seen in the second nomogram for virgin (without RK) corneas. Finally the last nomogram is for arcuate incisions and used for larger degrees of astigmatism, of particular use after cataract surgery. Note no incisions are made larger than 90 degrees and in fact incisions larger than 60 degrees are discouraged as a primary operation in patients older than 65 years old.

Buzard T-Cut Nomogram with Radial Keratotomy

T-Cuts 2 mm long
One pair of T-Cuts

		O p t i c a l Z o n e
		5.0	5.5	6.0	7.0
A G E	20	2.55	1.70	0.85	0.64
	25	2.78	1.85	0.93	0.69
	30	3.00	2.00	1.00	0.75
	35	3.23	2.15	1.08	0.81
	40	3.45	2.30	1.15	.086
	45	3.68	2.45	1.23	0.92
	50	3.90	2.60	1.30	0.98
	55	4.13	2.75	1.38	1.03
	60	4.35	2.90	1.45	1.09
	65	4.58	3.05	1.53	1.14
	70	4.80	3.20	1.60	1.20

BUZARD T-CUT NOMOGRAM
(To be used with or after radial keratotomy)

T-CUTS 2 - 2.5 MM LONG
One Pair of T-Cuts

		O p t i c a l Z o n e
		5.0	5.5	6.0	7.0
A G E	20	1.70	1.28	0.85
	25	1.85	1.39	0.93
	30	2.00	1.50	1.00
	35	2.15	1.61	1.08
	40	2.30	1.72	1.15
	45	2.45	1.84	1.23
	50	2.60	1.95	1.30	0.78
	55	2.75	2.06	1.38	0.85
	60	2.90	2.17	1.45	0.93
	65	3.05	2.28	1.53	1.00
	70	3.20	2.40	1.60	1.08
	75	3.35	2.51	1.68	1.15
	80	3.50	2.62	1.75	1.23

VIRGIN CORNEA

(No Previous Operation on Cornea)

BUZARD ARCUATE NOMOGRAM
7MM OPTICAL ZONE

		D e g r e e o f A r c
		45	60	90
A G E	20	1.70	2.55	3.40
	25	1.85	2.78	3.70
	30	2.00	3.00	4.00
	35	2.15	3.23	4.30
	40	2.30	3.45	4.60
	45	2.45	3.68	4.90
	50	2.60	3.90	5.20
	55	2.75	4.13	5.50
	60	2.90	4.35	5.80
	65	3.05	4.58	6.10
	70	3.20	4.80	6.40
	75	3.35	5.03	6.70
	80	3.50	5.25	7.00

VIRGIN CORNEA

(No Previous Operation on Cornea)

DISCLAIMER: These nomograms are provided under the provisions that each surgeon will obtain slightly different results and are also intended to be used as general guideline and not an absolute indication of desired treatment.