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Issue link: https://daily.eyeworld.org/i/124055
26 EW SHOW DAILY Tuesday, April 23, 2013 Meeting Reporter Residual error in "premium" IOLs by Chiles Aedam R. Samaniego EyeWorld AP Senior Staff Writer Scott MacRae, MD, speaks at the "Reducing Pseudophakic Ametropia to Drive Improved Refractive IOL Outcomes." I n an event designed to address areas in which attendees may need further education as identified by a preregistrant survey, a panel of experts sought to clarify the why, when, and how of intraop and postop enhancement for refractive IOL patients. "Reducing Pseudophakic Ametropia to Drive Improved Refractive IOL Outcomes," was an EyeWorld CME Education event. Refractive error may prevent eyes implanted with premium IOLs from receiving the full benefit of the lenses, said Scott MacRae, MD, Rochester, N.Y. It is a generally accepted fact that multifocal IOLs in particular are sensitive to any imperfection in the optical system. Using the optical bench to simulate "what a patient sees"—more precisely the image projected through a lens onto the retina—Dr. MacRae and his colleagues sought to quantify the impact of various amounts of residual spherical and cylinder error on the quality of BIG THINGS ARE here vision. Looking at the effect of corneal astigmatism on premium IOLs—specifically the AcrySof monofocal (Alcon, Fort Worth, Texas), Crystalens AO (Bausch + Lomb, Rochester, N.Y.), Crystalens HD (Bausch + Lomb), ReSTOR 3D (Alcon), and the Tecnis Multifocal (Abbott Medical Optics, Santa Ana, Calif.)—they found that the depth of field advantage began disappearing as corneal astigmatism increased from 0.5 to 1.0 D. In addition, increasing corneal astigmatism resulted in progressive and significant rise in the percent decrease in normalized image quality of these lenses. They also looked at the effect of corneal astigmatism on throughfocus image quality of four different IOLs: the FineVision Micro F Diffractive Trifocal (Physiol, Liège, Belgium); the Mplus rotationally asymmetric refractive multifocal (Oculentis, Berlin), essentially a "bifocal" IOL; the ReSTOR 3D, and the AcrySof spherical monofocal. In all cases, the defocus curves of each lens progressively flattened, graphically illustrating a decrease in image quality, an effect also seen with higher order aberrations. Corneal astigmatism greater than 0.5 D, Dr. MacRae concluded, affects all multifocal IOLs. The effect translates clinically as well. In a survey of 4,970 consecutive eyes (2,485 patients), Steve C. Schallhorn, MD, San Diego, found a "dramatic drop off" even with just 0.5 D of sphere and cylinder error. "To achieve patient satisfaction, you need to achieve 0.00 D of spherical and cylinder error," he said. He added that surgeons have several options for treating residual astigmatism, including lens repositioning or exchange, astigmatic keratotomy, and laser vision correction. PRK, he said, is indicated for visually significant residual refractive error in patients for whom either repositioning or exchange are not indicated, and who say they want better vision. EW Editors' note: This event was supported by unrestricted educational grants from Abbott Medical Optics and Alcon. Find Out At ASCRS 2013 Find Out At Booth #1102 Booth JOGP!FZFNBHJOBUJPOTDPNttXXXFZFNBHJOBUJPOTDPN JOGP!FZFNBHJOBUJPOTDPNttXXXFZFNBHJOBUJPOTDPN 8BTIJOHUPO"WFOVF 4VJUF #BMUJNPSF .% 8BTIJOHUPO"WFOVF 4VJUF #BMUJNPSF .%