Multifocal IOLs for post-LASIK eyes: linking preoperative high order aberration (HOAs) and spherical aberration (Z40) to postoperative visual performance

Session Details

Session Title: Presented Poster Session: Refractive Surgery New Techniques/Instrumentation/Devices III

Venue: Poster Village: Pod 2

First Author: : R.Cobo-Soriano SPAIN

Co Author(s): :    J. Baviera   F. Llovet   C. Munoz   C. Costa   J. Beltran           

Abstract Details

Purpose:

Laser corneal photorefractive surgery modifies corneal asphericity depending on myopic vs hyperopic ablation, and theoretically, subsequent presbyopia correction with a multifocal IOL should consider these aberrometric changes in order to compensate and minimize the whole optic system aberration. However current multifocal IOLs have a standard aspheric negative profile, and are indiscriminately implanted in post-keratorefractive-eyes without considering preexisting corneal aberrations. To investigate the influence of two topographic parameters (HOA-RMS and four-order-spherical aberration ( SA-Z40)) on visual performance and subjective satisfaction rates, in eyes having a diffractive multifocal aspherical IOL implant, with previous hyperopic vs myopic photorefractive procedure.

Setting:

Clinica Baviera- AIER Eye Group, Madrid, Spain

Methods:

Comparative retrospective study evaluating refractive, visual outcomes and subjective satisfaction rate of eyes that had a refractive lens exchange (RLE) with a multifocal IOL (diffractive-aspherical IOLs, Restor® and Trifocal Finevision®), and had undergone a previous myopic-LASIK (n=36) and hyperopic-LASIK (n=40) at our Institution. Pentacam® (Occulus) topographic HO-RMS and spherical aberration (Z40) parameters after lasik myopic versus hyperopic ablations, were correlated with visual performance: predictability, efficacy, safety, percentage of bioptics and Yag-Laser-capsulotomy and satisfaction survey values, after spherical multifocal phacoemulsification.

Results:

Preoperatively, mean spherical-equivalent lasik treatment was -3.09 D (1.7) and +2.2 D(0.9), post-LASIK HO-RMS was 0.21 (0.06) and 0.20 (0.05), and Z40-SA was 0.26 and -0.09 (0.2) microns in myopic vs hyperopic groups respectively. Postoperatively, after multifocal aspherical RLE, we did not find significant differences between groups regarding visual performance and survey satisfaction rates. Although it might be expected that aspheric IOLs matched better with post-myopic-corneas than with post-hyperopic-corneas adding negative-SA, in our series ( low-moderate hyperopic/myopic ablation), HOA-RMS was similar between groups, and SA- Z40 value did not predict a poorer or better outcome after multifocal aspheric IOL.

Conclusions:

Aspherical multifocal diffrative IOL implanted in eyes with previous photorefractive correction of low to moderate degrees of myopia and hyperopia, did have similar functional results. Larger series with higher ametropia correction and higher aberration induction, should determine if there is a cut-off value of RMS/Z40 that could predict a poorer outcome in order to identify the proper IOL/cornea couple

Financial Disclosure:

None