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Wavefront-guided LASIK corrects residual error after multifocal IOL implantation
All patients in a recent study said they would choose the aspheric multifocal IOL again.
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Combining an aspheric multifocal IOL with wavefront-guided LASIK can provide good near and distance vision for presbyopic hyperopic patients, according to one investigator.
 Michael C. Knorz |
Michael C. Knorz, MD, of the University Medical Center in Mannheim, Germany, described his results using the Advanced Medical Optics Tecnis Multifocal IOL in combination with wavefront-guided LASIK at the European Society of Cataract and Refractive Surgeons meeting in London. Dr. Knorz is chairman of the OSN Europe/Asia-Pacific Edition Editorial Board.
The study included 76 eyes of 38 hyperopic presbyopic patients who were candidates to undergo either refractive or cataract surgery. Average age was 54 years (range 35 to 78). Patients received the Tecnis Multifocal IOL in both eyes and underwent LASIK if necessary for distance vision correction, Dr. Knorz said. Ultimately, nine eyes (12%) underwent LASIK, he said.
Postoperatively, none of the patients needed spectacles for near or distance vision, Dr. Knorz reported. Three used spectacles for intermediate distances.
The Tecnis Multifocal IOL, with a prolate anterior surface designed to counteract the eye’s spherical aberration, has a powerful near add, about 4 D at the corneal plane and 3.2 D at the spectacle plane.
Dr. Knorz assessed visual acuity and patient satisfaction after implantation of the IOL. Distance uncorrected visual acuity averaged 20/25, ranging from 20/30 to 20/15. Uncorrected near acuity with distance correction ranged from 20/30 to 20/20.
All patients reported some visual disturbances, a downside to the Tecnis IOL’s diffractive multifocal technology, Dr. Knorz said. Still, he said, patients were satisfied with the implant.
“All patients were happy with the results, and all patients would choose the Tecnis aspheric multifocal IOL again,” he said.
Why customized LASIK?
Patients who had residual refractive errors after implantation of the Tecnis Multifocal IOL underwent wavefront-guided LASIK 3 months later. Dr. Knorz and colleagues used the AMO Visx Star S4 excimer laser with iris registration to correct the residual refractive error.
“Why should we do a customized LASIK on the multifocal IOL?” he asked rhetorically. “We have a couple of reasons. The most important is that customized LASIK … provides a perfect match, as measured over a 2-year period.”
The procedure is also capable of treating astigmatism and minimizing higher-order aberrations, he said.
Dr. Knorz described one case from the study, a 56-year-old patient whose preoperative error was 5.5 D and who had a residual error of 1.5 D after multifocal IOL implantation. The patient achieved an “excellent result” after wavefront-guided LASIK, Dr. Knorz said. The wavefront-guided procedure reduced the patient’s higher-order aberrations.
“You do see that coma preop was significantly reduced postoperatively,” he said.
Overall, he said, the Tecnis Multifocal IOL works well with customized ablation to adjust postop residual error, Dr. Knorz said.
“The Tecnis Multifocal IOL provides excellent distance and near vision in all cases if emmetropia is achieved,” he said. “If residual refractive errors are present, wavefront-guided ablation can be used to optimize results.”
The combination can provide patients with virtually perfect vision, Dr. Knorz said.
“The Tecnis Multifocal IOL is a refractive surgery procedure providing spectacle independence to our patients,” he said. “And the Tecnis aspheric multifocal IOL can be combined with straightforward laser vision correction to achieve perfect vision in patients who are having trouble after the implants.”
For more information:
- Michael C. Knorz, MD, can be reached at FreeVis LASIK Center University Clinic Mannheim, Universitätsklinikum Mannheim, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany; +49-621-383-3410; fax: +49-621-383-3803; e-mail: knorz@eyes.de. Dr. Knorz is a consultant to Alcon and AMO. He has no direct financial interest in any products mentioned in this article.
- Advanced Medical Optics, maker of the Tecnis Multifocal IOL and the Visx Star S4 laser, can be reached at 1700 E. St. Andrew Place, Santa Ana, CA 92799 U.S.A.; Web site: amo-inc.com.
- Matt Hasson is an OSN Staff Writer who covers all aspects of ophthalmology and focuses on regulatory, legislative and practice management topics.