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Aspheric IOL yields better visual results than spherical lens after previous LASIK

J Cataract Refract Surg. 2009;35(5):825-832.

Issue: September 10, 2009

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Implantation of an aspheric IOL provided better visual quality than a spherical IOL under mesopic conditions in patients who had previous LASIK.

The prospective, comparative study is believed to be the first to examine visual results of hybrid IOLs after previous LASIK, the study authors said.

“Hybrid refractive-diffractive [IOLs] provide good visual performance at distance and near in patients without laser refractive therapy,” they said. “To our knowledge, there are no reports in the literature of the visual and optical quality after implantation of hybrid IOLs in patients who have had LASIK for myopia.”

The study included 22 eyes of 12 patients implanted with the AcrySof ReSTOR spherical IOL (Alcon), 26 eyes of 18 patients implanted with the Acri.Lisa 366 D aspheric IOL (Carl Zeiss Meditec) and a control group of 32 phakic eyes of 16 patients. Postoperative evaluations were performed at 1 day, 1 week, 1 month and 6 months.

Data showed that at 6 months, the aspheric IOL group had better visual acuity than the spherical IOL group under mesopic conditions at all contrast levels (P < .01). The aspheric IOL group and control group had similar visual and optical outcomes.

“Further studies with a larger sample are needed to assess patient satisfaction and binocular viewing conditions,” the authors said.

Challenges in the management of presbyopia in patients having previously undergone laser refractive surgery provide the next frontier, as we look to provide solutions for patients desiring freedom from glasses and contact lenses.

This study demonstrates the statistical advantages of an aspheric, over a spherical, diffractive IOL in patients who have developed cataracts after myopic refractive laser correction. While no difference was noted under photopic light conditions, a statistically significant difference in favor of aspheric lenses was found in mesopic conditions in respect to best corrected visual acuity and contrast sensitivity at all levels less than 100%. In addition, results of the aspheric IOL were similar to those of matched, myopic, phakic patients having previously undergone refractive laser eye surgery.

While the clinical outcomes of aspheric diffractive IOLs appear promising, further analysis as to unaided patient subjective satisfaction and binocular viewing capacity is still required.

– Glenn Carp, MBBCh, FCOphth(SA)
London Vision Clinic