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Correcting residual astigmatism improves performance of new accommodating lens

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SAN FRANCISCO — Postoperative residual astigmatism after implantation of an accommodating IOL detrimentally affects refractive outcome.

"Astigmatism is the enemy of accommodating lenses," Guy M. Kezirian, MD, said at the American Society of Cataract and Refractive Surgery meeting here. "Those who are going to do refractive lens exchange will have to have a strategy in place to get all eyes in focus at the end of the treatment period."

According to a review of 1-month postoperative surgical outcomes from 3,104 patients implanted with a Crystalens HD (Bausch & Lomb) and from 41,538 patients implanted with a Crystalens Five-O (Bausch & Lomb) in the SurgiVision DataLink IOL system, an online database of surgical results funded by the device manufacturer, presence of cylinder reduces distance and near vision, Dr. Kezirian said. As well, cylinder in the presence of hyperopia decreases intermediate visual acuity.

According to Dr. Kezirian, the optimal refractive target for distance is hyperopia, and it is myopia for near vision. Previous targeting of myopia may explain reports of decreased distance vision with the Crystalens HD.