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Refractive lens exchange improves BCVA for medium and high hyperopes
The procedure carries little risk of retinal detachment and has a relatively low PCO rate.
LISBON, Portugal — Refractive lens exchange improves best corrected visual acuity with no serious complications in patients with medium and high hyperopia, according to one ophthalmologist.
Presenting clinical results from 251 eyes, Frank Goes, MD, told attendees at the European Society of Cataract and Refractive Surgeons meeting in Lisbon, that RLE is a safe and predictable approach to treating medium and high hyperopes.
Dr. Goes, medical director of Goes Eye Center in Belgium, has performed RLE using acrylic, PMMA and silicone IOLs over a period of 10 years. He evaluated his long-term clinical data, including the incidence of retinal detachment and the number of YAG treatments. He also compared IOL power calculation formulas.
“The hyperopes are extremely happy with this kind of treatment, and an important thing is that the risk of refractive lensectomy in hyperopia is practically zero,” Dr. Goes told Ocular Surgery News in an interview.
The average age of Dr. Goes’ patient set was 47 years, and the mean preoperative refraction was 6.3 D. The mean axial length was 20.9 mm with 39 eyes shorter than 20 mm.
Mean follow-up was 36 months, but lasted for more than 5 years in 69 cases.
The patients’ mean spherical equivalent improved from +6.29 D preop to +0.04 D postop. The mean uncorrected visual acuity changed from 0.1 at preop to 0.6 postop, and the mean BCVA improved from 0.7 preop to 0.8 postop.
Complications included short-term cystoid macular edema and posterior capsular opacification that was managed with YAG laser.
Better technique
While RLE in myopia carries an increased risk of retinal detachment, Dr. Goes said that performing this technique on hyperopes carries little risk.
“I talked to two surgeons who have operated on tens of thousands of eyes. Nobody has ever seen a retinal detachment in a high hyperope,” he said.
Dr. Goes said that the most common complication in RLE is PCO. In this study, the YAG rate was 52%, with no complications.
He said that the technique is versatile and can be performed with piggyback lenses, but that he does not do this often because he currently uses the Advanced Medical Optics Tecnis multifocal lens in most cases.
“With the Tecnis multifocal, we can go up to +39 or +40, so not so many need more than that,” he said. “This lens has the advantage that in more than 90% of the cases no spectacles, not even for reading, will be required afterwards.”
He said that in older patients, this technique could replace LASIK as more people learn about it and it becomes more popular, but he does not recommend it for young hyperopes.
“When they are less than +4, we would not propose a lens to them when they are young,” he said.
Getting the correct formula
Dr. Goes compared the accuracy of his results with four IOL power calculation formulas including two Holladay formulas, the Hoffer Q and the SRK-TH.
He said that first and foremost, the ophthalmologist should measure patients with the Carl Zeiss Meditec IOLMaster.
“You have to measure them because an error of 0.1 mm in a short eye is much more important than in a long eye,” Dr. Goes said.
Dr. Goes concluded that the Holladay 2 and Hoffer Q formulas gave the best prediction with a mean residual refractive error of –0.65 D, while Holladay 1 resulted in a mean residual of –1.4 D and SRK-TH resulted in –1.8.
“You should use at least two of [the formulas] and compare them and even add a little bit,” he said.
He said that Holladay 2 and Hoffer Q were two of the best formulas to compare to get the highest and most accurate values.
Dr. Goes said his conclusion is that “more refractive work will be done on the lens in the near future specifically for hyperopia.”
For Your Information:
- Frank Goes, MD, can be reached at Goes Eye Center, W. Klooslaan 6, B 2050 Antwerp, Belgium; 32-321-939-25; fax: 32-321-966-67; e-mail: frank@goes.be; Web site: www.goes.be. Dr. Goes has no financial interest in any of the products mentioned in this article, nor is he a paid consultant for any companies mentioned.
- Jared Schultz is an OSN Staff Writer who covers all aspects of ophthalmology. He focuses geographically on Europe and the Asia-Pacific region.