Surgeon: LASIK best for correcting residual post-cataract surgery refractive errors

BARCELONA — LASIK represents the best treatment option for correcting residual refractive errors after cataract surgery, according to a surgeon speaking here. However, results may be unpredictable and poor in eyes implanted with multifocal or accommodative IOLs, he noted.

Jorge L. Alió

"I recommend caution in these cases. Of all the factors that make the results of post-cataract LASIK still suboptimal, multifocal and accommodative IOLs are No. 1," Jorge L. Alió, MD, PhD, said at the European Society of Cataract and Refractive Surgeons Winter Refractive Surgery Meeting.

According to Dr. Alió, some degree of residual refractive error affects cataract surgery outcomes in most patients. The most common causes include clinically significant astigmatism, which is present in about 40% of patients, surgical complications, postoperative adverse events and errors in IOL power calculation. In addition, when either a multifocal or accommodative IOL is used, these factors have a greater impact, and patient satisfaction can be low in such cases.

Various options can be used to address residual refractive errors, although all have limitations, Dr. Alió said.

"LASIK is still the option that gives the highest degree of accuracy and allows us to address the astigmatic as well as the spherical components. However, results are still suboptimal, due to [several] potential hazards," he said.

Dry eye, which occurs more frequently in elderly and middle-aged patients, goblet cell depletion related to suction ring time and possibly even post-cataract medications all may affect outcomes. Also, there are no proven preventive actions that can be taken, he said.

For best results, Dr. Alió prefers performing LASIK using a mechanical microkeratome and applying a customized aspheric treatment.

For cases involving accommodative or multifocal IOLs, he recommended waiting at least 3 months after cataract surgery to allow sufficient time for the lens to become stable and for neuroadaptation to occur.

"Anticipate suboptimal accuracy with accommodative IOLs and multifocal IOLs. At least, this is my experience," Dr. Alió said.

With multifocal IOLs, wavefront-guided treatments may lead to even more unpredictable outcomes, he noted.

"Definitely there is a lack of adequate information concerning multifocal IOLs followed by LASIK. We need prospective studies to establish whether and how we can combine these two methods," he said.