Heritage lecture relates conflicting, complementary relationship of LVC, cataract surgery
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Two giant advances of ophthalmology, cataract surgery and laser vision correction, are friends and enemies.
On one hand, laser vision correction (LVC) jeopardizes the precision of cataract surgery, but on the other hand it creates a sort of compensation, enhancing the postoperative optical performance of cataract surgery.
This was the key message of the Heritage Lecture, awarded this year to one of the pioneers of refractive surgery, Theo Seiler, MD, PhD, at the virtual European Society of Cataract and Refractive Surgeons meeting.
Cataract surgeons now face the challenges of operating on eyes that have previously undergone refractive surgery.
“In these eyes, axial length, anterior chamber depth and corneal power have been altered by the laser treatment. The cornea is irregular and IOL power is difficult to estimate,” Seiler said.
The problem was highlighted by Berthold Seitz, MD, PhD, 20 years ago, but still in 2020, a study by Li Wong, MD, PhD, and Douglas Koch, MD, showed only 40% to 70% of patients postoperatively are within 0.5 D of their refractive target, Seiler said.
“It is still an unresolved problem,” Seiler said.
Because more than 20% of refractive surprises after cataract surgery are due to corneal irregularity, Seiler’s approach is to counsel these patients and offer another laser treatment or a lens exchange.
“That is why we choose lenses that can be easily exchanged,” he said.
LVC on the other hand can help in patients who are not satisfied after implantation of premium lenses. A questionnaire of the Moorfields Eye Hospital showed that only 77% do not wear spectacles after cataract surgery with multifocal IOL implantation and only 67% are really satisfied, Seiler said.
A prospective study by Seiler and co-authors also showed that 26% in a group of 108 patients implanted with trifocal lenses were dissatisfied.
“We performed selective wavefront-guided LASIK for free in these patients. We measured the wavefront with the pyramid sensor and found that 63% had residual astigmatism of 0.5 D or more. We did have myopia, we had hyperopia, and 15% had higher order aberration of more than 0.5 m, which we considered to be pathologic,” he said.
Satisfaction rate increased from 74% to 96%, and 38 of 42 patients said they would choose the procedure again.
“So, trifocal plus femto-LASIK was a very acceptable procedure for those patients. Still, four patients were not satisfied, and all of them were suffering from dry eye. That’s why in the future, in patients with significant dry eye, we will do the selective wavefront-guided treatment as PRK in order to reestablish the tear film faster,” he said.
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Seiler T. Cataract surgery and laser vision correction. Presented at: European Society of Cataract and Refractive Surgeons meeting; Oct. 2-4, 2020 (virtual meeting).
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