Diffractive IOLs can be used after laser vision correction
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SAN FRANCISCO — Multifocal diffractive lenses can be used with confidence in patients who have previously undergone laser vision correction, according to a speaker at the American Academy of Ophthalmology meeting.
“These are demanding patients who experience very good vision, they want it all, and why shouldn’t they have it all?” Sheraz Daya, MD, FACP, FACS, FRCOphth, FRCS(Ed), said.
Issues of concern in these patients are the aberrations induced by laser vision correction, specifically spherical aberration and coma, reduced contrast and visual quality, dry eye and, above all, the predictability of lens power calculation.
“Instruments are not designed for patients who have had laser eye surgery and abnormal corneas. There are anterior chamber depth assumption errors that take place, and there may well be refractive index changes from surgery,” Daya said.
A retrospective study published in 2015 analyzed the outcomes of refractive lens exchange or cataract surgery in 102 eyes of 59 patients who had previously undergone laser vision correction. Lens calculation was performed using the Pentacam Holladay Report looking at effective keratometry readings combined with the Holladay 2 formula. Lenses included the FineVision (BVI/PhysIOL) in the majority of patients, both myopic and hyperopic, and the At Lisa toric or Acri.Lisa bifocal (Carl Zeiss Meditec) in a few cases.
After laser vision correction, patients had good spherical equivalent, close to emmetropia, and good cylinder. Predictability was high, with 91% of the eyes within 1 D of intended correction and 68% within 0.5 D. Distance vision was very good, near was better binocularly, and intermediate at 60 cm was good and even better at 80 cm. There was no loss of lines of vision. Higher-order aberrations were quite high with Pentacam standardized at 6 mm but lower with OPD-Scan III standardized at 4 mm.
“So, I was very confident about treating these patients and did so,” Daya said.
After IOL implantation, visual outcomes were good at all distances for both groups of myopic and hyperopic patients. Hyperopes did slightly better for predictability, lens calculation and refractive error. Enhancement rate was 5.9%, and no lens was explanted.
“Contrast sensitivity was good at 3 months in both groups but slightly better in the hyperopic group. All our patients are spectacle free,” Daya said, and there were no patient complaints.
This study demonstrated that diffractive lenses can be used in patients after laser vision correction. However, careful patient selection and counseling are recommended, Daya said.
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Daya S. Diffractive multifocal lenses after corneal laser vision correction. Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
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