Effect of postoperative keratometry on quality of vision in the postoperative period after myopic wavefront-guided laser in situ keratomileusis

Comparison of visual quality after SMILE correction of low-to-moderate myopia in different optical zones

OBJECTIVE

To compare the effects of different optical zones for small-incision lenticule extraction (SMILE) on postoperative visual quality in low-to-moderate myopia.

METHODS

This retrospective case-control study involved patients who underwent SMILE using two optical-zone diameters: 6.5 mm (50 patients, 100 eyes) and 6.8 mm (50 patients, 100 eyes). Uncorrected visual acuity (UCVA), best corrected visual acuity, spherical equivalent (SE), corneal higher-order aberrations (HOAs), and subjective visual-quality questionnaire scores were assessed.

RESULTS

Postoperatively, UCVA and SE did not differ between the two groups (P > 0.05). In both groups, corneal HOAs, spherical aberration, and coma significantly increased at 1 and 3 months postoperatively (P < 0.05), while trefoil was unchanged after surgery (P > 0.05). Corneal HOAs, spherical aberration, and coma significantly differed between the groups at 1 and 3 months (P < 0.05), while trefoil did not (P > 0.05). Visual-quality scores were higher in the 6.8 mm group than in the 6.5 mm group at 1 month (P = 0.058), but not at 3 months (P > 0.05). In both groups, subjective scores significantly decreased at 1 month (P < 0.05) and gradually returned to the preoperative level at 3 months (P > 0.05). The subjective visual-quality scores were negatively and positively correlated with pupillary and optical-zone diameter, respectively (P < 0.05 for both). Objective visual-quality indicators (HOAs, spherical aberration, and coma) were negatively correlated with optical-zone diameter (P < 0.05) but not pupillary diameter (P > 0.05).

CONCLUSION

SMILE in different optical zones effectively corrected low-to-moderate myopia. The larger the optical-zone diameter, the better the early postoperative visual quality.

Two-Dimensional Peripheral Refraction and Image Quality for Four Types of Refractive Surgeries

PURPOSE

To provide a comprehensive investigation of the optical quality across the visual field for current mainstream types of refractive surgeries.

METHODS

Sixty eyes from 60 adults who received refractive surgery of either femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK), Q-value guided customized laser in situ keratomileusis (Q-LASIK), small incision lenticule extraction (SMILE), or Implantable Collamer Lens (ICL) (STAAR Surgical) implantation were included in this study. Refraction and optical aberrations from a visual field of horizontal 60° (from temporal 30° to nasal 30°) and vertical 36° (from superior 20° to inferior 16°) were measured using a custom-made Hartmann-Shack wavefront peripheral sensor. Refractive error, higher order aberrations, point spread function (PSF), and Strehl ratio were compared among these groups prior to and after the surgical procedures, respectively.

RESULTS

All types of surgical procedures achieved an almost plano refraction in the central retina. This was also the case in the peripheral retina for the three types of laser refractive surgeries. However, residual peripheral relative hyperopic defocus was observed after ICL implantation. In all groups prior to the surgery, PSFs showed increasing distortion with eccentricity and arrow-like shape pointing toward the central fovea in the periphery in diagonals. Degradation of the PSFs was diminished by all three types of laser refractive surgeries, whereas ICL implantation made the peripheral distortion more prominent.

CONCLUSIONS

Although ICL implantation produced a similar impact on refractive correction and objective optical quality in the central vision compared with other laser refractive surgeries, its outcome on the peripheral optics is different. The impact of this difference on visual performance deserves notice and warrants further investigation. [J Refract Surg. 2023;39(1):40-47.].

Outcomes of a Refractive Segmented Bifocal Intraocular Lens with a Lower Near Addition

Purpose

To evaluate clinical and subjective outcomes of a segmented bifocal IOL with a 2.0 D near addition.

Patients and Methods

Retrospective analyses of patients who had undergone refractive lens exchange with bilateral implantation of the SBL-2 IOL (Lenstec, Inc., Christ Church, Barbados) were performed. The number of patients included in the study was 389 (778 eyes). Refractive, visual and patient-reported outcomes were presented for the last available visit (mean follow-up 2.05 ± 1.33 months).

Results

The percentage of eyes within ±0.50D and ±1.00D of emmetropia was 82.5% (642/778) and 97.8% (761/778), respectively. The mean uncorrected intermediate visual acuity (66 cm) of the last available visit was 0.08 ± 0.15 logMAR monocularly and 0.04 ± 0.14 logMAR binocularly. The mean monocular and binocular uncorrected near visual acuity (40 cm) were 0.30 ± 0.15 logMAR and 0.24 ± 0.14 logMAR, respectively. Of all patients, 97.2% (378/389) claimed never to use any correction for distance vision, while 93.1% (362/389) of patients did not require any correction for near vision. The mean scores for visual phenomena (on the scale from 1 – no difficulty to 7 – severe difficulty) were 1.8 ± 1.3, 1.7 ± 1.2, 1.7 ± 1.2 and 1.6 ± 1.2 for glare, halo, starburst, and ghosting/double vision, respectively.

Conclusion

Despite the lower near addition of SBL-2 segmented bifocal IOL, patients achieved reasonable rates of spectacle independence and a low incidence of visual phenomena.

Informed consent in refractive surgery: in-person vs telemedicine approach

Purpose

The aim of this study was to compare the quality of consent process in refractive surgery between patients who had a preoperative consent discussion with the surgeon using a telemedicine approach and those who had a face-to-face discussion.

Methods

Patients treated between January and December 2017 (8,184 laser vision correction [LVC] and 3,754 refractive lens exchange [RLE] patients) that attended day 1 and 1-month postoperative visit were retrospectively reviewed. Preoperative consent preparation included a consultation with an optometrist, observation of an educational video, and written information. Patients then selected either a face-to-face appointment with their surgeon (in-clinic group) or a telemedicine appointment (remote group) for their consent discussion, according to their preference. Patient experience questionnaire and clinical data were included in a multivariate model to explore factors associated with consent quality.

Results

Prior to surgery, 80.1% of LVC and 47.9% of RLE patients selected remote consent. Of all LVC patients, 97.5% of in-clinic and 98.3% of remote patients responded that they were adequately consented for surgery (P=0.04). Similar percentages in the RLE group were 97.6% for in-clinic and 97.9% for remote patients (P=0.47). In a multivariate model, the major predictor of patient's satisfaction with the consent process was postoperative satisfaction with visual acuity, responsible for 80.4% of variance explained by the model. Other significant contributors were postoperative visual phenomena and dry eyes, difficulty with night driving, close-up and distance vision, postoperative uncorrected distance visual acuity, change in corrected distance visual acuity, and satisfaction with the surgeon's approach. The type of consent (remote or in-clinic) had no impact on patient's perception of consent quality in the regression model.

Conclusion

The majority of patients opted for telemedicine-assisted consent. Those who chose it were equally satisfied as those who had a face-to-face meeting with their surgeon. Dissatisfaction with surgical outcome was the major factor affecting patient's perception of consent quality, regardless of the method of their consent.

Refractive lens exchange in younger and older presbyopes: comparison of complication rates, 3 months clinical and patient-reported outcomes

Purpose

To compare refractive and visual outcomes, patient satisfaction, and complication rates among different age categories of patients who underwent refractive lens exchange (RLE).

Methods

A stratified, simple random sample of patients matched on preoperative sphere and cylinder was selected for four age categories: 45–49 years (group A), 50–54 years (group B), 55–59 years (group C), and 60–65 years (group D). Each group contained 320 patients. All patients underwent RLE with a multifocal intraocular lens at least in one eye. Three months postoperative refractive/visual and patient-reported outcomes are presented.

Results

The percentage of patients that achieved binocular uncorrected distance visual acuity 20/20 or better was 91.6% (group A), 93.8% (group B), 91.6% (group C), 88.8% (group D), P=0.16. Binocularly, 80.0% of patients in group A, 84.7% in group B, 78.9% in group C, and 77.8% in group D achieved 20/30 or better uncorrected near visual acuity (P=0.13). The proportion of eyes within 0.50 D of emmetropia was 84.4% in group A, 86.8% in group B, 85.7% in group C, and 85.8% in group D (P=0.67). There was no statistically significant difference in postoperative satisfaction, visual phenomena, dry eye symptoms, distance or near vision activities. Apart from higher rate of iritis in the age group 50–55 years, there was no statistically significant difference in postoperative complication rates.

Conclusion

RLE can be safely performed in younger as well as older presbyopes. No significant difference was found in clinical or patient-reported outcomes.

Role of the treating surgeon in the consent process for elective refractive surgery

Purpose

To compare patient’s perception of consent quality, clinical and quality-of-life outcomes after laser vision correction (LVC) and refractive lens exchange (RLE) between patients who met their treating surgeon prior to the day of surgery (PDOS) or on the day of surgery (DOS).

Design

Retrospective, comparative case series.

Setting

Optical Express, Glasgow, UK.

Methods

Patients treated between October 2015 and June 2016 (3972 LVC and 979 RLE patients) who attended 1-day and 1-month postoperative aftercare and answered a questionnaire were included in this study. All patients had a thorough preoperative discussion with an optometrist, watched a video consent, and were provided with written information. Patients then had a verbal discussion with their treating surgeon either PDOS or on the DOS, according to patient preference. Preoperative and 1-month postoperative visual acuity, refraction, preoperative, 1-day and 1-month postoperative questionnaire were compared between DOS and PDOS patients. Multivariate regression model was developed to find factors associated with patient’s perception of consent quality.

Results

Preoperatively, 8.0% of LVC and 17.1% of RLE patients elected to meet their surgeon ahead of the surgery day. In the LVC group, 97.5% of DOS and 97.2% of PDOS patients indicated they were properly consented for surgery (P=0.77). In the RLE group, 97.0% of DOS and 97.0% of PDOS patients stated their consent process for surgery was adequate (P=0.98). There was no statistically significant difference between DOS and PDOS patients in most of the postoperative clinical or questionnaire outcomes. Factors predictive of patient’s satisfaction with consent quality were postoperative satisfaction with vision (46.7% of explained variance), difficulties with night driving, close-up vision or outdoor/sports activities (25.4%), visual phenomena (12.2%), dry eyes (7.5%), and patient’s satisfaction with surgeon’s care (8.2%).

Conclusion

Perception of quality of consent was comparable between patients that elected to meet the surgeon PDOS, and those who did not.