Light adjustable intraocular lenses in cataract surgery: considerations

Presbyopia Correction in Lens Replacement Surgery: A Review

Presbyopia affects approximately 1.8 billion individuals globally, posing significant challenges as life expectancy and near-vision demands, particularly with mobile phone use, grow. Addressing presbyopia during lens replacement surgery has become a key focus for cataract surgeons, aiming to reduce dependence on corrective eyewear. This review provides an overview of current intraocular lens (IOL) technologies and surgical strategies for presbyopia correction. Personalised decision-making is essential, considering each patient's visual needs, expectations, and ocular anatomy. Partial correction approaches, such as monovision and extended depth-of-focus IOLs, can improve intermediate vision but involve specific trade-offs compared to monofocal lenses, depending on the technology utilised. For complete presbyopia correction, multifocal IOLs remain the most effective option. A mix-and-match strategy involving unilateral multifocal implantation shows promise, while sulcus-fixated supplementary IOLs offer the advantage of easier reversibility. Careful IOL selection is particularly important for patients with atypical ocular anatomy or coexisting conditions, which may be progressive.

Light-adjustable lens in eyes with a history of radial keratotomy

PURPOSE

To evaluate visual and refractive outcomes in eyes with a history of radial keratotomy (RK) implanted with the second-generation light-adjustable lens (LAL).

SETTING

Private practice, multiple locations.

DESIGN

Retrospective, consecutive case series.

METHODS

Eyes with a history of RK that underwent cataract surgery with implantation of the LAL and were targeted for emmetropia before lock-in were included. Data on the type and number of prior refractive surgeries were collected, in addition to the timing and number of postoperative adjustments. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity, and the percentage (%) of eyes within ±1.00 diopter (D), ±0.50 D, and ±0.25 D and of their refractive target.

RESULTS

94 eyes from 77 patients were included. 28% (n = 26) were a history of 4-cut RK, 12% (n = 11) were 6-cut RK, 55% (n = 52) were 8-cut RK, and 5% (n = 5) were 16-cut RK. Overall, 82% (n = 77) of all eyes achieved 20/25 UDVA or better, 74% (n = 70) of all eyes achieved UDVA of 20/20 or better, and 94% (n = 88) were correctable to 20/20 or better postoperatively. For refractive outcomes, 98% (n = 92) of eyes were within ±1.00 D of target, 88% (n = 83) were within ±0.50 D, and 69% (n = 65) were within ±0.25 D of preoperative refractive target.

CONCLUSIONS

Patients with a history of RK achieved favorable visual and refractive outcomes with the LAL. Postoperative light adjustments should be delayed to allow for refractive stabilization. The LAL is a promising option for post-RK patients who are motivated to obtain favorable uncorrected acuity after cataract surgery.

Functional Approach to IOL Selection in Eyes With Combined Cataract and Keratoconus With an Option for Refractive Lens Exchange

PURPOSE

To evaluate spherical intraocular lens (IOL) implantation for cataracts in keratoconic eyes followed by optional refractive toric lens exchange to improve uncorrected visual acuity.

METHODS

This retrospective study evaluated cataract surgery outcomes in keratoconic eyes. Eyes treated with a spherical IOL targeted for -2.00 diopters (D) either achieved acceptable manifest refraction and desired exchange with a toric IOL (Group 1); achieved satisfactory manifest refraction and chose to use spectacles or contact lenses (Group 2); or did not achieve acceptable refraction and used contact lenses (Group 3). Group 4 had single-stage toric IOL implantation with plano target. Corrected and uncorrected distance visual acuity (CDVA and UDVA) and keratometry were analyzed.

RESULTS

Groups 1 to 4 had 18, 23, 18, and 26 eyes, respectively. A staged toric exchange resulted in significantly better (P = .02) UDVA (mean: 0.15 logMAR; 20/25 Snellen) than initial toric IOL implantation (0.24 logMAR; 20/30 Snellen). All toric IOL exchange eyes achieved 20/30 or better CDVA and 94% had 20/40 or better UDVA. Mean manifest cylinder significantly decreased from 3.39 D before lens exchange to 1.10 D postoperatively.

CONCLUSIONS

Initial implantation of a spherical IOL in keratoconic eyes allows basing toric calculations on the manifest refraction, which may be more reliable than keratometry measurements in keratoconic eyes. UDVA after staged toric IOL exchange was significantly better than after initial toric IOL implantation. Importantly, by staging use of toric lenses, the authors avoided cases where patients required a rigid contact lens after a toric IOL was implanted. [J Refract Surg. 2024;40(4):e207-e217.].