Use of presbyopia-correcting intraocular lenses in patients with prior corneal refractive surgery

Abstract

Purpose of review Corneal refractive surgery has achieved spectacle-free vision for millions of patients, but this aging population is now developing cataracts. Many of these patients may wish to avoid reliance on glasses after cataract surgery. Presbyopia-correcting intraocular lenses (IOLs) offer a solution, but corneal changes after refractive surgery may compound higher order aberrations and dysphotopic symptoms associated with these IOLs. This review aims to discuss potential factors that could aid in determining suitable postkeratorefractive candidates for presbyopia-correcting IOLs. Recent findings Studies investigating which preoperative measures influence outcomes are lacking. The few studies that have examined presbyopia-correcting IOLs in postkeratorefractive patients report that satisfactory outcomes are possible. However, recommendations for preoperative thresholds appear limited to expert opinion and studies involving virgin corneas. Summary As the number of presbyopia-correcting IOLs and postkeratorefractive patients grows, continued investigation into relevant preoperative factors and appropriate IOLs is required to make evidence-based decisions. The current literature shows that with rigorous counseling and appropriate patient selection, presbyopia-correcting IOLs can provide postkeratorefractive patients with satisfactory results and spectacle independence. In addition, the development of postoperative modifiable IOLs may prove to be the preferred option.

Agreement between Scheimpflug Camera and the Swept-source Optical Coherence Tomography Measurements in Keratometry and Higher-order Aberrations

“…Among the HOAs, coma, trefoil, and spherical aberration are known as visually significant aberrations; the vertical coma and spherical aberration are known as the two major HOAs that clinically significantly increase in keratoconus patients [10,11], and are related to visual acuity and discomfort after cataract surgery patients [12][13][14]. In addition, as the number of premium cataract surgeries using multifocal or toric intraocular lens (IOL) gains popularity in patients who had corneal refractive surgery, cut-off values of HOAs are suggested for those patients to prevent postoperative suboptimal visual outcome and patient's dissatisfaction [15]. Therefore, measuring corneal HOAs is essential for predicting and interpreting visual performance under various conditions.…”

Presbyopia-Correcting Intraocular Lenses Implantation in Eyes After Corneal Refractive Laser Surgery: A Meta-Analysis and Systematic Review

“…To date, no explicit guidance exists to preclude the use of presbyopia-correcting IOLs regarding the amount of spherical aberrations or other HOAs. It is suggested that potential MIOLs contraindication thresholds for total HOAs was >2.0 SD ( 38 ).…”

Cataract surgery after corneal refractive surgery: preoperative considerations and management

“…A recent meta-analysis showed that both SMILE and wavefront-guided-LASIK result in a similar increase in total HOAs, with wavefront-guided-LASIK causing more spherical aberrations and SMILE causing more vertical coma and trefoil [46]. As presbyopia-correcting IOLs may potentially further exacerbate HOAs in eyes with prior CRS, implantation of these IOLs in CRS-treated eyes is generally not recommended and should only be used after thorough preoperative patient counselling and careful patient selection; for instance, in eyes with small amount of HOAs and more regular astigmatism [47,48].…”