ASCRS Boston 2010 Residual astigmatism after multifocal IOL

ASCRS Boston 2010 Residual astigmatism after multifocal IOL implantation: prediction and possible management Authors: Eva Vyplasilova, MD Katerina Buusova Smeckova, MD, MBA As. proff. Zdenek Smecka, MD, CSc. Klinika ocni a esteticke chirurgie in Zlin Czech Republic None of the authors has a financial interest on the presented data.

Aim Methods evaluation the satisfaction with Preoperative BCVA, autorefractometry unilateral and bilateral UCVA in values and corneal astigmatism values patients after implantation of from the IOL Master were measured. Acry. Sof Re. STOR +3 IOL. Lens clearness and pathologies were evaluated. prediction of the final refraction (mainly Dcyl) and overall patient Standard cataract / RLE surgery was satisfaction. performed-Infinity phaco, incision 2, 2 mm, one surgeon, in the case of the determination the amount of higher astigmatism incision in the K dioptries when patients usually max, no relaxation incisions. request a laser enhancement findning recommendations about Postoperatively was evaluated monoand binocular UCVA, suitable procedures to be chosen. autorefractometry values, requests for Dissatisfaction with optical glasses prescription, patient subjective phenomenons like halo, glare, satisfaction and laser enhancement speed of focusing, eye dryness rate- how many were requested and surgery or speed of recovery performed. were not taken into account. ASCRS Boston 2010 2

Setting / Venue ASCRS Boston 2010 3

Results: Refraction: 0, 33 Dsf +/- 0, 48 [-1, 5; +2, 50] 0, 50 Dcyl +/- 0, 79 [-5; 0] SE: 0, 7 +/- 0, 56 [-2, 5; +2, 6] UCVA: 0, 83 [0, 2; 1, 5] Subjective satisfaction: satisfied: parctially satisfied: unsatisfied: 390 eyes 95 eyes 23 eyes 77 % 19% of eyes 4% In 77% of cases was the astigmatism decreased, unchanged or increased by no more than 0, 1 Dcyl. ASCRS Boston 2010 4

Results- prediction of astigmatism Group 0 -0, 5 Dcyl Preoperative on the average: O, 33 Dcyl Residual astigmatism 82% 95% 100% to 0, 75 Dcyl to 1 Dcyl 0, 39 Dcyl [0; 1, 25] Postperative on the average: 55% 45% or unchanged x (max. by 0, 75 Dcyl) ASCRS Boston 2010 to 0, 5 Dcyl 5

Results- prediction of astigmatism Group 0, 5 - 1, 0 Dcyl Residual astigmatism Preoperative on the average: O, 74 Dcyl 84% 94% 69% 0, 54 Dcyl [0; 1, 75] Postperative on the average: 82% or unchanged x 18% ASCRS Boston 2010 to 0, 5 Dcyl to 0, 75 Dcyl to 1 Dcyl 6

Results- prediction of astigmatism Group 1, 0– 1, 5 Dcyl Residual astigmatism Preoperative on the average: 1, 20 Dcyl 0, 71 Dcyl Postperative on the average: 92% or unchanged x 8% ASCRS Boston 2010 87% 72% 44% to 0, 5 Dcyl to 0, 75 Dcyl to 1 Dcyl 7

Results- prediction of astigmatism Group 1, 5 Dcyl and more Residual astigmatism Preoperative on the average: 2, 50 Dcyl 19. 00% 12% 1, 9 Dcyl Postperative on the average: 86% or unchanged x 14% ASCRS Boston 2010 9% to 0, 5 Dcyl to 0, 75 Dcyl to 1 Dcyl 8

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Comparison with other means of correcting astigmatism ASCRS Boston 2010 11

Conclusion 80% of patients had post-operative astigmatism equal or better, so it is quite predictable. We recommend to tailor the solution upon the pre-operative corneal astigmatism. When pre-operative corneal astigmatism is higher than 1, 0 Dcyl, enhancement is highly possible. When more than 1, 5 Dcyl is measured, enhancement or other correction means (toric IOL) should be planned. Toric multifocal IOLs are technically very complex and according to our experience there might be a problem with their prediction and sometimes the dispersion in sphere or cylinder may be as high as 1, 5 D, When the result with toric MIOL is not perfect, enhancement is necessary and this modality increases costs for the clinic and patients are often distempered. That's why we prefer the alternative of MIOL followed by laser enhancement. The main disadvantage are 2 surgeries, but the result is precise. 12