Refractive

Several points to consider before you make the leap

Improving vision, nonvisual function, quality of life key for customized treatment plans

Researchers explore clinical and patient-reported outcomes after WFG LASIK for myopia

Shortcomings in ablative procedures mean that new developments in refractive surgery are welcome. Arthur Cummings, MD, FRCSEd, reviews two new technologies that will increase patient satisfaction.

A novel glistening-free IOL has been tested in 94 eyes and found to give good visual outcomes with a low incidence of PCO

Transepithelial topography-guided PRK can help correct irregular astigmatism after penetrating keratoplasty.

A new small-aperture intraocular lens (IOL) extends patients’ depth of focus as well as multifocal IOLs with fewer dysphotopsias, researchers say.

The most recent analyses of data from the ARMOR (Antibiotic Resistance Monitoring in Ocular micRoorganisms) Surveillance Program can guide clinicians choosing antibiotic therapy for initial empiric therapy and infection prophylaxis. The information also reinforces the importance of prudent antibiotic prescribing to limit the development of bacterial resistance to existing options, according to Penny Asbell, MD.

Though extended depth-of-focus lenses tend to be more forgiving of residual refractive error and mild decentration than other presbyopia-correcting IOLs, it is important to select patients carefully and follow good preoperative protocols for a successful outcome.

Addressing patient dissatisfaction after presbyopia-correcting IOL surgery requires listening to understand the problem. Time and patient reassurance may be adequate for resolving some issues.

Surgeons should use a centroid value for surgically induced astigmatism rather than a mean or median value when working with toric IOL calculators.

When it comes to recommending a premium IOL, a patient’s glaucoma is only one factor to consider. Just like any other patient planning cataract surgery, visual needs and preferences for/against glasses are also important factors.

Residual astigmatism is not uncommon after toric IOL implantation. Depending on its cause and magnitude, lens reorientation may be a good solution.

A 4-year study following trifocal IOL implantation (AT LISA tri 839MP, Carl Zeiss Meditec) found that the lens provided good distance, near, and intermediate visual acuity. The lens also improved patient quality of vision with better diffraction and less reduction in contrast sensitivity.

Cataract and refractive surgeons should use prophylaxis to avoid reactivation of the herpes simplex virus (HSV) in patients with a history of infection with this virus, according to Elizabeth Yeu, MD.

Implantation of an investigational device for presbyopia resulted in a minimal 2-line increase in distance-corrected near visual acuity and an actual reduction in the amount of near add needed over time, show findings from a single-center, subgroup analysis.

A comparative analysis suggests placement of a cornea inlay (Kamra, AcuFocus) has improved patient satisfaction, refractive stability, and visual results when placed at 250 μm or deeper in the cornea. Shallower implantation depths may be more prone to refractive instability and lower patient satisfaction.

The use of epi-on photorefractive intrastromal cross linking reduced myopia by about 0.25 D in a small study; In a high-oxygen group, the effect averaged 1.25 D.

Hyperopic SMILE is being investigated in a prospective study. Early outcomes show good efficacy, safety, and predictability along with some interesting differences compared with hyperopic LASIK.

Wavefront-guided LASIK and wavefront-guided PRK following previous keratorefractive surgery demonstrate similar safety, efficacy, and predictability and result in comparable wavefront outcomes.

Excimer laser treatments using vector planning resulted in less corneal astigmatism, less refractive cylinder, and better unaided visual acuity postoperatively than treatments using manifest refractive treatment parameters alone, according to Noel Alpins, MD.

A new questionnaire can help assess candidates’ symptoms before LASIK surgery, monitor them for visual symptoms as well as satisfaction after LASIK surgery, and measure the impact any post-LASIK symptoms have on a patient’s ability to function.

Decentration of less than 0.75 mm from a light-constricted pupil with a novel corneal inlay for the surgical correction of presbyopia does not affect visual acuity, task performance, or severity of halos and glare.

Patients with a contact lens lost in the eye are not a rare occurrence for ophthalmologists. However, 27 lenses at the same time may be another story! Another ophthalmologist shares his experience with a case involving 5 lenses within a patient's eye.