Cataract surgeons appear to have growing confidence using presbyopia-correcting IOLs in patients with a history of keratorefractive surgery.
This article was reviewed by Arthur B. Cummings, MD
Though a history of keratorefractive surgery has generally been considered a contraindication to implantation of a presbyopia-correcting IOL, the landscape appears to be changing, according to findings of a survey of surgeons.
According to Arthur B. Cummings, MD, consultant eye surgeon and medical director, Wellington Eye Clinic, Dublin, Ireland, patients who have previously undergone keratorefractive procedures and enjoyed the benefits of good vision demand similar results after IOL surgery.
Dr. Cummings sought to identify current practices for using presbyopia-correcting IOLs in patients with a history of keratorefractive surgery by sending a survey to almost 150 colleagues regarded as experts in both keratorefractive and cataract surgery. Ninety surgeons replied, and their responses showed that approximately two-thirds were using presbyopia-correcting IOLs in this challenging population, and the majority of those users were satisfied with the outcomes.
Additional data collected in the survey indicated that greater use of presbyopia-correcting IOLs in patients with a history of keratorefractive surgery was supported in part by the availability of new IOL technology and surgeon confidence gained from careful patient selection.
“When considering whether or not a patient is a good candidate for a presbyopia-correcting IOL, evaluation of corneal optics (i.e., higher order aberrations) and the state of the corneal surface were key,” Dr. Cummings said. “Patient personality, realistic expectations, and motivation also came forth as important issues.”