Dysmorphopsia major problem after IOL implantation

April 22, 2012

The corrections following phacoemulsification and IOL implantation that are achievable today are a far cry from those in the 1970s when 20/40 uncorrected visual acuity was considered an accomplishment following implantation of the early IOLs, recounted Randall J. Olson, MD, during his presentation of the 2012 Binkhorst Lecture.

Chicago-The corrections following phacoemulsification and IOL implantation that are achievable today are a far cry from those in the 1970s when 20/40 uncorrected visual acuity was considered an accomplishment following implantation of the early IOLs, recounted Randall J. Olson, MD, during his presentation of the 2012 Binkhorst Lecture.

Dr. Olson highlighted the technologic advances to the present and the areas that need improvement during his presentation, entitled “Where Are We on the Road to Optical Perfection?” at the opening session of the American Society of Cataract and Refractive Surgery.

After decades of leaps in cataract surgery technology, there is still room for improvement, according to Dr. Olson, professor and chairman, John A. Moran Eye Center, Salt Lake City. A study of patients who underwent cataract surgery indicated that pseudophakic dysmorphopsia is by far the biggest problem after cataract surgery, despite 20/20 or better visual acuity.

“Dysmorphopsia is not just an annoyance; it is actually a dysfunction in the overall visual capability,” he said.

Twenty-one percent of patients rated bright lights as problematic and rated them as 5 or greater on a scale of 0 to 10, with 10 being debilitating.

Dr. Olson claimed that the “20/20 unhappy patients” could become a thing of the past when the postoperative problems are addressed. The biggest challenge is the effective lens position (ELP).

Technology that should play a role in increasing patient satisfaction after cataract surgery is femtosecond laser cataract surgery, which Dr. Olson referred to as a “good step,” because of the very precise capsulorhexes that can be created. The near-perfect capsulorhexes will result in better ELPs and better visual outcomes. Use of intraoperative aberrometry, light-adjustable IOLs, and refractive index shaping are other technologies that are promising in the quest for improved outcomes after cataract surgery.

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