High expectations in pseudophakes fueling expansion in laser vision correction base

Demand for excellent uncorrected distance visual acuity after cataract surgery is increasing,especially with the availability of new presbyopia-correcting IOLs. This phenomenon is opening up anew class of patients to the benefits of laser vision correction, said Steven J. Dell, MD, atRefractive Surgery Subspecialty Day.

"If cataract surgery is now being considered refractive surgery, then cataract surgery withimplantation of a premium IOL is hyper-refractive surgery," said Dr. Dell, director, refractive andcorneal surgery, Texan Eye, Austin, TX. "Recipients of these lenses are less tolerant of misses inour refractive target than their younger, laser vision correction counterparts. This is because a lowhyperopic result in a young phakic patient may still result in 20/15 vision, but is totallyunacceptable in a pseudophake.

"If refractive errors occur in sphere and/or cylinder, there are a number of options for correctingthem. However, laser vision correction is the most accurate," Dr. Dell said.

When a decision is made to proceed with a laser vision enhancement, surgeons need to consider whetherto perform a customized ablation or a conventional procedure.

Dr. Dell suggested performing a wavefront-guided procedure in the eyes of patients who have receivedeither a monofocal lens, accommodating lens (crystalens, eyeonics), apodized diffractive lens(AcrySof ReSTOR, Alcon Laboratories), or multifocal lens (Tecnis, Advanced Medical Optics), assumingthe wavefront is capturable and the data make sense. However, he cautioned against a customwavefront-guided enhancement in eyes in which the zonal refractive multifocal IOL (ReZoom, AdvancedMedical Optics) is implanted.