Intraoperative aberrometry adds value in toric IOL surgery

Waltham, MA-Use of intraoperative aberrometry significantly improves refractive and visual outcomes after toric IOL implantation, according to a retrospective study presented by Kathryn Hatch, MD.

“We conducted this study because to our knowledge, there is no report in the peer-reviewed literature evaluating the use of intraoperative aberrometry with toric IOLs,” said Dr. Hatch, private practice, Waltham, MA, and clinical faculty, Brown Alpert Medical School, Providence, RI.

The analysis compared a traditional method group including 27 eyes and an aberrometry group with 37 eyes.

In the traditional method group, IOL cylinder power and axis of alignment were determined based on standard biometry and use of an appropriate toric IOL calculator.

In the aberrometry group, intraoperative aberrometry (ORA, WaveTec Systems) was performed in the aphakic state to determine cylinder power and axis of toric IOL placement, and then IOL placement was refined by pseudophakic refraction.

Use of aberrometry led to a change in cylinder power in about 1 in 4 eyes, in spherical power in about 1 in 3 eyes, and in IOL positioning in about 1 in 3 eyes.

Postoperative refractive astigmatism measured at a mean of about 2 months after surgery was analyzed as the primary outcome measure, and the mean value was significantly less among the aberrometry eyes compared with the traditional method group, 0.46 ± 0.42 D vs. 0.68 ± 0.34 D.

In addition, the chance of a patient being in a lower range of postoperative residual refractive astigmatism increased significantly when intraoperative aberrometry was used. Considering a cutoff of ≤0.5 D, the proportion of eyes falling within that range was about 2.5-fold higher in eyes managed with intraoperative aberrometry compared with the traditional method group, 78% vs. 33%.

Better refractive outcomes translated into better vision-mean logMAR distance UCVA was 0.11 for the aberrometry group and 0.16 for eyes managed with the traditional method, while 67% of the aberrometry group eyes and 39% of the traditional method eyes achieved distance UCVA of 20/25 or better.

“Our findings show that surgeons don’t always get it right the first time with toric IOL selection and positioning,” Dr. Hatch said. “Use of intraoperative aberrometry to guide intraoperative decisions improves outcomes.”

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