Laser enhancement may provide solution to 'waxy vision' complaints

Wavefront aberrometry should be considered for evaluation of patients who complain about their vision following implantation of the apodized diffractive IOL (ReSTOR, Alcon Laboratories) because it may reveal refractive errors amenable to laser vision enhancement, said Samuel Masket, MD. He is clinical professor, Jules Stein Eye Institute, University of California Los Angeles.

Dr. Masket said he was prompted to evaluate an unhappy diffractive IOL patient with wavefront aberrometry based on a report from Paolo Vinciguerra, MD, that decentration of the diffractive IOL may be associated with induction of higher-order aberrations. The patient Dr. Masket described had achieved uncorrected distance visual acuity (UCDVA) of 20/30 and uncorrected near visual acuity (UCNVA) of J2 early after surgery, but her visual acuity results worsened to 20/40 and J3, respectively at 6 weeks. With clinical refraction, she improved to only 20/30.

Dr. Masket was surprised to find on wavefront aberrometry that the patient had a significantly greater degree of mixed astigmatism than was identified in the clinical refraction. When a contact lens trial was done to correct the error, the patient's vision improved dramatically. Subsequent conventional LASIK was performed and the patient achieved 20/20 UCDVA and J1 at near.

Dr. Masket presented outcomes from a total of six eyes that he treated with conventional LASIK enhancement to treat mixed astigmatism found on wavefront aberrometry. He reported all achieved UCDVA of 20/25 and UCNVA of J1 or better along with spectacle independence.

"Due to the nature of its diffractive optics, the [apodized diffractive] IOL appears to be very sensitive to ametropia," Dr. Masket said. "Experience in this small series of eyes suggests aberrometry provides more accurate evaluation of postoperative refractive errors than clinical refraction and should be considered for patients with suboptimal visual results with no obvious cause.

"It is possible that reports of waxy or 'Vaseline' vision after [diffractive IOL] implantation may be related purely to refractive errors rather than reflect an inherent problem of the optic design," he said.