Laser vision correction: good results after multifocal IOL implantation resolve residual refractive errors

April 7, 2008

Using an excimer laser to treat patients with residual refractive error after implantation of a multifocal IOL reduces astigmatism and sphere and increases visual satisfaction. Using an excimer laser for re-treatment in this patient population may help overcome side effects of multifocal IOL implantation such as glare and halos, according to David Hardten, MD.

Using an excimer laser to treat patients with residual refractive error after implantation of amultifocal IOL reduces astigmatism and sphere and increases visual satisfaction. Using anexcimer laser for re-treatment in this patient population may help overcome side effects ofmultifocal IOL implantation such as glare and halos, according to David Hardten, MD.

"Implantation of presbyopic IOLs is becoming increasingly common," said Dr. Harden, adjunctassociate professor of ophthalmology, University of Minnesota, Minneapolis. "These patientshave very high expectations about the quality of their vision. Astigmatism is not managed withthese implants, which is very important to the results achieved for the uncorrected distancevisual acuity and near vision. The residual astigmatism will cause increased glare andhalos."

Forty patients were included in this study. The timing of the laser vision correction istypically 4 to 6 months following IOL implantation.

Dr. Hardten said that the results were very good. He cited the case of a patient implanted witha multifocal lens (ReZoom, Advanced Medical Optics) who achieved 20/20 at J3. In this group ofpatients who went on to laser vision correction, 13 eyes (33%) received an apodized diffractiveIOL (ReSTOR, Alcon Laboratories), 21 eyes (53%) an accommodating IOL (crystalens,eyeonics/Bausch & Lomb), and six eyes (15%) the multifocal.

The mean spherical equivalent in this patient group was about 1 D; the mean astigmatism afterimplantation of an IOL was about 1.3 D. The mean uncorrected visual acuity was 20/45 after IOLimplantation, but the patients were not satisfied with that result.

The vast majority (83%) of patients were treated with standard LASIK, and the remainder withstandard and custom PRK.

"After at least 3 months of follow-up, the mean spherical equivalent at the last follow-upvisit was -0.14 D, and the mean astigmatism 0.4 D from 1.3 D preoperatively. No eyes lost linesof best-corrected visual acuity," Dr. Hardten said. About 40% of patients had uncorrecteddistance visual acuity of 20/20; about 80% had 20/30; 40% had 20/25 at J2.

"The results of laser vision correction after multifocal IOL implantation are promising," Dr.Hardten said. "These patients can be enhanced. Astigmatism and sphere are decreased. Theenhancement rates are fairly low in patients with presbyopic IOLs, with about 10% requiringenhancement. Surface treatments are possible and this improved the results in our patients withpresbyopic IOLs by enhancing the astigmatism and myopia."