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With so many refractive options available now, many surgeons are focused on fine-tuning their refractive results to get the best visual results for their patients.
"Patients who undergo refractive lens exchange are usually those who are presbyopic and may have any type of refractive error without astigmatism," Dr. Carones said. "These patients are usually highly motivated to be spectacle free. In these patients, then, why not address all the ocular conditions, myopia, hyperopia, lens opacities, astigmatism, at once?"
Dr. Carones, medical director at the Carones Ophthalmology Center, Milan, Italy, and colleagues conducted a study in which 40 patients (80 eyes) were included. All patients had a refractive error with almost no lens opacities. The patients had no contraindications for undergoing RLE. All were highly motivated to be spectacle free, Dr. Carones explained. LASIK, which was planned for the postoperative period if there was any residual refraction following implantation of the ReSTOR lens, was performed at least 2 months after the IOL implantation.
"Twenty-three of the 80 eyes required an enhancement procedure after IOL implantation," Dr. Carones said. "Fifteen of the enhancement procedures had been planned before the primary surgery because of the presence of pre-existing astigmatism.
"The uncorrected visual acuity and uncorrected near distance visual acuity were both extremely good," Dr. Carones said. "With multifocal IOLs, the intermediate visual acuity was not as good as the near and distance vision, but it still was quite satisfactory in the vast majority of the cases. The best-corrected visual acuity was at least 20/20 in all eyes after surgery."
When the investigators analyzed the patients bilaterally, they found that 37 patients had at least 20/20 vision and J2, indicating that they were totally free of glasses. Overall, 90% of the study subjects were no longer dependent on glasses.
Dr. Carones reported that there was no severe induction of higher-order aberrations.
The results of the contrast sensitivity testing showed, as expected, according to Dr. Carones, that there were no changes in photopic testing. Regarding mesopic testing, he reported that in some cases there was some clinically significant reduction between the preoperative and postoperative results.
Psychometric testing showed that all patients were satisfied with the results.
"The results for distance and near vision were extremely good," Dr. Carones said. "No patients had severe visual symptoms in dim lighting. Some patients had slight to significant visual symptoms in dim light. Interestingly, the visual symptoms were much more important in the presence of a refractive error. This was reversed after the LASIK enhancement."
RLE with a multifocal IOL proved to be a very effective procedure that was able to correct myopia, presbyopia, and hyperopia simultaneously. The visual results were immediate and stable. The patient acceptance was extremely high, but achieving perfect refractive results is mandatory in order to get the best visual acuity performance and the best results regarding visual symptoms.
With these patients, laser vision correction is a viable option to fine-tune the results of the RLE. This procedure should be offered to patients who have high expectations of refractive surgery, Dr. Carones concluded.