Eyeworld

16 | EYEWORLD | DECEMBER 2021 ASCRS NEWS References 1. Melles RB, et al. Accuracy of intraocular lens calculation formulas. Ophthalmology. 2018;125:169–178. 2. Hayashi K, et al. Influence of astigmatism on multifocal and monofocal intraocular lenses. Am J Ophthalmol. 2000;130:477– 482. 3. Villegas EA, et al. Minimum amount of astigmatism that should be corrected. J Cataract Refract Surg. 2014;40:13–19. 4. Sigireddi RR, Weikert MP. How much astigmatism to treat in cataract surgery. Curr Opin Ophthalmol. 2020;31:10–14. 5. Hayashi K, et al. Effect of spherical equivalent error on visual acuity at various distances in eyes with a trifocal intraocular lens. J Refract Surg. 2019;35:274– 279. at higher levels of postoperative sphere; for a given diopter, patients with myopic sphere had higher odds ratios of not achieving 20/20 UDVA and "not being satisfied." As with astigmatism, there were nearly identical results within the monofocal IOL cohort. Axis of astigmatism was analyzed to de- termine if it was an independent predictor of UDVA; however, in a multivariate analysis, axis of astigmatism did not independently predict UDVA. Discussion The authors' data led to several important conclusions. First, patients were less likely to be "satisfied" with their refractive outcomes and less likely to achieve 20/20 UDVA if their resid- ual astigmatism was greater than 0.50 D. Sec- ond, for a given level of postoperative residual sphere, patients who were hyperopic were more likely to be satisfied with their vision and more likely to achieve 20/20 UDVA than patients who were myopic. Third, axis of astigmatism did not independently predict UDVA; with-the-rule, against-the-rule, and oblique astigmatism of the same magnitude resulted in the same UDVA. During the ASCRS Journal Club discus- sion of this study, the panelists discussed the importance of "raising the bar" with regard to astigmatism management. This study suggested that there is a need to improve our preoperative measurements, lens calculations, and intraoper- ative management options to optimize patient outcomes. Prior literature has been somewhat mixed, with some authors suggesting up to 1.0 D of astigmatism can be observed with good visual acuity outcomes, 2 while others suggest treating anything more than 0.50 D. 2,3 The results presented here suggest any amount of astigmatism decreases the odds of achieving 20/20 UDVA, however, only residual astigma- tism more than 0.50 D was associated with less patient satisfaction. The panelists also discussed their surprise at the results suggesting that patients with hyperopic refractive misses were more satis- fied and more likely to achieve 20/20 UDVA than their myopic counterparts. While the traditional teaching is to leave patients slight- ly myopic, these data would suggest just the opposite. While the effects of multifocal lenses could explain some of the patient satisfaction with residual hyperopia, the same results were increased the odds of not achieving 20/20 UDVA, with an odds ratio (OR) of 1.7 and p-value of <0.0001. However, the same amount of residual astigmatism was not associated with decreased odds of "not being satisfied" (defined as a score of 3 or higher on the survey), OR 1.1, p-value 0.1911. If the amount of residual astigmatism rose to 0.75–1.00 D, the odds ratio of not achieving 20/20 UDVA increased to 6.5 (p-value <0.0001), while the odds ratio of "not being satisfied" increased to 1.5 and gained statistical significance (<0.0001). The trend continued with higher levels of residual astig- matism, and there were nearly identical results within the monofocal IOL cohort. The authors also analyzed the association of residual hyperopic and myopic sphere with UDVA and patient satisfaction. Among pa- tients with multifocal IOLs, residual hyperopic sphere of 0.25–0.50 D was tolerated without an increase in OR of not achieving 20/20 vision (OR 1.1, p-value 0.0647) or of "not being satisfied" (OR 0.9, p-value 0.4308). The same amount of residual postoperative myopic sphere (0.25–0.50 D) was associated with an OR of 5.0 (p-value <0.0001) of not achieving 20/20 UDVA, and an OR of 1.4 (p-value of 0.0012) of "not being satisfied." This trend remained valid continued from page 14 The ASCRS Journal Club is a virtual, compli- mentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the August session was recorded live during the 2021 ASCRS Annual Meeting in Las Vegas, Nevada, and featured a presentation by William Wiley, MD, author of "Comparative study of phacoemulsification parameters with and without nitinol filament nuclear disassembly." The second manuscript, "Effect of residual astigmatism on uncor- rected visual acuity and patient satisfaction in pseudophakic patients," was presented by Thomas Meirick, MD, ophthalmology resident, University of Washington. To view the August Journal Club session, go to ascrs. org/clinical-education/journal-club/ schedule/august-2021.

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