Eyeworld

DECEMBER 2021 | EYEWORLD | 17 noted in the monofocal cohort. A previous study suggested that even slight hyperopic refractive misses degrade visual outcomes in patients with trifocal lenses, 5 however, this study used extra- ocular lenses to simulate a refractive surprise. Additional analyses would have been valu- able in this study. For instance, stratifying pa- tients based on preoperative refractive error as a predictor of level of satisfaction postoperatively would have been advantageous. Would previ- ously myopic patients have the same level of satisfaction with a hyperopic refractive outcome compared to other subgroups? Secondly, though the axis of astigmatism did not affect the UDVA, it would have been beneficial to determine if the axis played a role in the level of patient satisfac- tion postoperatively. Do patients with the same level of with-the-rule astigmatism have a higher level of satisfaction than patients with against- the-rule or oblique astigmatism? This study is limited by its retrospective nature and lack of a standardized treatment protocol for different levels of astigmatism. In addition, subjective assessments of vision likely vary between different populations, limiting the external validity of those results. Finally, only dominant eyes were included in the study, but the patient questionnaire was completed after both eyes underwent surgery. It is there- fore difficult to exclude the binocular impact of monovision on the level of patient satisfaction postoperatively. Conclusions In this large, retrospective database study, Schallhorn et al. suggested residual astigmatism of more than 0.50 D in pseudophakic patients is associated with less patient satisfaction and decreased visual acuity. These associations be- come larger and more significant with each 0.25 D of residual astigmatism. In addition, patients with hyperopic refractive misses of a given magnitude were more likely to be satisfied with their vision and to achieve 20/20 uncorrected distance visual acuity than those with equiva- lent myopic refractive misses. Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients Steven Schallhorn, MD, Keith Hettinger, MS, Martina Pelouskova, MSc, David Teenan, MD, Jan Venter, MD, Stephen Hannan, OD, Julie Schallhorn, MD J Cataract Refract Surg. 2021;47(8):991–998. n Purpose: To evaluate the effect of residual astigmatism on postoperative visual acuity and satisfaction after intraocular lens surgery. n Setting: Private practice, U.K. n Design: Retrospective case series n Methods: Postoperative data of patients who had previously undergone refractive lens exchange/cataract surgery were used in a multivariate regression model to assess the effect of residual astigmatism on 3 months postoperative monocular UDVA and patient satisfaction. The analysis was based on residual refraction in the dominant eye of each patient (17,152 eyes). Odds ratios were calculated to demonstrate the effect of increasing residual astigmatism on UDVA and satisfaction with separate calculations for monofocal and multifocal IOLs. n Results: Compared to eyes with 0.0 D residual astigmatism, the odds of not achieving 20/20 vision in eyes with 0.25–0.50 D residual astigmatism increased by a factor of 1.7 and 1.9 (p<0.0001) in monofocal and multifocal IOLs, respectively. For the residual astigmatism 0.75–1.00 D, the odds ratio for not achieving 20/20 vision compared to eyes with no astigmatism was 6.1 for monofocal and 6.5 for multifocal IOLs (p<0.0001). The effect of residual astigmatism on satisfaction was more evident at the 0.75–1.00 D level, where the odds of not being satisfied with vision increased by a factor of 2.0 and 1.5 in patients with monofocal and multifocal IOLs, respectively (p<0.0001). The orientation of astigmatism was not a significant predictor in multivariate analysis. n Conclusions: Multivariate analysis in a large population of patients demonstrated that low levels of residual astigmatism can degrade visual acuity. Corneal astigmatism of ≥0.50 D should be included in surgical planning. Contact Meirick: tmeirick@uw.edu Taravati: taravati@uw.edu

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