Eyeworld

FALL 2024 | EYEWORLD | 49 R Reference 1. Wallerstein A, et al. Angle kappa influence on multifocal IOL outcomes. J Refract Surg. 2023;39:840–849. Relevant disclosures Wallerstein: None Gauvin: None Contact Wallerstein: awallerstein@lasikmd.com Gauvin: mgauvin@lasikmd.com outcomes by analyzing multiple variables simul- taneously, paving the way for even more per- sonalized and effective treatments," they said Further studies could include longer fol- low-up periods to assess the stability of MIOL centration and its long-term impact on visual quality. "Additionally, investigating other mea- sures of visual quality, such as contrast sensitiv- ity and higher order aberrations, could provide deeper insights. We're also interested in examin- ing patient-reported visual disturbances, such as halos and glare, in relation to angle kappa. This expanded research will help refine our under- standing and further improve surgical outcomes for patients." Dr. Wallerstein and Dr. Gauvin concluded by emphasizing that eyes with a large angle kappa should not be excluded from MIOL surgery, nor should angle kappa be used independently for determining MIOL candidacy. They also high- lighted the importance of large-scale, data-driv- en research in resolving clinical debates and advancing ophthalmic practice. "We hope that our findings will encourage surgeons to adopt a more comprehensive approach to MIOL candi- dacy and thoroughly analyze their outcomes, ensuring that decisions are based on robust evidence rather than isolated variables. Ulti- mately, our goal is to improve patient outcomes and satisfaction in laser vision correction and IOL surgery, fostering a better quality of life for those undergoing these procedures." preoperatively, with 72% having an RMS angle kappa 0.5 mm or greater and 12% greater than 1.00 mm. The analysis showed that angle kappa does not correlate to postoperative refractive accura- cy, vision, subjective satisfaction, or the likeli- hood of recommending the procedure to friends and relatives. The contribution of angle kappa to clinical outcomes in most eyes undergoing refractive lens exchange and cataract surgery was negligible in this large-scale study. "Eyes with a large angle kappa should not be excluded from MIOL surgery, nor should angle kappa be used as a sole determinant for MIOL candidacy," Dr. Wallerstein and Dr. Gauvin said. Some surgeons use the criterion of an angle kappa DD greater than 0.5 mm to exclude pa- tients from surgery. "Had we used those criteria, our analysis reveals that 67% of the eyes in the current study—who had excellent outcomes— would have been excluded from undergoing MIOL surgery, leaving only one-third of patients as candidates," they said. While the evidence is strong that angle kappa cannot be used as a single variable to de- termine MIOL candidacy, they emphasized that the study does not suggest that angle kappa is totally without significance in a comprehensive preoperative assessment. "Angle kappa should be considered along- side other factors such as axial length, corneal topography, corneal higher order aberrations and astigmatism, retinal health, pupil size, and the patient's specific visual needs and lifestyle. This multi-variable approach ensures more accurate surgical planning and better overall prediction of outcomes. While angle kappa alone does not show evidence as being a critical factor, it should continue to be measured and combined with other diagnostic data to optimize MIOL outcomes." Dr. Wallerstein and Dr. Gauvin plan to extend their research by exploring additional variables that might influence MIOL outcomes, such as preoperative pupil size, which appears to be more predictive than angle kappa in their preliminary assessment. "In addition, machine learning will undoubtedly enhance our ability to predict patient satisfaction and refractive " Eyes with a large angle kappa should not be excluded from MIOL surgery, nor should angle kappa be used as a sole determinant for MIOL candidacy." —Avi Wallerstein, MD, and Mathieu Gauvin, PhD

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