Eyeworld

52 | EYEWORLD | FALL 2024 R EFRACTIVE comprehensive evaluation of total eye HOAs, offering both quantitative data and visual sim- ulations for patient education. In our practice, we use a newer aberrometry device called the Osiris [CSO], which integrates with tomograph- ic data from the MS-39 anterior segment OCT to provide a more comprehensive assessment of an eye." Dr. Armstrong said that while there is no data-driven link between a person's personality and their subjective perception of HOAs, the stereotypical "type A" personality is generally more likely to be bothered by visual quality issues related to HOAs. "It is important for the ophthalmologist to identify patients who prioritize visual quali- ty over spectacle independence as we decide upon an IOL to implant," he said. "Each sur- geon should develop a way to tease out that information, either by way of questionnaire or during face-to-face consultation. If you suspect the patient to be 'type A,' you should plan to do your best to address preexisting HOAs and possibly avoid presbyopia-correcting diffractive IOL implantation." HOAs informing IOL selection Dr. Armstrong said he'll tailor his IOL selection to the patient's corneal HOAs, avoiding presby- opia-correcting IOLs that use diffractive optics if the abnormal HOAs cannot be addressed preoperatively. "Monofocal IOLs are a safer option be- cause they are less affected by HOAs," he said. "Pinhole IOLs can partially neutralize the visual impact of corneal HOAs. … Normal spherical aberration of the cornea is about 0.3 μm for a 6-mm pupil size, thus most common IOLs have a negative spherical aberration of about –0.2 μm (matching that of the natural crystalline lens). However, in patients with abnormal levels of spherical aberration (>±0.5 μm), we should consider picking an IOL that shifts the spherical aberration of the eye closer to zero. We have an array of IOLs, some of which have negative, neutral, and positive spherical aberration, and we should do our best to utilize the right IOL to achieve the best possible visual outcome." Dr. Rocha offered a similar perspective, discussing the different enhanced monofocal IOL options that offer customization for patients with HOAs. "You can even customize with the new generation of monofocal IOLs or enhanced monofocal IOLs; we have a lot of options. Some are aberration-free. Some come with positive or negative spherical aberration. I think the rule is you should not end up with more than 0.4 μm of spherical aberration after implanting that IOL," she said. Dr. Gatinel said to focus on corneal aberra- tions in this case because any preop aberrations continued from page 50 65-year-old male with EBMD and nuclear sclerosis; corneal and internal aberrations should be addressed; the patient underwent superficial keratectomy followed by lens surgery 3 months later Source: Karolinne Rocha, MD, PhD 51-year-old female, hyperopic, complaining of decreased vision and glare; topography and ray tracing showed that internal aberrations were worse than corneal aberrations Source: Karolinne Rocha, MD, PhD

• Cover