Eyeworld

by John Vukich, MD Laser vision correction today: Expectations beyond 20/20 W ith the introduction of femtosecond lasers for cataract surgery and the newer tech- nology IOLs, cataract surgery has become a refractive sur- gical procedure. Our patients judge the quality of their surgery by their postop refractive error. Laser vision correction (LVC) is emerging as a technique with two distinct, unique patient groups: our traditional virgin eyes that need myopic or hyperopic correction, and now cataract pa- tients who want a touch-up to meet their vision goals/expectations. LVC can optimize outcomes by minimizing postop cylinder. What is the effect of residual cylinder on our premium lens patients? The 2014 ASCRS Clinical Survey found most respondents believe 0.63 D of residual cylinder is visually signif- icant, but levels lower than that are acceptable. 1 Data from Optical Express is emerging that shows we may need to be more diligent than we have been about residual cylin- der and lower levels of astigmatism. Data was presented at the 2014 Combined Ophthalmic Symposium on 4,970 consecutive refractive lens exchange eyes (2,485 patients) who had bilateral procedures (with a week in between surgeries). All patients received multifocal IOLs, and all underwent surgery between June 2010 and December 2012 at Optical Express sites throughout Europe. Because of the large num- bers, almost every typical endpoint resulted in statistical significance, but we must discern what is then clinically relevant. Baseline demographic data was to be expected: mean age was 57.7±7.5 years, 52% were female, 16% were myopic, and the average preop refractive error was –3.89 ±2.97 D for myopes and +2.36±1.68 D for hyperopes. Average preop cylinder was –0.61±0.59 D. Patient questionnaires distrib- uted at 1 month postop determined 94.1% of patients were either satisfied or very satisfied with their outcomes. While those numbers are en- couraging, what is disheartening is the 4% who are neutral about their procedure—after spending addition- al money to undergo the surgery. And 1.6% is dissatisfied. Almost 1 of every 18 patients is unhappy, and that's an issue. It may be our limiting factor to further market penetration with multifocal lenses. Three tipping points in refractive cataract surgery John Vukich, MD Dr. Vukich is a partner at the Davis Duehr Dean Center for Refractive Surgery, Madison, Wis. He can be contacted at javukich@facstaff.wisc.edu. Figure 2. Postop cylinder and correlation to percentage of neutral or dissatisfied patients Source: Steve Schallhorn, MD, presented at ASCRS 2013, courtesy of Optical Express Figure 1. Postop cylinder and percentage of patients with 20/20 uncorrected distance visual acuity

• Cover