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    High expectations in pseudophakes fueling expansion in laser vision correction base

    Demand for excellent uncorrected distance visual acuity after cataract surgery is increasing, especially with the availability of new presbyopia-correcting IOLs. This phenomenon is opening up a new class of patients to the benefits of laser vision correction, said Steven J. Dell, MD, at Refractive Surgery Subspecialty Day.

    "If cataract surgery is now being considered refractive surgery, then cataract surgery with implantation of a premium IOL is hyper-refractive surgery," said Dr. Dell, director, refractive and corneal surgery, Texan Eye, Austin, TX. "Recipients of these lenses are less tolerant of misses in our refractive target than their younger, laser vision correction counterparts. This is because a low hyperopic result in a young phakic patient may still result in 20/15 vision, but is totally unacceptable in a pseudophake.

    "If refractive errors occur in sphere and/or cylinder, there are a number of options for correcting them. However, laser vision correction is the most accurate," Dr. Dell said.

    When a decision is made to proceed with a laser vision enhancement, surgeons need to consider whether to perform a customized ablation or a conventional procedure.

    Dr. Dell suggested performing a wavefront-guided procedure in the eyes of patients who have received either a monofocal lens, accommodating lens (crystalens, eyeonics), apodized diffractive lens (AcrySof ReSTOR, Alcon Laboratories), or multifocal lens (Tecnis, Advanced Medical Optics), assuming the wavefront is capturable and the data make sense. However, he cautioned against a custom wavefront-guided enhancement in eyes in which the zonal refractive multifocal IOL (ReZoom, Advanced Medical Optics) is implanted.

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