Better IOL outcomes

‘My surgeon had to do two surgeries to get it right,’ is not something you want your patients to think after they’ve undergone a second procedure to correct residual refractive error, said Robert Cionni MD, Salt Lake City, USA, in a presentation on the Optiwave Refractive Analysis (ORA) System® from Alcon.

Speaking to delegates at the XXXIII Congress of the ESCRS in Barcelona, Spain, Dr Cionni discussed the high expectations that now frequently accompany cataract surgery outcomes, the challenges to obtaining good refractive results, and what can be done to improve them.

His answer is intraoperative aberrometry, which he says can be used to improve refractive outcomes in a variety of refractive cataract cases including monofocal, multifocal and toric intraocular lenses (IOLs) as well as post-corneal refractive surgery cases.

“Not getting it right the first time leads to extra post-op chair time, as well as time and expense to enhance the outcome. And even if an enhancement improves the results, the patients might start losing faith in you since you didn’t get it right the first time,” he said.

The ORA System provides intraoperative guidance to determine cylinder power and axis based on aphakic refraction, not corneal K-values. After the toric lens has been placed, intraoperative pseudophakic refraction can help guide the refining of the lens orientation during the procedure. Lastly, the ORA System provides guidance for the placement of arcuate incisions and limbal relaxing incisions.

Dr Cionni reviewed the results extracted from AnalyzOR, the ORA database, as well as the results of a prospective, randomised, contralateral design toric IOL study.

INTENDED TARGET

“In a large study of more than 2,500 eyes, the mean absolute value of the prediction error (MAVPE) using the ORA System was better, at 0.28D +/- 0.23D, than with pre-op data alone, which resulted in a MAPVE of 0.33D +/- 0.28D. The ORA System led to a final refraction within 0.5D of the intended target in 85 per cent of eyes, as opposed to 78 per cent using only pre-op data.”

The difference was even more pronounced when comparing results in post myopic LASIK eyes. Here, using ORA led to results within 0.5D in 67 per cent, compared to 46-50 per cent using conventional preoperative methods, said Dr Cionni.

“My own personal results in post myopic LASIK eyes show a 75 per cent success rate (within 0.5D) using the ORA and a 66 per cent rate using pre-op data,” he added.

“We’re getting better and better at hitting the refractive target, and intraoperative aberrometry represents a means to refine the process,” concluded Dr Cionni.

Robert Cionni: rcionni@theeyeinstitute.com