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Session Title: IOL Technology
Session Date/Time: Sunday 06/10/2013 | 16:30-18:30
Paper Time: 16:48
Venue: Auditorium (First Floor)
First Author: : H.Usmani UK
Co Author(s): : J. Huxtable I. Rahman
To report the visual and refractive outcomes following routine cataract and clear lens surgery with the use of light-adjustable intraocular lens (Calhoun Vision Inc, Pasadena, USA) implants to achieve spectacle independence through monovision.
Spire Fylde Coast Hospital, Blackpool, United Kingdom
Retrospective data retrieval was undertaken for all patients who underwent cataract and refractive lens exchange opting for monovision as their preferred method of presbyopic correction, from July 2010 to September 2012. Preoperative BCVA for near and distance vision and refractive error (spherical equivalence, SE) were compared to the postoperative outcomes. Ocular dominance was documented using the Miles test. All patients underwent uncomplicated standard phacoemulsification with UV protection for upto 14 days post implantation of the Light Adjustable Lens (LAL). Where possible the dominant eye was implanted first, aiming for emmetropia. The non-dominanteye was implanted approximately 1 month later for near with a refractive target of -1.25D.Refraction was undertaken at eachadjustment visitand adjustments continued (maximum of three times) until customisation of near vision by individual patients was achieved. Lock-in 1 and lock-in 2 were performed once the desired distance and near target was accomplished.
Of 22 patients, 36 eyes had undergone LAL implantation for monovision. The mean age was 55.2 years (range: 39-75) and preoperative spectacle SE ranged from-16.00 to +6.50. The mean follow up was 6 months. The non-dominant eye was implanted in 14 eyes and dominant eye in 22 eyes. Of the 8 patients who underwent surgery to one eye only, four each on the dominant and the non-dominant eye. A mean of -1.30D SE (range: -1.25 to -1.50) was targeted in the non-dominant eye and plano in the dominant eye. The mean refraction in the dominant eye was +0.19D (SE) correlating to a mean uncorrected Snellen visual acuity of 6/6 (range: 6/5-6/9).The mean refraction post-adjustment of -1.16D in the non-dominant eye correlated to a mean near vision of N6 (range:N5-N10), with mean uncorrected distance vision of 6/10 (range: 6/6-6/24). Overall, 91.7% were within +/-0.50D and 75.0% were within +/- 0.25D of the desired refractive target. Binocular near vision of N8 or better was achieved in 90.9% and N6 in 86.4% patients with binocular distance vision of 6/6 or better in 68.2% patients. 86.4% achieved both uncorrected binocular 6/9 distance vision and near vision of N6 or better.
The light adjustable lens (LAL) implant offers a unique technology to allow customised and changeable postoperative refractions. The LAL is therefore gaining popularity with cataract and refractive surgeons as it offers the possibility of non-invasively addressing postoperative errors of refraction and offers the ability to use the implanted refractive outcome as a guide to how presbyopic correction is suited to the individuals needs. The reassurance of this technique allows fine tuning of the near vision solution to cater for an individual’s requirements for near and potentially intermediatevision as each patient potentially has bespoke reading distances. The added advantage of predictable outcomes (published elsewhere) with adjustability of upto 3 dioptres of hypermetropia, myopia and astigmatism, of the desired refractive change offer monovision as a solution to a wider range of patients than most other lens solutions. Our results demonstrate that with careful planning, LAL can be used with high success rate of 86.4% in achieving N6 or better with 6/9 distance vision, in a multitude of preoperative refractive errors, to achieve customised and predictable spectacle independence through monovision. This is in the absence of haloes, glares, night vision difficulties and ghosting prominent with multifocal lenses but not apparent in monofocal lens surgery.
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