Defining Corneal Selection Criteria For Optimal Outcomes With A Spiral Intraocular Lens

To identify preoperative corneal parameters associated with visual performance following implantation of a spiral intraocular lens (Galaxy RayOne, Rayner) to refine patient selection.

Single center real-world study conducted at Guatemala City, in patients undergoing cataract surgery with implantation of presbyopia-correcting spiral intraocular lenses. Procedures were performed by a single surgeon using the phacoemulsification technique. No intraoperative or postoperative complications were reported. A single optometrist assessed visual acuity one month and six months after surgery. 

Forty eyes undergoing cataract surgery with spiral IOL implantation were retrospectively analyzed. Preoperative corneal parameters (total HOAs (tHOA), coma, trefoil, spherical aberration, angle kappa/alpha, pupil size; 4-mm zone) were assessed using Scheimpflug tomography. Monocular UDVA (4 m), UIVA (66 cm), and UNVA (40 cm) were measured at 6 months using ETDRS charts. Sphere (SPH) and the cylinder (CYL) spherical equivalent (SE) were measured before and after.Correlations between corneal metrics and visual acuity (VA) outcomes were evaluated using Pearson’s r, Spearman’s rho and multivariate regression.

At 6 months, mean monocular VA were: UDVA 0.05 ±0.06 logMAR, UIVA and UNVA were 0.04 ±0.06 logMAR and -0.007 ±0.07 logMAR, respectively. Post SPH and CYL (SE): 0.37 ±0.25D and 0.36 ±0.25D respectively. Mean UVA was 0.15 logMAR across all distances. Mean tHOAs were 0.20 ±0.08µm. Eyes with tHOAs <0.2µm and Kappa/Alpha <0.4mm showed UDVA 0.038±0.07 logMAR and 75% of eyes achieving ≤0.00 logMAR. Eyes with tHOAs ≥0.5 µm and Kappa/Alpha ≥0.5 mm showed UDVA 0.08 ±0.07 logMAR and 42% of eyes achieving ≤0.00 logMAR. tHOAs and Kappa/alpha angle correlated with UDVA (r = 0.54 and r = 0.51, respectively, P<0.05), while no significant associations were observed for intermediate or near acuity. Coma/Trefoil didn't have a significant association with VA.

The spiral IOL demonstrated stable visual performance across the spectrum of corneal characteristics represented in this cohort. Although total HOAs and angle kappa/alpha showed associations with distance visual acuity, overall visual outcomes remained consistently favorable across the corneal profiles evaluated, suggesting that typical variations in corneal characteristics do not meaningfully compromise clinical outcomes.