ESCRS - POCAT527 - Aberration‑Guided, Topography‑Integrated Iol Selection After Myopic And Hyperopic Lvc: A Retrospective Algorithm‑Based Approach

Aberration‑Guided, Topography‑Integrated Iol Selection After Myopic And Hyperopic Lvc: A Retrospective Algorithm‑Based Approach

Published 2026 - 44th Congress of the ESCRS

Reference: POCAT527 | Type: Free paper | DOI: 10.82333/s23f-qg53

Authors: Dr Pedro Arede* 1 , Gonçalo Pina 2 , Maria Vivas 3 , Tomás Reis da Costa 3 , Bruno Pombo 3 , José Charreu 3 , João Conniot 3 , Diana Silva 4

1Clínica Privada de Oftalmologia CPO,Lisboa,Portugal;Hospital da Luz,Lisboa,Portugal;Hospital Fernando da Fonseca,Amadora,Portugal, 2Clínica Privada de Oftalmologia CPO,Lisboa,Portugal, 3Hospital Fernando da Fonseca,Lisboa,Portugal, 4Hospital Fernando da Fonseca,Amadora,Portugal;Hospital da Luz,Lisboa,Portugal

Purpose

To evaluate the safety, efficacy, and visual outcomes of an individualized IOL‑selection algorithm for eyes with prior myopic or hyperopic LVC. The algorithm integrates topography‑based criteria (centration, optical zone diameter, and corneal regularity) with 4‑mm and 6‑mm aberrometry. Spherical aberration (SA) is analyzed to guide the choice of IOLs that either compensate or deliberately utilize laser‑induced SA to optimize depth of focus and reduce dependence on spectacles.

Setting

Pivate clinic and public hospital.

Methods

Retrospective study of post‑LVC eyes undergoing cataract surgery or lens exchange by a single surgeon (2022–2025). The stepwise algorithm included:

  1. Topographic evaluation of centration, optical zone size, and irregularity;
  2. Assessment of corneal HOAs at 4 mm and 6 mm;
  3. Classification of SA as negative, neutral, or positive;
  4. IOL selection based on SA profile, using compensatory designs or leveraging intrinsic SA to increase depth of focus.
    Outcomes included refractive accuracy, visual acuity, and functional spectacle independence.

Results

The algorithm produced high refractive predictability and strong safety indices. Most eyes achieved functional spectacle independence across distance, intermediate, and near. In cases with acceptable HOAs, multifocal or EDOF designs were successfully used; in others, the intrinsic spherical aberration was harnessed to extend depth of focus without compromising visual quality. Overall postoperative vision remained stable and high despite prior corneal ablation.

Conclusions

A structured aberration‑guided algorithm is a safe and effective strategy for IOL selection in post‑LVC patients. Incorporating 4‑mm aberrometry and individualized spherical aberration analysis supports personalized lens choice, enabling high levels of spectacle independence while maintaining excellent refractive accuracy and visual quality. This approach may help standardize decision‑making in a complex and increasingly common patient population.