Heritage lecture highlights evolution of laser vision correction and cataract surgery

Cheryl Guttman Krader

Published: Sunday, October 4, 2020

Theo Seiler MD, PhD

The history, development and complex implications of laser vision correction (LVC) both before and after cataract surgery were all addressed in a fascinating 2020 ESCRS Heritage Lecture delivered by Theo Seiler MD, PhD. In his talk, Prof. Seiler discussed the overlap between LVC and cataract surgery and the difficulty of obtaining consistently predictable refractive outcomes now that the first-generation of LVC patients has reached cataract age. The early history of laser vision correction (LVC) was a far cry from the high-tech technological precision that refractive surgeons today take for granted, said Prof. Seiler. “The first PRK surgeries that I performed were quite rudimentary by modern standards. The eye tracking and the IOL centration were performed using only my hands and my eyes so you can imagine that safety suffered accordingly, “ he said. Turning to modern cataract surgery, Prof Seiler noted that while significant improvements have been achieved in IOL power calculations due to advances in optical biometry, there is still considerable inaccuracy when it comes to keratometry measurements for post-LVC eyes. “Studies have shown that despite better preoperative diagnostics that the chance of postoperative refractive surprise is still greater than 20%,” he said. To counteract this, Prof Seiler advises the routine use of a dedicated corneal tomography unit to determine keratometry in these cases. “It is also wise to select an IOL type that makes an eventual IOL exchange easier,” he said. In the final part of his lecture, Prof Seiler discussed the possible benefits of LVC to fine-tune the outcomes of cataract surgery. In his published series of 56 eyes of 42 patients who were dissatisfied after cataract surgery with implantation of a trifocal IOL, Prof Seiler said that selective wavefront-guided LASIK greatly improved the outcomes, with target refraction obtained in 98% of eyes and patient satisfaction greatly enhanced.