LASIK corrects residual error after multifocal IOL implantation

Wavefront-guided LASIK is safe and effective in correcting residual refractive error after diffractive multifocal IOL implantation, according to a study published in the March 2008 issue of the Journal of Refractive Surgery.

Bettina B. Jendritza, MD and co-workers of the FreeVis LASIK Zentrum, Klinikum Mannheim, Germany investigated the use of wavefront-guided LASIK after multifocal IOL implantation to correct residual ametropia and higher order aberrations.

In a prospective, non-randomized case series, wavefront-guided LASIK was performed in 27 eyes (19 patients) after multifocal IOL (Tecnis; AMO, ReSTOR; Alcon and ReZoom; AMO) implantation using the VISX STAR S4 IR excimer laser (AMO). Visual acuity (VA), manifest refraction, and wavefront error were examined pre- and three months postoperatively.

In the Tecnis group (n=20), changes before and after LASIK, respectively, were: sphere +1.06±0.77D to -0.03±0.28D; cylinder -1.13±0.73D to -0.14±0.25D; distance uncorrected VA (UCVA) 20/45±0.09 to 20/29±0.16; near UCVA 20/30±0.24 to 20/25±0.16; higher order aberrations (4 mm pupil) 0.14±0.05 µm to 0.18±0.03 µm. Distance and near best spectacle-corrected visual acuity (BSCVA) did not change.

In the ReSTOR group (n=4), changes before and after LASIK, respectively, were: sphere +0.75±0.56D to +0.13±0.22D; cylinder -1.50±0.47D to -0.13±0.22D; distance UCVA 20/40±0.07 to 20/26±0.07; near UCVA 20/44±0.05 to 20/25±0.00; higher order aberrations (4 mm pupil) 0.14±0.03 µm to 0.20±0.02 µm. Distance and near BSCVA did not change.

In the ReZoom group (n=3), changes before and after LASIK, respectively, were: sphere +0.08±1.20D to 0.00D; cylinder -0.83±0.12D to 0.00D; distance UCVA 20/40±0 to 20/25±0; near UCVA 20/60±0.09 to 20/150±0.18; higher order aberrations (4 mm pupil) 0.43±0.04 µm to 0.39±0.03 µm. Patients lost one line of distance BSCVA and two lines of near BSCVA.

The researchers concluded that wavefront-guided LASIK is safe and effective in patients implanted with diffractive multifocal IOLs to correct residual refractive error, but higher order aberrations do not improve. It is not recommended in patients implanted with refractive multifocal IOLs, because of the lack of reliability of current wavefront sensors in this setting.