Accommodating IOL outcomes: Femtosecond laser or manual cataract removal

Take-home message: Patients with accommodating IOLs implanted using a femtosecond laser-assisted procedure or manual cataract removal had similar excellent visual outcomes.

Reviewed by Jeffrey Whitman, MD

Dallas-In the ever-expanding refractive arena, accommodating IOLs that correct both presbyopia and refractive errors are meeting patients’ high postoperative expectations by providing good vision for tasks at all distances.

Two IOLs, the Crystalens AO IOL, labeled as an accommodating IOL, and the Trulign Toric IOL (both from Bausch + Lomb), which corrects presbyopia, currently are the only such lenses that have been approved by the FDA for use in cataract surgery. While both IOLs correct presbyopia, the latter also corrects astigmatism. The Trulign IOL is not labeled as an accommodating IOL by the FDA.

The performances of the two IOLs were compared by Jeffrey Whitman, MD, in a prospective, non-randomized, two-arm study in which 100 patients received either the Crystalens AO or Trulign Toric IOL. The outcomes of the IOLs were compared based on use of a femtosecond laser platform (Victus, Bausch + Lomb) to create the primary incision and capsulotomy and for fragmentation of the nucleus or manual removal of the cataract. The patients were evaluated postoperatively at 1 week and 1 and 3 months.

The two patient groups were similar preoperatively The mean cataract grades in the femtosecond laser and manual groups were 2.2 and 2.1, respectively, and the mean patient ages were 64.7 and 61.8 years.

Refractive results

At the 3-month evaluation, Dr. Whitman, who is in private practice at the Key-Whitman Eye Center in Dallas, reported that the uncorrected distance visual acuity (UCDVA) was slightly better in the femtosecond laser group than in the manual group. The mean UCDVA levels were 20/28 and 20/30, respectively. In both groups, 28% of patients had 20/20 or better VA; 70% and 62%, respectively, had 20/30 or better; and 88% and 82% had 20/40 or better.

At the same time point, the mean uncorrected intermediate VA (UCIVA) levels were 20/18 and 20/17; 68% and 76% had 20/16 or better UCIVA; 82% and 92% had 20/20 or better; and 96% and 98% had 20/32 or better.

Finally, at the 3-month assessment, the mean uncorrected near VA (UCNVA) levels were 20/28 and 20/26; 26% and 24% had 20/20 or better UCNVA; 74% and 80% had 20/30 or better; and 94% and 96% had 20/40 or better.

Manifest refraction

The femtosecond laser group had slightly better manifest refraction spherical equivalent results compared with the manual group. Dr. Whitman reported that the respective percentages of patients who were within 0.5 D of the target were 64% and 60%, within 0.75 D 86% and 78%, and within 1 D 94% and 92%.

Based on these results, Dr. Whitman commented, “Both cohorts had an excellent combination of uncorrected distance, intermediate and near vision. There was no significant difference in the uncorrected vision between the femtosecond and manual cohorts at the 3-month evaluation. The femtosecond laser group had slightly better refractive accuracy. Additional analyses are under way to determine the time to visual stability of the UCVA and MRSE at 1 week versus 1 month.”

Jeffrey Whitman, MD

E: Jeffrey.Whitman@keywhitman.com

Dr. Whitman is a consultant for Bausch + Lomb.