Combination of technology maximizes cataract outcomes

Take-Home

Cataract surgery performed with intraoperative wavefront aberrometry while implanting a new aspheric hydrophobic acrylic IOL maximizes visual acuity and quality-of-vision results.

By Cheryl Guttman Krader; Reviewed by Dee Stephenson, MD

San Francisco, CA-Implantation of a new aspheric hydrophobic acrylic IOL (enVista, Bausch + Lomb) with intraoperative wavefront aberrometry (ORA System, WaveTec Vision) to guide IOL power selection is a reliable approach for delivering refractive and visual outcomes in cataract surgery, said Dee Stephenson, MD.

“LASIK-like results” were achieved in her first 50 recipients of the lens who were operated on utilizing intraoperative wavefront aberrometry to confirm the IOL power, said Dr. Stephenson, associate professor of ophthalmology, University of South Florida, Tampa, and in private practice, Venice, FL.

Distance uncorrected visual acuity was 20/30, or better in 92% of eyes, and 20/25, or better in 76% of eyes.

All eyes achieved 20/20 or better best-corrected visual acuity and had an SE within 0.5 D of target, while 72% of eyes were ±0.25 D of the target refraction. Mean absolute prediction error was 0.17±0.12 D.

The power implanted matched that chosen preoperatively based on A-scan measurement in only 12% of eyes, while the intraoperative wavefront aberrometer measurement confirmed the preoperative selection in 34% of eyes and influenced the choice in 54%.

“With its aspheric, aberration-free optic and optically clear, glistening-free material, this new IOL provides great quality of vision,” Dr. Stephenson said.

“I was able to get great refractive results from the start by using the intraoperative aberrometer to guide power selection,” she said. “Combining these technologies, I know I can deliver the best vision results possible and meet the high expectations of today’s cataract surgery patient population.”

Benefits of approach

The proprietary glistening-free material of the new acrylic IOL was a major attraction that led her to its use, Dr. Stephenson said.

The acrylic copolymer is highly crosslinked and prehydrated to an equilibrium water content of 4% so that there is no egress of water into the lens while it remains on the shelf.

“We know that glistenings can affect quality of vision, and if all factors are equal otherwise, I would prefer a lens without glistenings,” Dr. Stephenson said.

The large, 6-mm aberration-free aspheric optic also improves contrast sensitivity and minimizes dysphotopsias, even in the presence of mild decentration or tilt.

With its continuous 360° square posterior edge and haptics that vault the optic posteriorly, the lens is well designed to minimize the development of posterior capsule opacification.

The IOL also remains pristine in the eye because the acrylic material is durable and resists surface damage that can be induced during folding and implantation.

Implantation is performed using a new inserter system that allows placement through a 2.2-mm incision with a wound-assisted technique.

“I perform coaxial microincisional surgery through a 1.8-mm incision, and after enlarging the incision to 2.2-mm for IOL implantation, I still maintain the benefit of minimal surgically induced astigmatism,” Dr. Stephenson said.

The new inserter also allows implantation with minimal manipulation of the lens inside the eye.

Once inserted, the lens unfolds smoothly and gently, thus allowing easy rotation into position and removal of all viscoelastic from behind and in front of the lens.

Maximizing success

Dr. Stephenson said she began using intraoperative wavefront aberrometry to guide IOL power implantation more than 4 years ago and is now using it in almost all of her cases.

Checking the aphakic refraction with the intraoperative aberrometer has allowed Dr. Stephenson to achieve reproducibly good refractive results, even when making modifications to her standard surgical technique.

“Intraoperative wavefront aberrometry has been an invaluable adjunct that allows me to consistently achieve my refractive target and happy patients,” she said. “It adds just 30 seconds to the surgical time and has improved by outcomes by at least 20% to 25%, thereby also reducing the need for IOL exchange or enhancement surgery.”

Dee Stephenson, MD

E: eyedrdee@aol.com

Dr. Stephenson is on the dpeakers’ bureau for Bausch + Lomb and is a member of the WaveTec Vision surgical advisory board.

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