Cataract Extraction with Pseudoaccommodating Intraocular Lens in Patients with Previous Radial Keratotomy

1. Cataract Extraction with Pseudoaccommodating Intraocular Lens in Patients with Previous Radial Keratotomy Ross Bloomberg, MD Niraj Shah, BS William Martin, MD University of Toledo Health Science Campus Ross Bloomberg, MD has no financial interest to disclose. Niraj Shah has no financial interest to disclose. William Martin, MD is a consultant to Alcon and AMO.

2. Background • An increasing number of radial keratectomy (RK) patients are reaching an age where cataracts are becoming visually significant • Many previous RK patients desire spectacle independence • RK induces a multifocal cornea and other higher order aberrations1-3, so prior RK patients are poor candidates for multifocal intraocular lenses • RK patients may tolerate pseudoaccommodating intraocular lenses

3. Purpose • To report the safety, efficacy, and patient satisfaction of phacoemulsification with implantation of a pseudoaccommodating intraocular lens in patients with prior radial keratotomy

4. Methods • A retrospective chart review was performed on 15 eyes of 8 patients with previous RK undergoing cataract extraction using phacoemulsification • All procedures were performed by a single surgeon (WGM) through a scleral tunnel incision with implantation of a pseudoaccommodating intraocular lens (Crystalens AT-50SE, Eyeonics, Aliso Viejo, California, USA)

5. Methods • Distance, intermediate, and near visual acuity were measured at 1 day, 1 week, 1 month, and 3 months. Residual refractive error was measured at 1 month and 3 months. • Patients were asked to complete follow up satisfaction surveys. Subjective complaints at follow up visits were noted.

6. Results • Uncorrected vision 14/15 (93.3%) of eyes had distance VA >20/40 • Uncorrected vision 12/15 (80%) of eyes had intermediate VA >20/40 • Uncorrected vision 12/15 (80%) of eyes had near VA J3 or better • 1 eye had VA of 20/80 at 1 month post op with manifest refraction of +2.75 -0.50 x 90. After subsequent sulcus placed piggyback IOL, 3 month post op from piggyback DVA was 20/20, IVA was 20/20, and NVA was J3.

7. Visual Results

8. Results

9. Results – Spectacle Dependence • Percentage of time wearing spectacles • Patient 1 – 0% • Patient 2 – did not reply • Patient 3 – 0% • Patient 4 – 10% • Patient 5 – 10% • Patient 6 – did not reply • Patient 7 – 30% • Patient 8 – 0%

10. Results • 5/5 (100%) of patients stated they would make the same choice for their eyes again • One patient who completed the survey did not answer this question • 3/6 (50%) of patients rated glare symptoms as >3/10 • 2/6 (33%) of patients rated halo symptoms as >3/10 • 1 patient complained of monocular diplopia at distance • 1 patient noted blurred vision in the morning that improved through the day • 2/8 patients did not complete the survey • one patient could not be reached • one patient refused survey stating they were unhappy with the experience, but did not elaborate

11. Conclusions • Pseudoaccommodating IOLs can be well tolerated in post-RK patients • Pseudoaccommodating IOLs can allow for spectacle independence in post RK patients • Multifocal cornea may contribute to spectacle independence1-3 • Post op complaints were consistent with prior RK (glare, halos, monocular diplopia, diurnal fluctuation, error in IOL calculation)4-11 • Glare • 14/16 eyes in this study had glare 20/70 or worse preop (BAT or MCT) • Post op significant glare complaints are comparable to those in PERK study • 225/425 (52.9%) patients in the Prospective Evaluation of Radial Keratotomy (PERK) study reported glare with bright lights4

12. References • 1. Moreira H, Fasano AP, Garbus JJ, Lee M, McDonnell PJ. Corneal topographic changes over time after radial keratotomy. Cornea. 1992 Sep;11(5):465-70. • 2. Maguire LJ, Bourne WM. A multifocal lens effect as a complication of radial keratotomy. Refract Corneal Surg. 1989 Nov-Dec;5(6):394-9. • 3. McDonnell PJ, Garbus J, Lopez PF. Topographic analysis and visual acuity after radial keratotomy. Am J Ophthalmol. 1988 Dec 15;106(6):692-5. • 4. Cartwright CS, Bourque LB, Lynn M, Waring GO III, the PERK Study Group. Relationship of glare to uncorrected visual acuity and cycloplegic refraction 1 year after radial keratotomy in the Prospective Evaluation of Radial Keratotomy (PERK) Study. J Am Optom Assoc. 1988;59:36-39. • 5. Ghaith AA, Daniel J, Stulting RD, Thompson KP, Lynn M. Contrast Sensitivity and Glare Disability After Radial Keratotomy and Photorefractive Keratectomy. Arch Ophthalmol. 1998;116:12-18. • 6. Bourque LB, Cosand BB, Drews C, Waring GO 3rd, Lynn M, Cartwright C. Reported satisfaction, fluctuation of vision, and glare among patients one year after surgery in the Prospective Evaluation of Radial Keratotomy (PERK) Study. Arch Ophthalmol. 1986 Mar;104(3):356-63. • 7. Wyzinski P, O'Dell L. Subjective and objective findings after radial keratotomy. Ophthalmology. 1989 Nov;96(11):1608-11. • 8. Gimbel H, Sun R, Kaye GB. Refractive error in cataract surgery after previous refractive surgery. J Cataract Refract Surg. 2000 Jan;26(1):142-4. • 9. Grimmet MR, Holland EJ. Complications of small clear zone radial keratotomy. Ophthalmology. 1996 Sep;103(9):1348-56. • 10. Chen L, Mannis MJ, Salz JJ, Garcia-Ferrer FJ, Ge J. Analysis of intraocular lens power calculation in post-radial keratotomy eyes. J Cataract Refract Surg. 2003 Jan;29(1):65-70. • 11. Kemp JR, Martinez CE, Klyce SD, Coorpender SJ, McDonald MB, Lucci L, Lynn MJ, Waring GO 3rd. Diurnal fluctuations in corneal topography 10 years after radial keratotomy in the Prospective Evaluation of Radial Keratotomy Study. J Cataract Refract Surg. 1999 Jul;25(7):904-10.