Stephen J. Hannan

Visual outcomes and patient satisfaction in 9366 eyes using a refractive segmented multifocal intraocular lens

Purpose To report the effectiveness, patient satisfaction, and complication rate with a zonal refractive intraocular lens (IOL) in a high volume of patients. Setting Private clinic, London, United Kingdom. Design Case series. Methods Retrospective data of patients with binocular Lentis Mplus IOLs were analyzed. The main outcome measures were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity, manifest refraction, patient satisfaction, and complications. One‐month, 3‐month, and 6‐month data were analyzed. Results The study comprised 9366 eyes of 4683 patients. The mean spherical equivalent changed from +1.73 diopters (D) ± 3.37 (SD) preoperatively to −0.02 ± 0.60 D at 3 months and +0.03 ± 0.60 D at 6 months. Ninety‐five percent of patients achieved a binocular UDVA of 6/7.5 (0.1 logMAR) or better 3 months postoperatively. The mean binocular UNVA was 0.155 ± 0.144 logMAR and 0.159 ± 0.143 logMAR at 3 months and 6 months, respectively. Severe dysphotopsia requiring an IOL exchange occurred in 55 eyes. Patient satisfaction was high, with 97.5% of patients willing to recommend the procedure. Conclusions The zonal refractive IOL provided excellent distance and near visual acuity. The postoperative complication rate was clinically acceptable, and patient satisfaction high. Financial Disclosure Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No author has a financial or proprietary interest in any material or method mentioned.

The role of the mesopic pupil on patient-reported outcomes in young patients with myopia 1 month after wavefront-guided LASIK.

PURPOSE To determine the relationship between low-light pupil size and patient-reported outcomes 1 month after wavefront-guided LASIK in young patients with myopia. METHODS Retrospective case series of 10,944 eyes of 5,563 young patients with myopia who underwent wavefront-guided LASIK (6.0-mm optical zone). Preoperative pupil size was measured under low-light conditions with an infrared pupillometer. Visual and refractive outcomes were evaluated at 1 month postoperatively. A questionnaire was administered to assess patient-reported outcomes including satisfaction with the procedure, night driving, and glare and halo visual symptoms. RESULTS The average patient age was 29.8 years (range: 18 to 40 years). The mean preoperative manifest spherical equivalent of -3.49 diopters (D) (range: -0.50 to -11.75 D) was reduced to -0.04 ± 0.29 D at 1 month, with 94% of eyes achieving an uncorrected distance visual acuity of 20/20 or better. The mean low-light pupil diameter was 6.6 mm (range: 4 to 9 mm) and 1,514 patients (27.2%) had a diameter of 8 mm or larger. No correlation between pupil diameter and patient-reported outcomes was found (r range: -0.02 to 0.07). Logistic regression analysis identified postoperative uncorrected distance visual acuity and postoperative manifest refraction as significant predictors of night halo complaints after wavefront-guided LASIK (P < .01). CONCLUSIONS In this large series of young patients with myopia treated with wavefront-guided LASIK, low-light pupil diameter was not predictive of surgery satisfaction, ability to perform activities, or visual symptoms at 1 month postoperatively.

Visual outcomes and patient satisfaction with a rotational asymmetric refractive intraocular lens for emmetropic presbyopia

Purpose To evaluate the efficacy, safety, predictability, and patient satisfaction after refractive lens exchange with a zonal refractive intraocular lens (IOL) with an inferior reading addition in emmetropic patients. Setting Optical Express, London, United Kingdom. Design Retrospective case series. Methods Emmetropic presbyopic patients who had implantation of a Lentis Mplus LS‐313 MF30 IOL were evaluated. Inclusion criteria were sphere between −0.50 diopter (D) and +1.00 D with no more than 0.75 D of refractive cylinder and an uncorrected distance visual acuity (UDVA) of 6/6 or better in each eye. The main outcome measures were monocular and binocular UDVA, uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), and patient satisfaction. Three months data are presented. Results Four hundred forty eyes of 220 patients were evaluated. The mean monocular UDVA changed from −0.04 logMAR ± 0.06 (SD) preoperatively to −0.04 ± 0.11 logMAR postoperatively (P = .39). The mean CDVA was −0.10 ± 0.05 logMAR preoperatively and −0.09 ± 0.06 logMAR postoperatively (P = .06). At 3 months, 99.7% of eyes were within ±1.00 D of emmetropia. The mean UNVA was 0.13 ± 0.14 logMAR monocularly and 0.10 ± 0.12 logMAR binocularly. On the patient satisfaction questionnaire, 91.9% of patients said the refractive procedure improved their lives and 93.5% were willing to recommend it to friends and family. Three patients requested IOL exchange because of severe night‐vision phenomena or unsatisfactory quality of vision. Conclusion Refractive lens exchange with this zonal refractive IOL was safe in emmetropic presbyopic patients. Financial Disclosure Dr. Schallhorn is a consultant to Abbott Medical Optics. No other author has a financial or proprietary interest in any material or method mentioned.

Clinical outcomes of wavefront-guided laser in situ keratomileusis to treat moderate-to-high astigmatism.

Purpose The purpose of this study was to evaluate the refractive and visual outcomes of wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopic astigmatism and cylindrical component ≥2.0 diopter (D). Methods In this retrospective study, 611 eyes that underwent LASIK for simple or compound myopic astigmatism were analyzed. Preoperative refractive cylinder ranged from −2.00 D to −6.00 D (mean −2.76±0.81 D), and the sphere was between 0.00 D and −9.75 D (mean −2.79±2.32 D). Predictability, visual outcomes, and vector analysis of changes in refractive astigmatism were evaluated. Results At 3 months after LASIK, 83.8% of eyes had uncorrected distance visual acuity of 20/20 or better, 90.3% had manifest spherical equivalent within ±0.50 D, and 79.1% had residual refractive cylinder within ±0.50 D of intended correction. The mean correction ratio for refractive cylinder was 0.92±0.14, the mean error of angle was −0.45°±2.99°, and the mean error vector was 0.37±0.38 D. A statistically significant correlation was found between the error of magnitude (arithmetic difference in the magnitudes between surgically induced refractive correction and intended refractive correction) and the intended refractive correction (r=0.26, P<0.01). Conclusion Wavefront-guided LASIK for the correction of myopic astigmatism is safe, effective, and predictable.

Flap lift and photorefractive keratectomy enhancements after primary laser in situ keratomileusis using a wavefront-guided ablation profile: Refractive and visual outcomes.

Purpose To analyze results of wavefront‐guided laser vision correction retreatments performed either by lifting the original flap or by surface ablation over the flap. Setting Optical Express, Glasgow, United Kingdom. Design Retrospective case series. Methods This retrospective study included patients grouped according to whether they had flap lift enhancement or photorefractive keratectomy (PRK) performed over the LASIK flap. All retreatment procedures were performed with the Visx Star S4 IR excimer laser with wavefront‐guided ablation profile derived from the iDesign aberrometer. Visual acuities, refractive outcomes, vector analysis of refractive cylinder and complications were analyzed in this study. The results of the last available clinical visit are presented. Results This retrospective study included 290 eyes of 202 patients divided into 2 groups: 119 eyes that had flap lift enhancement (Group A), and 171 eyes in which photorefractive keratectomy (PRK) was performed over the LASIK flap (Group B). The mean follow‐up was 4.0 ± 1.9 months in Group A and 4.2 ± 1.6 in Group B. The mean postoperative manifest spherical equivalent was −0.01 ± 0.35 D and +0.06 ± 0.39 D in Groups A and B, respectively. The percentage of eyes with postenhancement UDVA 20/20 or better was 87.4% in Group A and 79.5 % in Group B (P = .09). In Group A, 22 eyes (18.5%) developed epithelial ingrowth, of which surgical intervention was required in 2 eyes (1.7%). Grade 1 or less haze was noted in 9 (5.3%) eyes in Group B, and resolved in all cases within the first 6 postoperative months. Conclusion Both retreatment techniques were considered to be effective, predictable, and safe. Financial Disclosure Steven C Schallhorn MD is a consultant to Abbott Medical Optics and Zeiss, and Global Medical Director for Optical Express. None of the other authors have a financial or proprietary interest in the products and materials presented in this paper.

Patient-reported outcomes 5 years after laser in situ keratomileusis.

Purpose To assess vision‐related, quality‐of‐life outcomes 5 years after laser in situ keratomileusis (LASIK) and determine factors predictive of patient satisfaction. Setting Optical Express, Glasgow, Scotland. Design Retrospective case series. Methods Data from patients who had attended a clinical examination 5 years after LASIK were analyzed. All treatments were performed using the Visx Star S4 IR excimer laser. Patient‐reported satisfaction, the effect of eyesight on various activities, visual phenomena, and ocular discomfort were evaluated 5 years postoperatively. Multivariate regression analysis was performed to determine factors affecting patient satisfaction. Results The study comprised 2530 patients (4937 eyes) who had LASIK. The mean age at the time of surgery was 42.4 years ± 12.5 (SD), and the preoperative manifest spherical equivalent ranged from −11.0 diopters (D) to +4.88 D. Five years postoperatively, 79.3% of eyes were within ±0.50 D of emmetropia and 77.7% of eyes achieved monocular uncorrected distance visual acuity (UDVA) and 90.6% of eyes achieved binocular UDVA of 20/20 or better. Of the patients, 91.0% said they were satisfied with their vision and 94.9% did not wear distance correction. Less than 2.0% of patients noticed visual phenomena, even with spectacle correction. Major predictors of patient satisfaction 5 years postoperatively were postoperative binocular UDVA (37.6% variance explained by regression model), visual phenomena (relative contribution of 15.0%), preoperative and postoperative sphere and their interactions (11.6%), and eyesight‐related difficulties with various activities such as night driving, outdoor activities, and reading (10.2%). Conclusion Patient‐reported quality‐of‐life and satisfaction rates remained high 5 years after LASIK. Uncorrected vision was the strongest predictor of satisfaction. Financial Disclosure Dr. S.C. Schallhorn is a consultant to Abbott Medical Optics, Inc., Zeiss Meditec AG, and Autofocus Inc. and a global medical director for Optical Express. No other author has a financial or proprietary interest in any material or method mentioned.

Wavefront-Guided Photorefractive Keratectomy with the Use of a New Hartmann-Shack Aberrometer in Patients with Myopia and Compound Myopic Astigmatism

Purpose. To assess refractive and visual outcomes and patient satisfaction of wavefront-guided photorefractive keratectomy (PRK) in eyes with myopia and compound myopic astigmatism, with the ablation profile derived from a new Hartmann-Shack aberrometer. Methods. In this retrospective study, 662 eyes that underwent wavefront-guided PRK with a treatment profile derived from a new generation Hartmann-Shack aberrometer (iDesign aberrometer, Abbott Medical Optics, Inc., Santa Ana, CA) were analyzed. The preoperative manifest sphere ranged from −0.25 to −10.75 D, and preoperative manifest cylinder was between 0.00 and −5.25 D. Refractive and visual outcomes, vector analysis of the change in refractive cylinder, and patient satisfaction were evaluated. Results. At 3 months, 91.1% of eyes had manifest spherical equivalent within 0.50 D. The percentage of eyes achieving uncorrected distance visual acuity 20/20 or better was 89.4% monocularly and 96.5% binocularly. The mean correction ratio of refractive cylinder was 1.02 ± 0.43, and the mean error of angle was 0.00 ± 14.86° at 3 months postoperatively. Self-reported scores for optical side effects, such as starburst, glare, halo, ghosting, and double vision, were low. Conclusion. The use of a new Hartmann-Shack aberrometer for wavefront-guided photorefractive keratectomy resulted in high predictability, efficacy, and patient satisfaction.

Outcomes of wavefront-guided laser in situ keratomileusis using a new-generation Hartmann-Shack aberrometer in patients with high myopia

Purpose To evaluate refractive and visual outcomes of wavefront‐guided laser in situ keratomileusis (LASIK) to correct high myopia using a new Hartmann‐Shack aberrometer. Setting Optical Express, Glasgow, United Kingdom. Design Retrospective noncomparative case series. Methods Data of eyes that had wavefront‐guided LASIK for high myopia and myopic astigmatism (spherical equivalent [SE] between −6.00 diopters [D] and −10.25 D, up to 5.00 D of cylinder) were analyzed. The treatment profile was derived from a new‐generation Hartmann‐Shack aberrometer (iDesign Advanced Wavescan). Visual acuities, refractive outcomes, vector analysis of refractive cylinder, and patient satisfaction were assessed. Three‐months data are presented. Results Data were obtained for 621 eyes. The mean manifest SE reduced from −7.28 D ± 1.05 (SD) (range −10.25 to −6.00 D) preoperatively to −0.09 ± 0.44 D (range −2.13 to +1.38 D) at 3 months. The mean manifest cylinder changed from −1.02 ± 0.82 D (range −5.00 to 0.00 D) to −0.27 ± 0.33 D (range −1.75 to 0.00 D) postoperatively. The percentage of eyes achieving an uncorrected distance visual acuity 20/20 or better was 82.4% monocularly and 92.5% binocularly. The mean correction ratio of refractive cylinder was 1.02 ± 0.48, and the mean error of angle was −0.29 ± 14.56 degrees. A postoperative questionnaire revealed high satisfaction with the outcomes of the procedure, with low scores for night‐vision phenomena. Conclusion The results in this study were promising in terms of safety, efficacy, and predictability in eyes with high degrees of myopia. Financial Disclosure Dr. Schallhorn is a consultant to Abbott Medical Optics, Inc. No other author has a financial or proprietary interest in any material or method mentioned.

Outcomes and complications of excimer laser surgery in patients with collagen vascular and other immune-mediated inflammatory diseases

Purpose To assess refractive and visual outcomes and postoperative complications in a large number of patients with well‐controlled collagen vascular and other immune‐mediated inflammatory diseases. Setting Optical Express, Glasgow, United Kingdom. Design Retrospective case series. Methods The files were reviewed of patients who had collagen vascular and other immune‐mediated inflammatory diseases and who had excimer laser surgery between 2008 and 2015. In all cases, the disease was well controlled with no flare or symptoms for a minimum of 6 months preoperatively. Results The study comprised 622 patients (1224 eyes) with 1 of the following underlying diseases: rheumatoid arthritis (50.6% of patients), systemic lupus erythematosus (19.5%), psoriatic arthritis (10.5%), sarcoidosis (10.0%), ankylosing spondylitis (6.4%), multiple sclerosis (1.9%), or scleroderma (1.1%). Laser in situ keratomileusis (LASIK) was performed in 1114 eyes (91.0%) and photorefractive keratectomy (PRK) in 110 eyes (9.0%). The mean follow‐up was 10.9 months. The preoperative spherical equivalent ranged between −10.13 diopters (D) and +4.13 D (LASIK) and −9.50 D and +4.00 D (PRK). Postoperatively, 81.8% LASIK eyes and 82.3% PRK eyes were within ±0.50 D. The uncorrected distance visual acuity was 20/20 or better in 76.8% and 73.4%, respectively. Complications were mostly those that would be expected after excimer laser surgery in a population of patients without disease with the exception of 1 peripheral flap melt that responded to treatment with topical steroids. Conclusion Excimer laser surgery can be safely performed in patients with well‐controlled collagen vascular or other immune‐mediated inflammatory disease. Financial Disclosure Dr. S.C. Schallhorn is a consultant to Abbott Medical Optics, Inc., Acufocus, Inc., and Carl Zeiss Meditec AG, and a global medical director for Optical Express. No other author has a financial or proprietary interest in any material or method mentioned.

Outcomes of excimer laser enhancements in pseudophakic patients with multifocal intraocular lens

Purpose The aim of this study was to assess visual and refractive outcomes of laser vision correction (LVC) to correct residual refraction after multifocal intraocular lens (IOL) implantation. Patients and methods In this retrospective study, 782 eyes that underwent LVC to correct unintended ametropia after multifocal IOL implantation were evaluated. Of all multifocal lenses implanted during primary procedure, 98.7% were refractive and 1.3% had a diffractive design. All eyes were treated with VISX STAR S4 IR excimer laser using a convectional ablation profile. Refractive outcomes, visual acuities, patient satisfaction, and quality of life were evaluated at the last available visit. Results The mean time between enhancement and last visit was 6.3±4.4 months. Manifest spherical equivalent changed from −0.02±0.83 D (−3.38 D to +2.25 D) pre-enhancement to 0.00±0.34 D (−1.38 D to +1.25 D) post-enhancement. At the last follow-up, the percentage of eyes within 0.50 D and 1.00 D of emmetropia was 90.4% and 99.5%, respectively. Of all eyes, 74.9% achieved monocular uncorrected distance visual acuity 20/20 or better. The mean corrected distance visual acuity remained the same before (−0.04±0.06 logMAR [logarithm of the minimum angle of resolution]) and after LVC procedure (−0.04±0.07 logMAR; P=0.70). There was a slight improvement in visual phenomena (starburst, halo, glare, ghosting/double vision) following the enhancement. No sight-threatening complications related to LVC occurred in this study. Conclusion LVC in pseudophakic patients with multifocal IOL was safe, effective, and predictable in a large cohort of patients.