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Jason E. Stahl, MD Overland Park, KS

Comparing Refractive Outcomes and Enhancement Rates for Silicone Hinged Accommodating IOLs and Monofocal IOLs in RLE. Jason E. Stahl, MD Overland Park, KS. Consultant: Alcon, Bausch & Lomb, Abbott Medical Optics, TrueVision. Purpose.

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Jason E. Stahl, MD Overland Park, KS

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  1. Comparing Refractive Outcomes and Enhancement Rates for Silicone Hinged Accommodating IOLs and Monofocal IOLs in RLE Jason E. Stahl, MD Overland Park, KS Consultant: Alcon, Bausch & Lomb, Abbott Medical Optics, TrueVision

  2. Purpose • Evaluate refractive outcomes and rate of enhancement surgery in eyes undergoing refractive lens exchange with Crystalens HD and AcrySof WF IOLs. • Is there any difference in early and late predictability (refractive stability) • Is there continued myopic shift with Crystalens HD resulting in less predictability compared to monofocal IOLs • What is the enhancement rate with Crystalens HD compared to aspheric (monofocal) IOLs targeted for pseudophakic monovision?

  3. Methods This retrospective study evaluated 40 eyes (20 patients with mean age of 60 y) implanted with Crystalens HD and 50 eyes (25 patients with mean age of 59 y) implanted with AcrySof WF. All dominant eyes were targeted at plano for both IOL groups. Mini-monovision (-0.50 to -0.75D) was the target in non-dominant Crystalens HD eyes and monovision (-1.50 to -1.75D) was the target in the non-dominant AcrySof WF eyes. Refractive outcomes were analyzed at 1, 3 and 12 months. The enhancement surgery rate (LASIK, PRK, CK) for both IOL groups was analyzed during the 12 month follow-up period. Defocus curves were performed for both IOL groups.

  4. MRSE Diopters Dominant Not statistically significant P > 0.05 Diopters Non-Dominant Not statistically significant P > 0.05

  5. Predictability: 1 Month P > 0.05 Not statistically significant

  6. Predictability: 3 Month P > 0.05 Not statistically significant

  7. Predictability: 12 Month P > 0.05 Not statistically significant

  8. Mean Cylinder Diopters P > 0.05 Not statistically significant

  9. Enhancement Rates P = 0.056 Not statistically significant

  10. Results Summary: AcrySof WF vs Crystalens HD • No significant difference in refractive outcomes • No progressive refractive shift (myopic) observed with Crystalens HD or AcrySof WF • 1-3 mo, 3-12 mo or 1-12 mo • No significant difference in predictability • Slightly better predictability with Crystalens HD • Greater enhancement rate in AcrySof WF eyes • Almost statistically significant • The effects of target refraction and LRI were examined. Neither had a statistically significant effect on prediction errors for either lens model at any post-op period. • No significant difference in postop cylinder at any postop visits.

  11. Why is the enhancement rate greater with AcrySof WF? AcrySof WF OU AcrySof WF Crystalens HD OU Crystalens HD Significantly greater defocus curves with Crystalens HD gives greater visual range P = 0.001 P = 0.001

  12. Conclusion • Crystalens HD refractive outcomes are as predictable as monofocal AcrySof WF • Enhancement rates greater with AcrySof WF • Despite similar refractive outcomes to Crystalens HD • Crystalens HD has significantly greater defocus curve resulting in greater range of vision • Achieving refractive target more challenging with AcrySof WF when targeting monovision due to smaller defocus curve (smaller range of vision) • Presbyopia-correction: Need to finish the job • Enhance patients to achieve best results and patient satisfaction

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