Refractive lens exchange

Clear lens exchange safe and effective in large five-year real world study

Roibeard O’hEineachain

Posted: Friday, March 1, 2019

Andreas Hartwig PhD

Presbyopia-correcting intraocular lens surgery can produce visual and refractive outcomes with low complication rates and high patient satisfaction, according to the findings of a large study presented by Andreas Hartwig PhD at the 36th Congress of the ESCRS in Vienna, Austria.

“The outcomes are in line with benchmark data. Refractive lens exchange (RLE) is a safe and effective way of providing visual rehabilitation to presbyopes,” said Dr Hartwig, Optegra Eye Sciences, UK.

This observational case series review included data from 12,990 RLE procedures performed between January 1, 2011 and June 30, 2017. The implanted IOLs included eight designs comprising extended depth of focus, diffractive trifocal and rotationally asymmetric bifocals.

The study showed that postoperative monocular uncorrected distance visual acuity (UDVA) was 20/40 or better in 96.2% of eyes and 20/20 or better in 60.8% of eyes. Furthermore, binocular UDVA was 20/40 or better in 99.5% of patients and 20/20 or better in 77.3%. Furthermore, 89.3% of eyes achieved a near visual acuity of N6 or better.

Dr Hartwig noted that the visual outcomes achieved with RLE appear to have improved during the years studied, which may be a result of improvements in surgical techniques and lens design. However, it also appears that more recently observed very good uncorrected near visual acuity results may have come at a cost of uncorrected distance vision.

Refraction was within 1.0D of target in 96.1% of eyes and within ±0.5D of target in 80.2% of eyes respectively. There were no intraoperative complications in 99.7% of cases and visually significant postoperative complications were also infrequent.

Shafiq Rehman FRCOphth

RLE also appears to achieve good and predictable results in eyes with high ametropia, said Dr Hartwig’s associate, Shafiq Rehman FRCOphth. He presented an analysis of data from 264 highly myopic (-6.0D to -16.5D) and 152 highly hyperopic (+6.0D to +20.0D) eyes included in the total study group.

Monocular uncorrected distance visual acuity (UDVA) of 20/40 or better was achieved by 99% of high myopic eyes and 93% of high hyperopic eyes. 20/20 or better UDVA was achieved by 68% of myopic eyes and 38% of hyperopic eyes, Dr Rehman said.

In addition, 84.5% of high myopic eyes and 72.5% of high hyperopic eyes achieved a near visual acuity of N6 or better. Postoperative refraction was within ±0.50D of target in 85.6% of myopic eyes and in 75.0% of hyperopic eyes.

No operative complications were recorded in 99.6% and 100.0% of highly myopic and hyperopic eyes respectively, whereas postoperative complications were observed more frequently in the hyperopes.

“The data indicates better outcomes were achieved for high myopic eyes in comparison to high hyperopic eyes in this cohort for most metrics assessed,” Dr Rehman added.

Clare O’Donnell PhD

For most patients who underwent RLE in the observational case study, longer-term surgery results met or exceeded their expectations, said Clare O’Donnell PhD, Head, Optegra Eye Sciences, UK, in a separate presentation of a subset of the cohort. In response to a questionnaire completed between two and seven years after discharge, 88% of respondents reported their quality of life improved following surgery and 87% of respondents reported the treatment met or exceeded their expectations regarding freedom from spectacles, she noted.

In addition, 90% of patients said the treatment met their expectations regarding vision during daytime and in dim light and 73% said the treatment exceeded their expectations. Furthermore, 83% and 73% of respondents, respectively, said the treatment met or exceeded their expectations regarding glare and halos. Some 29% of respondents reported that dry eye sensation was worse than expected after surgery.

Nearly 65% of respondents said they experienced dry eye, although this was expected in almost 50% of respondents. Dry eyes are thus potentially a key variable to target to further improve patient experience following surgery. Other vision-related variables are also likely to improve when the tear film is optimised, Dr O’Donnell said.

Andreas Hartwig:
Clare O’ Donnell:
Shafiq Rehman:

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