Dr. A. James Khodabakhsh, a leading eye care specialist at Beverly Hills Institute of Ophthalmology in California recently wrote an opinion article on the benefits offered by laser-assisted cataract surgery for patients with presbyopia. The article is entitled “Laser-assisted cataract surgery beneficial for presbyopic patients” and was published online in the Ocular Surgery News U.S. Edition.
Presbyopia is defined as age-related long-sightedness. It is a natural condition, part of the aging process, in which the eye has a progressive diminished ability to focus on near objects. Presbyopia can be corrected by wearing reading glasses, contact or implant lenses, and laser vision correction.
Dr. Khodabakhsh believes that once patients are submitted to cataract surgery to remove the clouded lens that characterizes the condition, they may also choose to undergo an additional surgical procedure to correct presbyopia and improve their vision. Astigmatism, an optical defect that causes blurred or distorted vision, can also be corrected at this point through toric (particular lens in a “donut” shape) intraocular lens implants (IOL), corneal relaxing incisions and laser vision correction.
“About 90% of patients in my practice choose the lifestyle benefits of multifocal, accommodating or toric IOLs and/or femtosecond laser-assisted cataract surgery. Central to the promise we make in offering lifestyle lenses is the provision of high-quality uncorrected visual acuity, and that means correcting astigmatism is essential.” said Dr. Khodabakhsh. “Leaving presbyopic IOL patients with residual astigmatism — even seemingly minor amounts of 0.5 D to 0.75 D — can severely affect a patient’s vision and make him or her unhappy. Astigmatism degrades visual quality, particularly with multifocal optics, and can result in patient dissatisfaction with the outcome of an otherwise excellent surgery.”
According to Dr. Khodabakhsh, “It is not difficult for cataract surgeons to treat astigmatism at the time of surgery, particularly with the addition of femtosecond lasers to our armamentarium.” He has acquired the Catalys femtosecond laser (Abbott Medical Optics) and currently relies heavily on this key device for eye care practice. He found that astigmatic keratotomy (AK) incisions with the laser to correct astigmatism are more reproducible and predictable than limbal relaxing incisions (LRI). Thanks to this laser technique, Dr. Khodabakhsh has reduced the rate of required laser vision correction enhancement after presbyopic IOL implantation.
However, Dr. Khodabakhsh is cautious about the success of laser-assisted surgery in treating cataract and correcting optical defects. “Even with improvements in incisional correction and great toric IOL options, there is no getting around the fact that a minority of patients will need LASIK [laser-assisted in situ keratomileusis] or PRK [photorefractive keratectomy] enhancement. As a premium IOL surgeon, if you are not prepared to perform laser vision correction yourself, you should partner with a refractive surgeon to handle those cases for you.”
“I now use the Catalys femtosecond laser in almost every presbyopia-correcting IOL case, even if there is as little as 0.5 D to 1 D of astigmatism. I have seen many cases as second-opinion consults in which the patient is unhappy and posting negative feedback online about his or her original surgeon simply because of residual astigmatism. Taking the initiative to manage astigmatism proactively with on-axis incisions, manual LRIs, laser AKs or laser vision correction is the key to satisfying your presbyopic lifestyle lens patients,” concluded Dr. Khodabakhsh.
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