MOROHOSHI EYE CLINICCATARACT SURGERY CASES

Cataract Surgery Cases / Case

Multifocal IOL

Case #14: Woman in her 60s from Suginami (after LASIK, extended depth of focus multifocal lens: TECNIS Symfony)

This is an English translation of the original Japanese case report. If the two differ, the Japanese version takes precedence. Visual acuity is shown in decimal notation (1.0 ≈ 20/20).

Change in visual acuity (decimal; corrected values in parentheses)

Right eye: pre-op → post-op
Right eyeDistance: 0.6(1.2)Distance: 1.2(1.5)Near: 0.7(1.0)
Left eye: pre-op → post-op
Left eyeDistance: 0.4(0.7)Distance: 1.2(1.5)Near: 0.7(1.0)

After LASIK she had become myopic due to nuclear cataracts, and wished for cataract surgery with multifocal lenses. Before LASIK she apparently had high corneal astigmatism besides myopia, but there was little regression after LASIK, and the cornea had a relatively clean shape.
In LASIK eyes, where the cornea has been reshaped, standard intraocular lens power formulas using corneal power produce postoperative refractive error (a hyperopic shift), so it is common to decide the lens power using several formulas dedicated to LASIK eyes recommended by the American society. Even so, some cases still miss the target, so at our clinic, in addition to those formulas, we decide the power with reference to corneal topography from the OPD-Scan III, a wavefront analyzer.
With advances in measuring equipment, the accuracy of axial length measurement, one of the factors determining intraocular lens power, has become quite high, while the influence of corneal power on postoperative refractive error seems to have grown. The OPD-Scan III we use can measure the refractive power at more than 3,000 points in the central cornea, and using that power, we calculate with the Camellin-Calossi formula, reported to have high predictive accuracy. Also, extended depth of focus (EDOF) lenses, which focus continuously and have some astigmatism-correcting effect, seem relatively well suited to people after LASIK, so for her too the surgery was done with the EDOF lens TECNIS Symfony.
She had also brought her pre-LASIK data, so we could achieve the target refraction with greater accuracy, and she was delighted with binocular uncorrected near vision of 1.0. Cataract is a disease everyone gets with age. The legal retention period for medical records is five years, so if you have had LASIK, it would be wise to obtain your pre-LASIK data while you still can.
Intraocular lens power formulas for LASIK eyes are updated constantly and are becoming more accurate, and recently some using AI (artificial intelligence) have appeared. Still, none is perfect, so it seems safest to decide the power with reference to the results of several calculations. At its 2008 peak, 450,000 LASIK procedures were performed, and cataract surgery in LASIK eyes is certain to increase, so we will continue to incorporate the latest findings in our practice to raise patients' postoperative satisfaction.

2018.7.22

2018.07.22

Patient questionnaire

Answers translated from Japanese.

What was your condition before surgery?

At night and inside art galleries and museums my vision didn't come up, so much so that I avoided going out. My left eye in particular was blurry both far and near.

What led you to have surgery?

Because I wanted to restore my body to good condition.

Which did you choose, a multifocal lens or a monofocal lens?

I felt the benefit of the remarkable advances in medicine and wanted to experience them myself, so I chose multifocal.

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