Use of Presbyopia-Correcting Intraocular Lenses in Patients With Prior Corneal Refractive Surgery

Majid Moshirfar; Andrew C. Thomson; Robert J. Thomson; Tanisha Martheswaran; Shannon E. McCabe


Curr Opin Ophthalmol. 2021;32(1):45-53. 

In This Article

Future Directions

As of today, no studies were found describing the use of accommodating IOLs (AIOL) in eyes with previous keratorefractive surgery. FDA approved AIOLs include the Crystalens (Bausch & Lomb) and the toric version, Trulign, which are designed to mimic accommodation via compression of hinged haptic plates that allow anterior motion of the lens. Initial commercial studies on AIOLs were favorable, but later independent studies revealed only a modest dynamic focus that eventually faded over time due to atrophy and fibrosis of the capsular bag after phacectomy.[15] Although newer AIOLs, such as those designed for ciliary sulcus placement, have shown promising results, AIOLs are a developing technology.

The RxSight (RxSight, Inc., Aliso Viejo, California, USA) is the only FDA-approved light-adjustable IOL (LAL) available today. Using ultraviolet (UV) radiation to induce silicone polymerization, surgeons can noninvasively adjust IOL power, which could obviate the reliance on imperfect calculation techniques, with the potential of implementing multifocality and EDOF.[2,49] A case report detailed the successful implantation of a LAL in a post-LASIK patient with a traumatic cataract who achieved postoperative manifest refraction of +0.50 D, uncorrected distance visual acuity of 20/20, and decrease in HOAs.[50] A retrospective study on 34 myopic eyes with previous refractive surgery reported that, after LAL implantation, 97% of eyes achieved mean refractive spherical equivalent within ±0.50 D after LAL lock-in.[2] Because of this ability to address residual errors and stable long-term results,[51] LAL remains a promising option for postkeratorefractive patients. However, multiple appointments and expensive equipment required to alter and lock-in treatments can be prohibitive for patients and physicians. Second, LAL implants may fail without strict compliance with UV-light protection until the final lock-in appointment.

IOL power adjustment using a femtosecond laser system, Perfector (Perfect Lens LLC, Irvine, California, USA), is based on refractive-index shaping which is significantly faster than LAL treatments and does not require special IOL material. A femtosecond laser is used to increase the hydrophilicity within defined zones of a standard hydrophobic IOL causing the material to absorb water, thus changing refractive characteristics.[52] Surgeons could potentially modify spherical power, asphericity, toricity, and multifocality with a simple and quick in-office procedure.[16,53]