Dissatisfaction After Trifocal IOL Implantation and Its Improvement by Selective Wavefront-Guided LASIK

To evaluate a substantially improved wavefront acquisition technique (Peramis; SCHWIND eye-tech-solutions, Kleinostheim, Germany) for selective wavefront-guided aberration correction to improve satisfaction after implantation of trifocal intraocular lenses (IOLs).

Of 213 eyes from 108 consecutive patients receiving cataract surgery with multifocal IOL implantation (FineVision; PhysIOL, Liége, Belgium), 56 eyes (26%) of 42 dissatisfied patients were treated with selective wavefront-guided laser in situ keratomileusis (LASIK) (Amaris 1050; SCHWIND eye-tech-solutions) free of cost with a follow-up of 12 months. Selective wavefront-guided ablation corrected for all aberrations except spherical aberrations to preserve the apodization and therefore to enhance the multifocal effect. The degree of satisfaction after trifocal IOL implantation, its increase after selective wavefront-guided LASIK, and the refractive error (spherical equivalent, refractive astigmatism) before and after selective wavefront-guided LASIK were evaluated.

Refractive astigmatism of greater than 0.50 diopters (D) was the most frequent residual refractive error (63%), followed by myopia (45%), hyperopia (20%), and increased ocular higher order aberrations (13%). After selective wavefront-guided LASIK, the refractive target (±0.50 D) was achieved in 98% and refractive astigmatism was 0.50 D or less in 93% of the eyes operated on. The overall satisfaction score in dissatisfied patients increased from 2.1 ± 0.8 preoperatively to 3.6 ± 0.8 (out of 4). Eighty-eight percent of initially dissatisfied patients would choose this procedure again.

Selective wavefront-guided LASIK reduced refractive errors and significantly increased spectacle independence and satisfaction, which may lead to a better acceptance of trifocal IOLs. [J Refract Surg. 2019;35(6):346-352.].