Importance of corneal spherical aberration in pupil area for multifocal intraocular lens selection: a case report

This case report presents a unique approach to vision restoration following the implantation of an extended depth of focus (EDOF) intraocular lens (IOL) in an eye with negative corneal spherical aberration (SA) within a 4-mm area. Vision was successfully restored by modifying the corneal SA through topography-guided ablation (TGA). This novel combination of EDOF IOL implantation and TGA provides a potential solution for optimizing postoperative visual outcomes in patients with atypical asphericity induced by refractive surgeries.

A patient who had undergone LASIK surgery underwent EDOF IOL implantation to treat cataracts. Although no significant issues were noted during a routine preoperative examination, he complained of blurry vision postoperatively. Furthermore, his best-corrected visual acuity was decreased compared with the preoperative level. A reevaluation of the preoperative examination results revealed that the anterior corneal SA within the 2-4-mm zone was negative, whereas the primary corneal SA (6-mm zone) and total higher-order aberration (4-mm zone) remained within the normal range, measuring 0.155 μm and 0.150 μm, respectively. To correct the negative SA, TGA was performed after lifting of the flap. Consequently, an uncorrected distance visual acuity of 0.0 (logMAR) was achieved at 1 month postoperative.

Given that most presbyopia-correcting IOL are designed with a negative SA to compensate for a positive corneal SA, assessing the SA in the pupil area is crucial to the success of multifocal IOL implantation.