Femtosecond Laser-Assisted RLE Offering Better Outcomes In Vision Correction

Abstract
Coupling femtosecond laser-assisted Refractive lens exchange (RLE) with a presbyopia-correcting IOL can provide better patient satisfaction.

The technology surrounding IOLs has actually developed tremendously, as well as with that patients’ expectations for the very best feasible results after refractive lens-based surgery have increased tremendously.

In response to using multifocal as well as extended-depth-of-focus (EDOF) IOLs, femtosecond laser-assisted refractive lens exchange (RLE) may be the technology of choice to achieve much better end results, consisting of correction of refractive error and spectacle independence, with presbyopia-correcting IOLs.

“RLE is performed increasingly more frequently to address refractive error, presbyopia, as well as to eliminate the need for a future cataract surgery,” said an ophthalmologist.

Nonetheless, with that fad come some drawbacks. Multifocal IOLs and also extended-depth-of-focus IOLs are a lot more sensitive to tilt and defocus than mono-focal IOLs. To establish the potential benefit of femtosecond laser-assisted RLE with presbyopia-correcting IOLs, the doctor and his associates carried out a research study to evaluate the visual as well as refractive outcomes postoperatively.

“The specific or targeted or precise as well as automated (with all the measurements being precisely executed with the laser) nature of the femtosecond laser may positively impact precision, safety, and patient satisfaction,” he stated.

In support of that, the doctor recalled a research that contrasted the refractive and aberrometry end results gotten with a diffractive multifocal IOL using femtosecond laser-assisted surgical procedure as compared to phacoemulsification in 39 patients.

The research reported that while the visual outcomes with mono-focal IOLs were unaffected, a decline in the interior aberrations was seen in the group treated with femtosecond laser-assisted surgical treatment compared to phacoemulsification. The decrease was because of much less tilt as well as the far better efficient lens setting of the IOL in the eye, assisted with the femtosecond laser.

The research
The research was a single-site retrospective chart review that included 590 eyes of presbyopic patients that desired spectacle freedom. One doctor did all the RLEs, to remove any differences in experience and technique under different doctors.

Eyes were included if they had corneal higher-order aberrations (HOAs) under 0.4 μm at 4 mm and stable tear film. Total corneal astigmatism (TCA) less than 0.5 D was left untreated and not considered for treatment; TCA exceeding 0.5 D was considered for treatment and attended to, that is, by arcuate keratotomy or toric IOLs.

Patients with residual refractive error who were disappointed with the visual quality went through laser vision modification from 10 to 12 weeks after the RLE treatment.

The researchers used a combination of an EDOF IOL and a multifocal IOL. The ZLBOO model was used to attain distance and also near vision in one eye as well as the EDOF IOL for distance as well as intermediate in the other eye.

“This would permit seamless quality of vision from near to distance with the help of both eyes and also with no loss of quality and high visual acuity,” the doctor mentioned.

A femtosecond laser system was utilized in all eyes for femtosecond laser-assisted RLEs with or without arcuate keratotomy. When a toric IOL was utilized, originally the treatment axis was noted with the femtosecond laser utilizing intrastromal corneal arcuate marks or later anterior capsulotomy marks.

For presbyopia correction, the researchers implanted an intermediate add EDOF IOL (group 1; 475 eyes); for patients with extreme astigmatism, they used a reciprocal EDOF toric IOL with a near target in the nondominant eye (group 2; 115 eyes).

The ophthalmologist reported that in group 1, 91% of eyes accomplished within ± 0.5 D of the target refraction with an average manifest refraction spherical equivalent of about plano. In group 2, the astigmatism was decreased to an average 0.47 D compared with baseline (p = 0.001).

In group 1, 97% of eyes accomplished an postoperative uncorrected distance visual acuity of 20/40 or better; in group 2, 94% did so.

“As anticipated,” the doctor stated, “the uncorrected near visual acuity (UNVA) was excellent; 93% of eyes achieved an UNVA of 20/40 or better, which is also the safe driving limit in the US of A. In group 2, 83% attained that level of UNVA.”.

A patient satisfaction survey suggested that 90% were entirely or extremely pleased with the visual results postoperatively, and also 10% reported that they were rather satisfied. Over 90% suggested that they were completely delighted or very pleased that they undertook vision improvement surgical treatment; under 10% reported that they were somewhat pleased.

The large majority, i.e., 97% said they would certainly recommend the treatment to a good friend or relative, according to the researching doctor.

A caveat is that with RLE it is naturally harder to achieve patient satisfaction due to the fact that patients have a clear lens, larger pupils, and also greater expectations than those undertaking cataract surgery. We tell patients that they will certainly need readers for fine print, although many do not require readers at all, the doctor noted.

“Provided the better consistency of the treatment, with it being precise, targeted and automated, I believe the femtosecond laser can aid in attaining even better outcomes in the group,” he stated. “With 97% recommending this to family members, which is a good recommendation as it is to close and loved ones, this has been the fastest expanding part of our practice over the last three years.”


The doctor concluded that patients can accomplish positive refractive as well as visual outcomes after femtosecond laser-assisted RLE with presbyopia-correcting IOLs.

“This is potentially because of enhanced prediction of the effective lens placement, based on automated and precise targeting, much easier centration, for the same reasons and decreased interior higher order aberrations, as well as enhanced toric alignment because of a reproducible capsulotomy and femtosecond capsular marks,” he claimed. “Enhanced patient satisfaction which is key in any type of refractive error eye surgery, likely can be accomplished by combining multifocal as well as EDOF IOLs to attain a fuller depth of focus as seen with the better near as well as distance uncorrected vision.”

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