• AAO OTAC Refractive Management/Intervention Panel and Hoskins Center for Quality Eye Care

    A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Refractive Management/Intervention Panel

    Seth M. Pantanelli, MD,1 Charles C. Lin, MD,2 Zaina Al-Mohtaseb, MD,3 Jennifer R. Rose-Nussbaumer, MD,4 Marcony R. Santhiago, MD,5 Walter Allan Steigleman III, MD,6 Julie M. Schallhorn, MD,7

    Ophthalmology, Vol. 128, Issue 5, 781-792 © 2020 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Purpose: To review the literature to evaluate the outcomes of intraocular lens (IOL) power calculation in eyes with a history of myopic LASIK or photorefractive keratectomy (PRK).

    Methods: Literature searches were conducted in the PubMed database in January 2020. Separate searches relevant to cataract surgery outcomes and corneal refractive surgery returned 1169 and 162 relevant citations, respectively, and the full text of 24 was reviewed. Eleven studies met the inclusion criteria for this assessment; all were assigned a level III rating of evidence by the panel methodologist.

    Results: When automated keratometry was used with a theoretical formula designed for eyes without previous laser vision correction, the mean prediction error (MPE) was universally positive (hyperopic), the mean absolute errors (MAEs) and median absolute errors (MedAEs) were relatively high (0.72–1.9 diopters [D] and 0.65–1.73 D, respectively), and a low (8%–40%) proportion of eyes were within 0.5 D of target spherical equivalent (SE). Formulas developed specifically for this population requiring both prerefractive surgery keratometry and manifest refraction (i.e., clinical history, corneal bypass, and Feiz-Mannis) produced a proportion of eyes within 0.5 D of target SE between 26% and 44%. Formulas requiring only preoperative keratometry or no history at all had lower MAEs (0.42–0.94 D) and MedAEs (0.30–0.81 D) and higher (30%–68%) proportions within 0.5 D of target SE. Strategies that averaged several methods yielded the lowest reported MedAEs (0.31–0.35 D) and highest (66%–68%) proportions within 0.5 D of target SE. Even after using the best-known methods, refractive outcomes were less accurate in eyes that had previous excimer laser surgery for myopia compared with those that did not have it.

    Conclusions: Calculation methods requiring both prerefractive surgery keratometry and manifest refraction are no longer considered the gold standard. Refractive outcomes of cataract surgery in eyes that had previous excimer laser surgery are less accurate than in eyes that did not. Patients should be advised of this refractive limitation when considering cataract surgery in the setting of previous corneal refractive surgery. Conclusions are limited by the small sample sizes and retrospective nature of nearly all existing literature in this domain.

    1Penn State College of Medicine, Hershey, Pennsylvania

    2Byers Eye Institute, Stanford University, Palo Alto, California

    3Baylor College of Medicine, Houston, Texas

    4Division of Research Kaiser Permanente Northern California and Francis I Proctor Foundation University of California, San Francisco, California

    5Federal University of Rio de Janeiro, Rio de Janeiro, Brazil

    6University of Florida College of Medicine, Gainesville, Florida

    7Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California