Boxer Wachler Vision Institute

To compare visual and refractive outcomes between the Visian Implantable Collamer Lens (ICL) and Verisyse phakic intraocular lens. Comparative interventional case series for myopia between 6.00 and 20.00 diopters (D). Thirty consecutive eyes of 16 patients had a Visian ICL implanted and 31 consecutive eyes of 19 patients had the Verisyse lens implanted. Outcomes measured at 3 months postoperatively included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and refractive predictability as well as adverse events. Preoperatively, the groups were no different in regard to age (P=.72) and spherical equivalent refraction (P=.38). Postoperative UCVA of 20/20 or better and 20/25 or better in the Visian ICL group was 67% and 96%, respectively, compared to 63% and 79%, respectively, in the Verisyse lens group (P=.10). Binocular UCVA of 20/20 or better and 20/25 or better in the Visian ICL group was 92% and 100%, respectively, and in the Verisyse group, 70% and 80%, respectively (P=.007). One and two lines gain of postoperative BSCVA in the Visian ICL group was 40% and 10%, respectively, which was statistically significantly better than the Verisyse group of 16% and 6%, respectively (P=.025). Postoperative deviation from target refraction was 0.038+/-0.39 D in the Visian ICL group and -0.38+/-0.89 D in the Verisyse lens group (P=.018). Monocular UCVA was similar for both groups, whereas binocular UCVA was better in the Visian ICL group. The Visian ICL group had more accurate refractive outcomes than the Verisyse lens group.

To understand what level of higher order aberrations increases the relative risk of visual symptoms in patients after myopic LASIK. This study was a retrospective comparative analysis of 103 eyes of 62 patients divided in two groups, matched for age, gender, pupil size, and spherical equivalent refraction. The symptomatic group comprised 36 eyes of 24 patients after conventional LASIK with different laser systems evaluated in our referral clinic and the asymptomatic control group consisted of 67 eyes of 38 patients following LADARVision CustomCornea wavefront LASIK. Comparative analysis was performed for uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contrast sensitivity, refractive cylinder, and higher order aberrations. Wavefront analysis was performed with the LADARWave aberrometer at 6.5-mm analysis for all eyes. Blurring of vision was the most common symptom (41.6%) followed by double image (19.4%), halo (16.7%), and fluctuation in vision (13.9%) in symptomatic patients. A statistically significant difference was noted in UCVA (P = .001), BSCVA (P = .001), contrast sensitivity (P < .001), and manifest cylinder (P = .001) in the two groups. The percentage difference between the symptomatic and control group mean root-mean-square (RMS) values ranged from 157% to 206% or 1.57 to 2.06 times greater. Patients with visual symptoms after LASIK have significantly lower visual acuity and contrast sensitivity and higher mean RMS values for higher order aberrations than patients without symptoms. Root-mean-square values of greater than two times the normal after-LASIK population for any given laser platform may increase the relative risk of symptoms.

To report a case of decreased best spectacle-corrected visual acuity (BSCVA) 2 months after Intacs implantation. A 33-year-old woman with keratoconus and contact lens intolerance underwent Intacs surgery in the left eye at another institution. Two segments were used--a thinner one (0.25 mm) below the cone and a thicker one (0.35 mm) above the cone. Two months postoperatively, the patient presented to our practice with BSCVA reduced from 20/20 to 20/30. The superior Intacs segment was explanted, the inferior segment was exchanged for a thicker one (0.35 mm), and collagen cross-linking with riboflavin treatment was performed. This resulted in visual, topographic, and refractive improvement with BSCVA returning to 20/20. Single inferior segment Intacs may be more appropriate for paracentral and peripheral cones. Collagen cross-linking may help cause further flattening. Using asymmetrical segments, with the thicker segment above the cone, may increase distortions and result in loss of BSCVA.