NEWS & OPINION 66 EWAP MARCH 2022 4. Durr GM, Ahmed IIK. Intraocular lens complications: decentration, uveitis-glaucoma-hyphema syndrome, opacification, and refractive surprises. Ophthalmology. 2020. Online ahead of print. 5. Dalby M, et al. Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation. J Cataract Refract Surg. 2021;47:1147–1152. 6. Samuelson TW. Managing an unstable subluxated intraocular lens with uncontrolled intraocular pressure and progressing glaucoma: July consultation #1. J Cataract Refract Surg. 2016;42:1098–1099. 7. Ahmed IIK, Snyder ME. Management of dislocated intraocular lenses: Clinicians’ Corner. American Academy of Ophthalmology. 8. Zhang L, et al. Mechanisms for inthe-bag uveitis-glaucoma-hyphema syndrome. J Cataract Refract Surg. 2014;40:490–492. 9. Boutboul S, et al. Pigmentary glaucoma secondary to in-the-bag intraocular lens implantation. J Cataract Refract Surg. 2008;34:1595–1597. 10. Price MO, et al. Late dislocation of scleral-sutured posterior chamber intraocular lenses. J Cataract Refract Surg. 2005;31:1320–1326. Editors’ note: Dr. Parra is a PGY4 Resident at Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California. The residency program’s Director is Stacy Pineles, MD. The ASCRS Journal Club is a virtual, complimentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the September session featured a presentation by Jeremy Kieval, MD, author of “Prevention and management of refractive prediction errors following cataract surgery.” The second manuscript, “Repositioning surgery of different intraocular lens designs in eyes with late in-the-bag intraocular lens dislocation,” was presented by Andres Parra, MD, resident, Stein Eye Institute, University of California, Los Angeles. To view the September Journal Club session, go to ascrs.org/ clinical-education/journal-club/schedule/ september-2021. of astigmatism decreases the odds of achieving 20/20 UDVA, however, only residual astigmatism more than 0.50 D was associated with less patient satisfaction. The panelists also discussed their surprise at the results suggesting that patients with hyperopic refractive misses were more satisfied and more likely to achieve 20/20 UDVA than their myopic counterparts. While the traditional teaching is to leave patients slightly myopic, these data would suggest just the opposite. While the effects of multifocal lenses could explain some of the patient satisfaction with residual hyperopia, the same results were noted in the monofocal cohort. A previous study suggested that even slight hyperopic refractive misses degrade visual outcomes in patients with trifocal lenses,5 however, this study used extraocular lenses to simulate a refractive surprise. Additional analyses would have been valuable in this study. For instance, stratifying patients based on preoperative refractive error as a predictor of level of satisfaction postoperatively would have been advantageous. Would previously myopic patients have the same level of satisfaction with a hyperopic refractive outcome compared to other subgroups? Secondly, though the axis of astigmatism did not affect the UDVA, it would have been beneficial to determine if the axis played a role in the level of patient satisfaction postoperatively. Do patients with the same level of with-the-rule astigmatism have a higher level of satisfaction than patients with against-the-rule or oblique astigmatism? This study is limited by its retrospective nature and lack of a standardized treatment protocol for different levels of astigmatism. In addition, subjective assessments of vision likely vary between different populations, limiting the external validity of those results. Finally, only dominant eyes were included in the study, but the patient questionnaire was completed after both eyes underwent surgery. It is therefore difficult to exclude the binocular impact of monovision on the level of patient satisfaction postoperatively. Conclusions In this large, retrospective database study, Schallhorn et al. suggested residual astigmatism of more than 0.50 D in pseudophakic patients is associated with less patient satisfaction and decreased visual acuity. These associations become larger and more significant with each 0.2x D of residual astigmatism. In addition, patients with hyperopic refractive misses of a given magnitude were more likely to be satisfied with their vision and to achieve 20/20 uncorrected distance visual acuity than those with equivalent myopic refractive misses. EWAP References 1. Melles RB, et al. Accuracy of intraocular lens calculation formulas. Ophthalmology. 2018;125:169–178. 2. Hayashi K, et al. Influence of astigmatism on multifocal and monofocal intraocular lenses. Am J Ophthalmol. 2000;130:477–482. 3. Villegas EA, et al. Minimum amount of astigmatism that should be corrected. J Cataract Refract Surg. 2014;40:13–19. 4. Sigireddi RR, Weikert MP. How much astigmatism to treat in cataract surgery. Curr Opin Ophthalmol. 2020;31:10–14. 5. Hayashi K, et al. Effect of spherical equivalent error on visual acuity at various distances in eyes with a trifocal intraocular clens. J Refract Surg. 2019;35:274– 279. Editors’ note: Dr. Taravati is Residency Program Director, Department of Ophthalmology, University of Washington, Seattle, Washington. Dr. Meirick is an ophthalmology resident at the University of Washington. The ASCRS Journal Club is a virtual, complimentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the August session was recorded live during the 2021 ASCRS Annual Meeting in Las Vegas, Nevada, and featured a presentation by William Wiley, MD, author of “Comparative study of phacoemÕlsification parameters Üith and ÜithoÕt nitinol filament nÕclear disassembly.” The second manuscript, “Effect of residual astigmatism on uncorrected visual acuity and patient satisfaction in pseudophakic patients,” was presented by Thomas Meirick, MD, ophthalmology resident, University of Washington. To view the August Journal Club session, go to ascrs. org/ clinical-education/journal-club/schedule/ august-2021. Review of ‘Effect’ - from page 63
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