EyeWorld Asia-Pacific December 2024 Issue

35 EyeWorld Asia-Pacific | December 2024 REFRACTIVE SURGERY by Liz Hillman, Editorial Co-Director The Impact Of HOAs On Refractive Options And Outcomes Whether you’re performing laser vision correction or refractive cataract surgery with an advanced-technology IOL, higher order aberrations (HOAs) are among the many measurements that influence procedural decisions. “Corneal HOAs should be assessed during the preoperative evaluation for all refractive and cataract surgeries, as a standard practice to inform surgical planning,” said Brian Armstrong, MD. “Missing preoperative HOAs can lead to suboptimal outcomes, including residual refractive error, poor visual quality, and visually significant dysphotopsias. Postoperative management of a dissatisfied patient may involve IOL exchange or laser vision enhancement to address these issues.” While whole chapters have been written on the topic of HOAs, Dr. Armstrong, along with Karolinne Maia Rocha, MD, PhD, and Damien Gatinel, MD, PhD, discussed measuring and quantifying HOAs, their impact on IOL selection for cataract surgery, procedure and candidate selection for corneal refractive surgery, and some of their eccentricities. Dr. Rocha said that HOAs and light scatter can be induced by various sources: dry eye, age-related cataract, posterior capsular opacification, vitreous floaters, keratoconus, and too small of an optical zone or decentered ablations post-corneal refractive surgery. No eye is perfect, she said, though patients are more likely to tolerate/compensate for HOAs that they’re “born with,” compared to those that are induced. 51-year-old female, hyperopic, complaining of decreased vision and glare; topography and ray tracing showed that internal aberrations were worse than corneal aberrations. Source: Karolinne Rocha, MD, PhD 65-year-old male with EBMD and nuclear sclerosis; corneal and internal aberrations should be addressed; the patient underwent superficial keratectomy followed by lens surgery 3 months later. Source: Karolinne Rocha, MD, PhD

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