33 EyeWorld Asia-Pacific | December 2024 “Our lab, the McGill Refractive Surgery Research Unit, leverages large databases to investigate controversies in refractive surgery. With more than 100,000 new eyes added yearly, we utilize big data analytics to gain insights to improve patient care, dispel misinformation, and address unresolved questions in our field,” Dr. Wallerstein and Dr. Gauvin said in an email to EyeWorld. The ongoing debate around angle kappa’s impact on multifocal IOL (MIOL) outcomes caught the attention of these researchers due to its potential to affect large numbers of MIOL surgeries worldwide. The literature is divided: some studies suggest that a large angle kappa might negatively impact postoperative MIOL outcomes, while others find no significant correlation. Additionally, some surgeons reject high angle kappa patients, while others are convinced that angle kappa or an attempt at IOL centration on the corneal vertex does not play a clinically significant role. Given the lack of consensus and the small sample sizes of previous studies, Dr. Wallerstein, Dr. Gauvin, and colleagues saw an opportunity to bring clarity to this issue with a large-scale investigation. “Our goal was to conduct a robust, evidence-based study that would provide definitive answers and clarify the true impact of angle kappa on MIOL refractive outcomes and patient satisfaction, thereby guiding clinical decision making. As per all our investigations, we maintained a neutral stance, understanding the need for an unbiased, large-scale study,” they said. According to Dr. Wallerstein and Dr. Gauvin, their study is the largest of its kind, involving a comprehensive review of 26,470 eyes from 13,235 patients across 21 Canadian IOL surgery centers. Conducting a study on this scale required meticulous data collection enabled by a custom EMR, designed with research capabilities. They described REFRACTIVE SURGERY by Ellen Stodola, Editorial Co-Director Angle Kappa And Its Influence On Multifocal IOL Outcomes “Eyes with a large angle kappa should not be excluded from MIOL surgery, nor should angle kappa be used as a sole determinant for MIOL candidacy.” Avi Wallerstein, MD, and Mathieu Gauvin, PhD In a recent study, Avi Wallerstein, MD, Mathieu Gauvin, PhD, and colleagues explored the influence of angle kappa on multifocal IOL outcomes.1 Dr. Wallerstein and Dr. Gauvin shared with EyeWorld the motivation behind this study, what was discovered, and what this means for future research.
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