Cataract Surgery
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Marjan Farid, Hawaiian Eye and Retina 2023: Residual refractive error after cataract surgery

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Published Online: Mar 8th 2023

Editorial Board member, Dr Marjan Farid (University of California, Irvine, Irvine, CA, USA) talked us through her presentation at this year’s Hawaiian Eye and Retina meeting, sharing her insight on causes and surgical options for correcting residual refractive error after cataract surgery.


  1. What is the incidence of residual refractive error after cataract surgery, and what are the most common causes? (0:11)
  2. What surgical options do you recommend in cases of residual refractive error? (2:25)
  3. What options do we have for non-surgical postoperative refractive adjustments, and what does the future hold? (3:26)

The presentation entitled, Residual Refractive Error After Cataract Surgery: Now What? was presented at the Hawaiian Eye and Retina 2023 meeting, 14–20 January, 2023.

Disclosures: Marjan Farid is a consultant for Acufocus, Aldeyra, Alcon, Allergan, B&L, CorneaGen, Glaukos, JNJ, Novarittis, Oyster Point, Tarsus, Zeiss; and serves on advisory boards for Oasis and Aurion.

Support: Interview and filming supported by Touch Medical Media. Interview conducted by Lisa Glass.

Filmed as a highlight of Hawaiian Eye and Retina 2023.

Click here for more content from Dr Marjan Farid.

What is the incidence of residual refractive error after cataract surgery, and what are the most common causes? (0:11)

Very good question. So despite our best efforts with again excellent El formulas, now we still will hit refractive errors. I think that’s part of cataract surgery and really is cataract surgeons. We have to be ready and able to sort of systematically go through what is the cause of the refractive error and what are the options for correcting it. So refractive errors, obviously residual things like astigmatism, mild astigmatism from the torque power, maybe being off or toric IOL rotation or whether their spherical power is off because of incorrect power calculations. You know, we have to be able to go through those systematically with the patient, make sure they’re consistent postoperatively, because oftentimes dry eye is a big cause of either preoperative biometry errors or post-operative fluctuations and refractive errors. So first of all, we need to make sure that refractive error is consistent. So I’ll talk patients. We do a lot of hand-holding, make sure they realize, OK, there’s we’ve sort of missed our target. Is it consistent? We want to make sure now that we’re correcting it, we’re correcting the correct refractive error. And then we systematically look at, OK, what is our approach? Does this patient just need a little laser vision correction, touch up a little lasik, touch up after cataract surgery to fine tune that last refractive bit? Or is it are we looking at an intraocular lens manipulation, whether it’s a rotation or an intraocular lens exchange? So there’s really a systematic way of going through these different options. And then some patients don’t necessarily want these surgically corrected. So obviously we have to be in communication with our patients. Sometimes patients, it’s about 20 happy. If patients are happy with their outcome and are OK with wearing glasses for certain times, that’s, you know, the lowest hanging fruit and the easiest way of correcting a post-operative refractive error.

What surgical options do you recommend in cases of residual refractive error? (2:25)

The intraocular lens manipulation if the toric lens is off axis. My theory is go in and fix it. You can correct it with laser vision correction. But I think you sometimes bring in higher order aberrations when you have a toric lens that’s off axis. And now you fix your cornea to offset that. Sometimes you actually create higher order aberrations between the cornea and the lens. So my rule of thumb is if the lens toric is off, go in and fix that. If the spherical power is off and the astigmatism is off and it’s significant enough sometimes that requires an intraocular lens exchange. But if it’s often a small amount and the patient is willing and we feel that the dry eye part of laser vision correction is tolerable for that particular patient. I think at least a touch up is also reasonable in some of these patients.

What options do we have for non-surgical postoperative refractive adjustments, and what does the future hold? (3:26)

So the future is great. I think for patients who we preoperative we can tell will have post-operative unpredictability in their refractive outcomes. These are the perfect patients that I nudged towards a light adjustable lens, because that’s the easiest way to correct a post-operative refractive error is by adjusting the power of the lens. So really, I’m leaning a lot of my patients that I think might be a little unpredictable towards laser, towards light, adjustable lens. Also patients who don’t exactly know what they want. Do they want a little mono vision? Do they not want model vision? These types of patients are the perfect candidates for a light adjustable lens where you have that non-surgical approach to correcting the refractive error. The other non-surgical approach is certainly we are offering patients, the use of glasses, contact lenses to correct their refractive error. Again, some patients will be just fine to do that for certain tasks like distance driving at night or for fine print reading. So, you know, I always offer that as an option for patients who we may miss the target a little bit.

Subtitles and transcript were auto-generated.

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