Kenneth A Beckman, Hawaiian Eye and Retina 2023: Light-adjustable IOL for complex corneas

It was a pleasure to have the opportunity to meet with Dr Kenneth A Beckman (Comprehensive Eyecare of Central Ohio, Westerville, OH, USA)  about his presentation on implantation of intraocular lenses in eyes with complex corneas.

Questions:

1. What corneal issues would make a patient a poor candidate for presbyopic lenses? (0:22)

2. What factors influence the decision between a toric lens and a light adjustable intraocular lens in patients with complex corneas? (1:33)

3. What are the key take-home messages of your presentation? (3:00)

The presentation entitled, Light Adjustable IOL for Complex Corneas was presented at the Hawaiian Eye and Retina 2023 meeting, 14–20 January, 2023.

Disclosures: Kenneth A Beckman is a consultant for RxSight.

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

Filmed as a highlight of Hawaiian Eye and Retina 2023.

I’m Ken Beckman. I’m a corneal specialist in Columbus, Ohio. I’m the director of Cornell’s service at comprehensive eye care of Central Ohio and a clinical assistant professor of ophthalmology at the Ohio State University.

What corneal issues would make a patient a poor candidate for presbyopic lenses? (0:22)

In general, the presbyopic lens, particularly lenses with rings. So a multifocal lens, runs the risk of side effects to the patient glare and Halos and just dysphotopsia and that can make it less than desirable in certain corneas with underlying anatomical problems or other retinal diseases and such. They may not be able to tolerate these lenses at all. So if a patient has, let’s say, macular pucker macular edema, diabetic retinopathy, things like that, I do not like to use these lenses because they don’t seem to tolerate it well. But what makes it tricky is some patients have a completely normal back of the eye, but their cornea may have some irregularities and they desire the ability to do a multifocal, but they’re just not a good candidate. Maybe they have keratoconus irregular astigmatism, corneal dystrophies, a basement membrane dystrophy, or most importantly, Fuchs corneal dystrophy with guttata. And all of those things can cause so much irregularity that they just don’t seem to be able to tolerate a multifocal lens.

What factors influence the decision between a toric lens and a light adjustable intraocular lens in patients with complex corneas? (1:33)

For a patient with astigmatism, many of them can do very well with a toric lens. They also can do well with a light adjustable lens. The issue with the toric lens is we are more dependent on the regularity of the astigmatism. So sometimes a patient who has a skewed axis or an irregular astigmatism, it’s very difficult to say where you’re going to put the lens and to get it lined up appropriately. Many of these patients will have some residual post-op astigmatism. Despite your best efforts, what’s unique about the light adjustable lens rather than the toric is we are actually adjusting the refractive power of the lens after surgery, starting a couple of weeks later. So you’re not merely correcting the astigmatism of the cornea by placing a toric lens lined up in the axis you need. You’re actually correcting the refractive astigmatism. So your refractive, patient, correct and as best we can. And then sort of dial that power into the lens. So in a patient who has an irregular astigmatism, a complex cornea, the light adjustable lens is a great option because like I said, you can correct the refractive error without necessarily having to match up to where the axis of astigmatism is on the cornea. And if the cornea is irregular, the toric just may not be able to do that.

What are the key take-home messages of your presentation? (3:00)

There were several key messages to my presentation. The point of it was very few patients are able to buy a suit off the rack and the same thing happens with a lens implant. It is not uncommon for there to be some residual refractive error, no matter how accurate our measurements are. So at the light adjustable lens does it gives us the opportunity to refine the post-op refraction after the lenses in the eye to fine tune these outcomes in a patient who has a complex cornea. Maybe there post LASIK or post RK. The IOL calculations are less accurate to begin with. There’s a much higher likelihood of having a greater refractive miss, and this allows us the option of going back after the fact and really fine tuning them, giving them the best vision possible. And even in some patients who have normal corneas, you still have that luxury of being able to fine tune that and to refine their outcome. Patients think they want monovision and they decide, I need more near. You can change it and add it more nearer. They need more distance. You can change that. And you can do it several times until you lock them in. So having that flexibility is a great option, particularly in a cornea. You may not hit the target on the button right off the bat.

Subtitles and transcript were auto-generated.