Refractive Lens Surgery I. H. Fine
M. Packer
R. S. Hoffman (Eds.)
Editors I. Howard Fine Mark Packer
Richard S. Hoffman
With 170 Figures, Mostly in Colour, and 11 Tables
Refractive
Lens Surgery
123
Editors
I. Howard Fine, MD Mark Packer, MD, FACS Richard S. Hoffman, MD Department of Ophthalmology Oregon Health & Science University 1550 Oak St. Suite 5
Eugene, Oregon 97401 USA
Library of Congress Control Number: 2005924302
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The editors respectfully dedicate this book to the many pioneers of refractive surgery who had the courage to operate on healthy eyes in order to enhance the quality of life of their patients. They were right all along
and those of us who were doubters have learned that lesson and as a result have enhanced the satisfaction we derive from our own careers.
V
Dedication for Refractive Lens Surgery
The first recorded time a human lens was removed for the purpose of addressing a refractive error was by an ophthalmologist named Fukala in 1890. We do not know what type of criticism he experienced, but we know that today he is a forgotten man in ophthalmology. The introduction of this as a concept in the late 1980s by both Drs. Paul Koch and Robert Osher’s manuscripts, re- sulted in considerable disdain and some condemnation by some of their colleagues and peers. At the time, refractive surgery in the United States was limited to radial ker- atotomy. With the development of excimer lasers came a very marked change in the at- titude of eye surgeons internationally re- garding the concept of invading “healthy”
tissue for refractive purposes and within a relatively short period of time, LASIK was a firmly established procedure as were other modalities of corneal refractive surgery.
However, we have come to recognize that corneal refractive surgery, and especially LASIK, has limitations. We have also learned much in the recent past about functional vision through the use of con- trast sensitivity and an analysis of higher order optical aberrations. We have also learned that the cornea has constant spher- ical aberration but the lens has changing spherical aberrations. In the young, the hu- man lens compensates for the cornea’s pos- itive spherical aberration, but as we age the changing spherical aberration within the lens exacerbates corneal spherical aberra-
tion. Because of the changing spherical aberration in the lens, no matter what is done to the cornea as a refractive surgery modality, including the most sophisticated custom corneal shaping, functional vision is going to be degraded by changing spher- ical aberration in the lens over time.
This coupled with the fact that higher myopes and hyperopes, patients with early cataracts, and presbyopes are not necessar- ily good candidates for LASIK has resulted in a fresh look at lens-based refractive sur- gery. We have seen recent improvements in phakic IOL technology and utilization and we ourselves have been increasingly moti- vated to work with lens related refractive surgery modalities.
Our own work with power modulations, the IOL Master, and wavefront technology IOLs has convinced us that lens-related re- fractive surgery can give superior results.
Stephen Klyce, MD, the developer of corneal topography has demonstrated, using topographical and wavefront analysis methods, that IOL intraocular optics are far superior to the optics of the most so- phisticated, customized wavefront treated cornea. We have also seen the development of new lens technologies including im- proved multifocal IOLs, improved accom- modative IOLs, light adjustable IOLs, in- jectable IOLs, and a variety of other investigational IOL technologies that sug- gest unimaginable possibilities. Our own results with the Array and Crystalens have
VII
Preface
been very encouraging as has our work with bimanual micro-incision phacoemul- sification, which I believe has allowed us to develop a refractive lens exchange tech- nique that sets a new standard for safety and efficacy. It is our belief that refractive lens exchange is indeed not only the future of refractive surgery, but in many ways the procedure that will become a mainstay of ophthalmology within the coming decades.
A major task for any editor is delegation, and this book represents the ultimate in
delegation. My reliance on my two partners is evident throughout the book in the au- thorship of the chapters we have produced.
It is my belief that just as refractive lens exchange represents the future of refractive surgery that my partners, Drs. Richard S.
Hoffman and Mark Packer, represent the new generation of leadership in anterior segment ophthalmic surgery.
I. Howard Fine
VIII Preface
Chapter 1
The Crystalline Lens as a Target
for Refractive Surgery . . . 1 Mark Packer, I. Howard Fine,
Richard S. Hoffman Chapter 2
Refractive Lens Exchange
as a Refractive Surgery Modality . . . 3 Richard S. Hoffman, I. Howard Fine, Mark Packer
Chapter 3
Biometry for Refractive Lens Surgery. . 11 Mark Packer, I. Howard Fine,
Richard S. Hoffman Chapter 4
Intraocular Lens Power Calculations:
Correction of Defocus . . . 21 Jack T. Holladay
Chapter 5
IOL Calculations Following
Keratorefractive Surgery. . . 39 Douglas D. Koch, Li Wang
Chapter 6
Correction of Keratometric Astigmatism:
Incisional Surgery . . . 49 Louis D. Nichamin
Chapter 7
STAAR Toric IOL . . . 59 Stephen Bylsma
Chapter 8
Correction of Keratometric Astigmatism:
AcrySof Toric IOL . . . 71 Stephen S. Lane
Chapter 9
Wavefront Technology
of Spherical Aberration . . . 79 Mark Packer, I. Howard Fine,
Richard S. Hoffman Chapter 10
The Eyeonics Crystalens . . . 87 Steven J. Dell
Chapter 11
Presbyopia – Cataract Surgery with Implantation of the Accommodative Posterior
Chamber Lens 1CU. . . 99 Nhung X. Nguyen,
Achim Langenbucher, Berthold Seitz, M. Küchle Chapter 12
Synchrony IOL. . . 113 H. Burkhard Dick, Mana Tehrani, Luis G. Vargas, Stephen D. McLeod Chapter 13
Sarfarazi Elliptical Accommodative Intraocular Lens . . . 123 Faezeh Mona Sarfarazi
IX
Contents
Chapter 14 AcrySof ReSTOR
Pseudo-accommodative IOL . . . 137 Alireza Mirshahi, Evdoxia Terzi, Thomas Kohnen
Chapter 15
The Tecnis Multifocal IOL . . . 145 Mark Packer, I. Howard Fine,
Richard S. Hoffman Chapter 16
Blue-Light–Filtering Intraocular
Lenses . . . 151 Robert J. Cionni
Chapter 17
The Light–Adjustable Lens. . . 161 Richard S. Hoffman, I. Howard Fine, Mark Packer
Chapter 18
Injectable Polymer . . . 173 Sverker Norrby
Chapter 19
The Vision Membrane . . . 187 Lee Nordan, Mike Morris
Chapter 20
Bimanual Ultrasound
Phacoemulsification . . . 193 Mark Packer, I. Howard Fine,
Richard S. Hoffman Chapter 21
Low Ultrasound Microincision
Cataract Surgery . . . 199 Jorge L. Alio, Ahmed Galal,
Jose-Luis Rodriguez Prats, Mohamed Ramzy
Chapter 22
The Infiniti Vision System . . . 209 Mark Packer, Richard S. Hoffman, I. Howard Fine
Chapter 23
The Millennium . . . 213 Rosa Braga-Mele, Terrence Devine, Mark Packer
Chapter 24
The Staar Sonic Wave . . . 221 Richard S. Hoffman, I. Howard Fine, Mark Packer
Chapter 25 AMO Sovereign
with WhiteStar Technology . . . 227 Richard S. Hoffman, I. Howard Fine, Mark Packer
Chapter 26
Refractive Lens Exchange in High Myopia:
Weighing the Risks . . . 233 Mark Packer, I. Howard Fine,
Richard S. Hoffman Chapter 27
Conclusion: The Future
of Refractive Lens Surgery . . . 237 Mark Packer, I. Howard Fine,
Richard S. Hoffman
Subject Index . . . 239
X Contents
Jorge L. Alio, MD,PhD Inst Oftalmologico de Alicante Avda Denia 111
Alicante 03015, Spain
Rosa Braga-Mele, MD, FRCSC 200-245 Danforth Ave.
Toronto, Ontario M4K 1N2, Canada Stephen S. Bylsma, MD
Shepherd Eye Center 1414 E Main Street
Santa Maria, CA 93454, USA Robert J. Cionni, MD Cincinnati Eye Institute 10494 Montgomery Rd Cincinnati, OH 45242, USA Steven J. Dell, MD 1700 S Mopac
Austin, TX 78746-7572, USA H. Burkhard Dick, MD,PhD Department of Ophthalmology Johannes Gutenberg-University Langenbeckstraße 1
55131 Mainz, Germany I. Howard Fine, MD
Department of Ophthalmology Oregon Health & Science University 1550 Oak St. Suite 5
Eugene, Oregon 97401, USA
Richard S. Hoffman, MD Department of Ophthalmology Oregon Health & Science University 1550 Oak St. Suite 5
Eugene, Oregon 97401, USA Jack Holladay, MD 5108 Braeburn Drive
Bellaire, TX 77401-4902, USA John Hunkeler, MD Hunkeler Eye Institute, P.A.
4321 Washington, Suite 6000 Kansas City, MO 64111-5905, USA Douglas Koch, MD
Cullen Eye Institute 6565 Fannin, Suite NC205 Houston, TX 77030, USA Thomas Kohnen, MD
Johann Wolfgang Goethe-University Department of Ophthalmology Theodor-Stern Kai 7
60590 Frankfurt, Germany Stephen S. Lane, MD Associated Eye Care, Ltd.
232 North Main Street Stillwater, MN 55082, USA Richard L. Lindstrom, MD Minnesota Eye Consultants, P.A.
710 E. 24th Street, Suite 106 Minneapolis, MN 55404, USA
Contributors
XI
Alireza Mirshahi, MD Recklinghausen Eye Center Erlbruch 34-36
45657 Recklinghausen, Germany Mike Morris, MD
Ocala Eye Surgeons
1500 S Magnolia Ext Ste 106 Ocala, FL 34471, USA Nhung X. Nguyen, MD University Eye Hospital University Erlangen-Nürnberg Schwabachanlage 6
91054 Erlangen, Germany Louis D. Nichamin, MD Laurel Eye Clinic
50 Waterford Pike
Brookeville, PA 15825, USA Lee Nordan, MD
6183 Paseo Del Norte, Ste. 200 Carlsbad, CA 92009, USA
Sverker Norrby, MD Van Swietenlaan 5 9728 NX Groningen The Netherlands
Mark Packer, MD, FACS Department of Ophthalmology Oregon Health & Science University 1550 Oak St. Suite 5
Eugene, Oregon 97401, USA
Faezeh Mona Sarfarazi, MD, FICS President, Shenasa Medical LLC 7461 Mermaid Lane
Carlsbad, CA 92009, USA Evdoxia Terzi, MD
Johann Wolfgang Goethe-University Department of Ophthalmology Theodor-Stern Kai 7
60590 Frankfurt, Germany
XII Contributors
