Aspheric Optical Zones in hyperopia with the SCHWIND AMARIS

Purpose: To evaluate the corneal Functional Optical Zone (FOZ) and the Effective Optical Zone (EOZ) of the ablation, among eyes that underwent LASEK/Epi-LASEK treatments for hyperopic astigmatism. Methods: Twenty LASEK/Epi-LASEK treatments with mean defocus +2.21 ± 1.28 D performed using the SCHWIND AMARIS were retrospectively evaluated at 6-month follow-up. In all cases pre-/post-operative Corneal-Wavefront analyses using the Keratron-Scout (OPTIKON2000) were performed. FOZ-values were evaluated from the Root-Mean-Square of High-Order Wave-Aberration (RMSho), whereas EOZ-values were evaluated from the changes of Root-Mean-Square of High-Order Wave-Aberration (ΔRMSho) and Root-Mean-Square of the change of High-Order Wave-Aberration (RMS(ΔHOAb)). Correlations of FOZ and EOZ with Planned Optical Zone (POZ) and Defocus correction (SEq) were analyzed using a bilinear function. Results: At six-month, defocus was −0.04 ± 0.44 D, ninety percent eyes were within ± 0.50 D from emmetropia. Mean RMSho increased 0.18 ± 0.22 μm, SphAb −0.30 ± 0.18 μm, and Coma 0.07 ± 0.18 μm 6-month after treatment (6-mm diameter). Mean FOZPre was 7.40 ± 1.48 mm, mean POZ was 6.76 ± 0.22 mm, whereas mean FOZPost was 5.53 ± 1.18 mm (significantly smaller, p < 0.0001; bilinear correlation p < 0.005), mean EOZΔRMSho 6.47 ± 1.17 mm (bilinear correlation p < 0.005), EOZRMS(ΔHOAb) 5.67 ± 1.23 mm (significantly smaller, p < 0.0005; bilinear correlation p < 0.05). EOZ positively correlates with POZ and declines steadily with SEq. A treatment of +3 D in 6.50-mm POZ results in 5.75-mm EOZ (7.75-mm NPOZ), treatments in 7.00-mm POZ result in about 6.25-mm EOZ (8.25-mm nomogrammed POZ). Conclusions: FOZPost was significantly smaller than FOZPre. EOZΔRMSho was similar to POZ, whereas EOZRMS(ΔHOAb) was significantly smaller. Differences were larger for smaller POZ or larger Defocus. SEq up to +2 D result in EOZ, at least, as large as POZ. For SEq higher than +2 D, a nomogram for OZ can be applied

IOL Power Calculation in an Unusual Long Fellow Eye: A Case Report

Background: Intra-Ocular Lens (IOL) power calculation in long eyes remains challenging despite the availability of new formulas and biometers. This case report shows that optimization of the A-constant in the first eye can reduce postoperative refractive error in the second eye, even in the case of an IOL with negative power. This report aimed to describe a case in which this method was used to calculate IOL power to reduce postoperative refractive error in a long fellow eye. As far as we know, this is the first paper reporting the use of the optimized constant in the first eye to reduce postoperative error in the second eye in the case of a negative IOL. Case presentation: A highly myopic patient with nuclear cataracts underwent phacoemulsification cataract surgery (PCS) in both eyes. The axial length (AL) was 39.42 mm in the right eye and 37.45 mm in the left eye. All biometric data were obtained via low-coherence reflectometry using an OA-2000 biometer (Tomey, Nagoya, Japan). First, an IOL power calculation using the Barrett II formula and PCS was performed in the shorter eye. To evaluate the postoperative refractive error, the optimized A-constant in the left eye was estimated using the Camellin-Calossi formula. The new A-constant was then used for the right eye IOL power calculation using the same formula. The prediction error (PE) in the left eye was −0.23 D with the Barrett II formula. The optimized A-constant method using the Camellin-Calossi formula in the fellow eye gave −0.28 D of PE. Conclusions: The A-constant optimization for very long eyes, using data from the first operated eye, may be useful to reduce refractive prediction error in the second eye in very long eyes, as well as in the case of IOL power with negative values