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Dr.Jai Gopal Agrawal

Background

  • Cataract surgery is now refractive surgery after modern intra ocular lens(IOL) implantation.
  • Distance 6/6 visual acuity along with extend N/6 near vision the desired goal to be achieved by every ophthalmologist.
  • Multifocal IOLs are commonly used  to achieve good quality extended near vision. Complications of multifocal IOLs are glare, ghost images and decrease contrast sensitivity.
  • Myopic or compound surgical induced astigmatism (SIA) at vertical meridian also contribute to extended near vision along with excellent distance vision 1 .
  • SIA induced near vision by mono focal IOLs is under explored field and required more research.
  • So in this study, our endeavor was to discover more in this field.

Aims and Objectives

  • To study and identify factors responsible for Surgical Induced Astigmatism (SIA) induced extended near vision in monofocal psuedophakic eyes.
  • To suggest the type and amount of surgical induced astigmatism responsible of the best quality extended near vision

Material and Methods

  • This was a prospective non interventional observational study.
  • The study was done at J. Watumull Global Hospital & Research Centre, Mount Abu Rajasthan.
  • 144 mono focal psuedophakic eyes, who had 6/18 or better distant vision were assessed for extended near vision.
  • Near vision was recorded on the illuminated Landolt C chart.

Criteria

Inclusion Criteria:

  • Patients with monofocal psuedophakic eyes having 6/18 or better unaided vision

Exclusion Criteria:

  • Patients with monofocal psuedophakic eyes having worse than 6/18 unaided vision
  • Patients with other ocular co-morbidity

Data Collection

  • Distance and near uncorrected visual acuity (UCVA ),best corrected visual acuity (BCVA) ,refraction and acceptance of the monofocal psuedophakic patients visiting to  out patient department of the ophthalmology

Data Analysis

  • Data would be analyzed using appropriate statistical formulae

Results

  • The eyes with 0.50 D simple myopic astigmatism (SMA) had N18 and 6/9 or better in 61% (22/36) eyes, N24 and 6/9 or better in 92 % eyes(33/36).
  • The eyes with 0.75D SMA had N6 and 6/6 in 25%(4/16) eyes, N6 and 6/9 in 50% (8/16) eyes and N6 and 6/12 in 25%(4/16) eyes.
  • The eyes with 1.0D SMA had N9 and 6/9 in 11/18(61%) eyes, N9 and 6/12 or better in 14/18(77.7%) eyes , N9 and 6/18 or better in 100 % eyes (table 1)
  • All patients(6/6) 5 D simple hyperopic astigmatism had   6/9 or better distance vision and  N18 near vision
  • The patients with 0.75D simple hyperopic astigmatism had N6 and 6/9 or better in 60% (9/15) eyes and N6 and 6/12 or better in 86% (13/15). (Table 2)

Table 1: Simple myopic astigmatism

                                         Table 2: Simple hyperopic astigmatism

Discussion

  • Post cataract surgery simple myopic astigmatism (SMA),Simple hyperopic astigmatism (SHA),compound astigmatism and mixed astigmatism contribute extended near vision by mono focal IOL.
  • 92 % Patients with simple myopic astigmatism of 0.50 D had 6/9 or better unaided  distance vision and N24 or better useful near vision
  • All patients with 0.75 simple myopic astigmatism had 6/12 or better unaided distance vision and N6.
  • The patients with 1.0D simple myopic astigmatism had N9 near vision and 6/12 or better distance vision.
  • All patients 5 D simple hyperopic astigmatism had   6/9 or better distance vision and  N18 near vision
  • The patients with 0.75D simple hyperopic astigmatism had N6 and 6/9 or better in 60% eyes and N6 and 6/12 or better in 86%.
  • In this study, we found that patient with 0.75 D simple myopic astigmatism had very good distance vision along with excellent near vision.

Conclusion

  • Planned post cataract surgery 0.75 D residual myopic astigmatism provides excellent distance vision as well as near vision by monofocal intra ocular lens.
  • It is a simple, effective and economical option of an extended near vision in contrast to costly multifocal intra ocular lens.

Disclosure

  • Author does have no conflicts of interest to disclose

References

1 .Sudhir Singh. Techniques over technology. Cataract refractive surgery today Europe February 2017  https://crstodayeurope.com/articles/2017-feb/ophthalmology-wish-list/
 

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