Impact of Wavefront Aberrometry, Algorithm Optimization, and Device Standardization on Acuity Potential in Premium Refractive Cataract Surgery
Narrative Responses:
Purpose
To assess the utility of wavefront aberrometry measured higher order aberrations (HOA), Algorithm Optimization (AO) from prior clinical data, need for pupil dilation and standardization of acuity potential testing (in the form of a retinal acuity meter (RAM)) on the accuracy of predicting post-op BSCVA (POVa).
Methods
A retrospective chart review of 1370 eyes screened for premium refractive cataract surgery was performed. 522 consecutive cataract surgeries w/ adequate follow-up were identified. Corneal wavefront aberrometry(C-HOA), algorithm optimized pinhole acuity potential(AO-PAP), RAM, co-morbid diagnoses and BSCVAs were compared at 4 & 8wks post-op. Eyes were divided into 3 Grps on preop BSCVAs: I:20/20-50, II:20/60-200, III:<20/400. Lines of inaccuracy (LI) were calculated by subtracting pre-op predicted Va from POVa. T-tests were performed between OPAP and RAM for different levels of C-HOA and diagnoses including ERM, AMD, amblyopia, pterygia/corneal.
Results
AO-PAP(dilated) had cumulative 0,+/-1,2,3 LIs in 41%/82%/94%/98% of eyes vs RAM(undilated) in 39%/84%/94%/98%, there was no sig. diff.(p>0.01). RAM had sig. more overestimates of POVa than AO-PAP, especially in GrpsI and II and in subgroups ERM/AMD. AO-PAP and RAM underestimated POVa in 33% and 21% of eyes and overestimated in 27% and 40% respectively. Both AO-PAP and RAM were poor estimates of POVa in GrpIII pts. Although there was no sig. diff.(p>0.01) in the average or median C-HOA of patients, there was a trend towards higher C-HOAs w/ more LI’s.
Conclusion
Acuity potential testing is most accurate w/pre-op Va<20/400(Grp I&II). Algorithm optimization and wavefront aberrometry can potentially improve standardized acuity potential estimates. This was surprisingly similar both for dilated & undilated pupils and can be used to improve acuity potential testing in refractive cataract surgery.