1. Cataract Extraction with Pseudoaccommodating Intraocular Lens in Patients with Previous Radial Keratotomy Ross Bloomberg, MD Niraj Shah, BS William Martin, MD University of Toledo Health Science Campus Ross Bloomberg, MD has no financial interest to disclose. Niraj Shah has no financial interest to disclose. William Martin, MD is a consultant to Alcon and AMO.

2. Background An increasing number of radial keratectomy (RK) patients are reaching an age where cataracts are becoming visually significant An increasing number of radial keratectomy (RK) patients are reaching an age where cataracts are becoming visually significant Many previous RK patients desire spectacle independence Many previous RK patients desire spectacle independence RK induces a multifocal cornea and other higher order aberrations 1-3, so prior RK patients are poor candidates for multifocal intraocular lenses RK induces a multifocal cornea and other higher order aberrations 1-3, so prior RK patients are poor candidates for multifocal intraocular lenses RK patients may tolerate pseudoaccommodating intraocular lenses RK patients may tolerate pseudoaccommodating intraocular lenses

3. Purpose To report the safety, efficacy, and patient satisfaction of phacoemulsification with implantation of a pseudoaccommodating intraocular lens in patients with prior radial keratotomy To report the safety, efficacy, and patient satisfaction of phacoemulsification with implantation of a pseudoaccommodating intraocular lens in patients with prior radial keratotomy

4. Methods A retrospective chart review was performed on 15 eyes of 8 patients with previous RK undergoing cataract extraction using phacoemulsification A retrospective chart review was performed on 15 eyes of 8 patients with previous RK undergoing cataract extraction using phacoemulsification All procedures were performed by a single surgeon (WGM) through a scleral tunnel incision with implantation of a pseudoaccommodating intraocular lens (Crystalens AT-50SE, Eyeonics, Aliso Viejo, California, USA) All procedures were performed by a single surgeon (WGM) through a scleral tunnel incision with implantation of a pseudoaccommodating intraocular lens (Crystalens AT-50SE, Eyeonics, Aliso Viejo, California, USA)

5. Methods Distance, intermediate, and near visual acuity were measured at 1 day, 1 week, 1 month, and 3 months. Residual refractive error was measured at 1 month and 3 months. Distance, intermediate, and near visual acuity were measured at 1 day, 1 week, 1 month, and 3 months. Residual refractive error was measured at 1 month and 3 months. Patients were asked to complete follow up satisfaction surveys. Subjective complaints at follow up visits were noted. Patients were asked to complete follow up satisfaction surveys. Subjective complaints at follow up visits were noted.

6. Results Uncorrected vision 14/15 (93.3%) of eyes had distance VA >20/40 Uncorrected vision 14/15 (93.3%) of eyes had distance VA >20/40 Uncorrected vision 12/15 (80%) of eyes had intermediate VA >20/40 Uncorrected vision 12/15 (80%) of eyes had intermediate VA >20/40 Uncorrected vision 12/15 (80%) of eyes had near VA J3 or better Uncorrected vision 12/15 (80%) of eyes had near VA J3 or better 1 eye had VA of 20/80 at 1 month post op with manifest refraction of +2.75 -0.50 x 90. After subsequent sulcus placed piggyback IOL, 3 month post op from piggyback DVA was 20/20, IVA was 20/20, and NVA was J3. 1 eye had VA of 20/80 at 1 month post op with manifest refraction of +2.75 -0.50 x 90. After subsequent sulcus placed piggyback IOL, 3 month post op from piggyback DVA was 20/20, IVA was 20/20, and NVA was J3.

7. Visual Results

8. Results

9. Results – Spectacle Dependence Percentage of time wearing spectacles Percentage of time wearing spectacles Patient 1 – 0% Patient 1 – 0% Patient 2 – did not reply Patient 2 – did not reply Patient 3 – 0% Patient 3 – 0% Patient 4 – 10% Patient 4 – 10% Patient 5 – 10% Patient 5 – 10% Patient 6 – did not reply Patient 6 – did not reply Patient 7 – 30% Patient 7 – 30% Patient 8 – 0% Patient 8 – 0%

10. Results 5/5 (100%) of patients stated they would make the same choice for their eyes again 5/5 (100%) of patients stated they would make the same choice for their eyes again One patient who completed the survey did not answer this question One patient who completed the survey did not answer this question 3/6 (50%) of patients rated glare symptoms as >3/10 3/6 (50%) of patients rated glare symptoms as >3/10 2/6 (33%) of patients rated halo symptoms as >3/10 2/6 (33%) of patients rated halo symptoms as >3/10 1 patient complained of monocular diplopia at distance 1 patient complained of monocular diplopia at distance 1 patient noted blurred vision in the morning that improved through the day 1 patient noted blurred vision in the morning that improved through the day 2/8 patients did not complete the survey 2/8 patients did not complete the survey one patient could not be reached one patient could not be reached one patient refused survey stating they were unhappy with the experience, but did not elaborate one patient refused survey stating they were unhappy with the experience, but did not elaborate

11. Conclusions Pseudoaccommodating IOLs can be well tolerated in post-RK patients Pseudoaccommodating IOLs can be well tolerated in post-RK patients Pseudoaccommodating IOLs can allow for spectacle independence in post RK patients Pseudoaccommodating IOLs can allow for spectacle independence in post RK patients Multifocal cornea may contribute to spectacle independence 1-3 Multifocal cornea may contribute to spectacle independence 1-3 Post op complaints were consistent with prior RK (glare, halos, monocular diplopia, diurnal fluctuation, error in IOL calculation) 4-11 Post op complaints were consistent with prior RK (glare, halos, monocular diplopia, diurnal fluctuation, error in IOL calculation) 4-11 Glare Glare 14/16 eyes in this study had glare 20/70 or worse preop (BAT or MCT) 14/16 eyes in this study had glare 20/70 or worse preop (BAT or MCT) Post op significant glare complaints are comparable to those in PERK study Post op significant glare complaints are comparable to those in PERK study 225/425 (52.9%) patients in the Prospective Evaluation of Radial Keratotomy (PERK) study reported glare with bright lights 4 225/425 (52.9%) patients in the Prospective Evaluation of Radial Keratotomy (PERK) study reported glare with bright lights 4

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