Outcomes After Implantation of a Trifocal Toric Intraocular Lens Using Intraoperative Aberrometry, Digital Image Tracking, and Femtosecond Laser.

Purpose: To evaluate the refractive and visual acuity outcomes when using trifocal toric intraocular lenses (IOLs), femtosecond laser assisted cataract surgery (FLACS), swept-source optical coherence tomography (SS-OCT) biometry, digital image tracking (DT) and intraoperative aberrometry (IA). Methods: This prospective, single-arm, observational study of refractive and visual outcomes included 40 eyes of 34 subjects. Preoperative biometry was performed with the Argos, FLACS and digital marking with LenSx, and IA and DT with ORA. Eyes were implanted with the Clareon PanOptix toric IOL. Study outcome measures included absolute prediction error, residual refractive astigmatism, and monocular uncorrected and distance corrected visual acuity at distance (UDVA, CDVA), intermediate (UIVA, DCIVA; 60cm), and near (UNVA, DCNVA; 40cm). Results: Mean absolute prediction error (spherical equivalent) was 0.43 ± 0.36 D, and the percentage of eyes with absolute prediction error ≤ 0.5 D was 72.5% (29/40 eyes). Mean residual astigmatism was 0.36 ± 0.65 D, and the percentage of eyes with residual astigmatism ≤ 0.5 D was 80% (32/40 eyes). Monocular UDVA, UIVA, and UNVA was 20/25 or better in 75%, 64%, and 87% of eyes respectively. Monocular CDVA, DCIVA, and DCNVA was 20/25 or better in 95%, 64%, and 87% of eyes respectively. Conclusion: The results of this study suggest that trifocal toric implantation with SS-OCT, FLACS, DT, and IA can provide excellent refractive and visual outcomes.

When the natural lens inside the eye becomes opaque (develops a cataract), it can be surgically replaced with a clear artificial intraocular lens (IOL). There are many different technologies available to the cataract surgeon in order to maximize postoperative visual outcomes with implanted IOLs. These include, modern biometers, femtosecond laser-assisted cataract surgery (FLACS), trifocal IOLs, toric IOLs, image-guided digital tracking (DT), and intraoperative aberrometry (IA). Individually, good refractive outcomes have been reported with these technologies. However, there is minimal data on outcomes using a combination of all of them. The purpose of this study was to determine the refractive and visual acuity outcomes when using modern biometers, toric IOLs, FLACS, DT, IA, and trifocal IOLs. The results of this study suggest that trifocal toric implantation with modern biometry, FLACS, DT, and IA can provide excellent refractive and visual outcomes.

Visual Function After Implantation of Trifocal and Trifocal Toric Intraocular Lenses Using Intraoperative Aberrometry.

Purpose: To evaluate patient outcomes and visual function following trifocal and trifocal toric intraocular lens (IOL) implantation using intraoperative aberrometry at a single site in the US. Methods: This prospective, single arm study included 21 subjects that completed 3 month follow-up. Inclusion criteria were visually significant cataract and potential post-operative visual acuity of 20/25 or better. Endpoints included postoperative prediction error, refractive outcomes, uncorrected visual acuities at distance (UDVA), intermediate (UIVA), and near (UNVA), contrast sensitivity, and subject responses on the modified Visual Function Quality of Life Questionnaire (VF-14 QOL). Results: Binocular UDVA, UIVA, and UNVA were 20/25 or better in 100% (21/21), 100% (21/21), 90% (19/21) of subjects. The absolute prediction error was 0.50 D or less in 79% (33/42) of eyes, and 81% (34/42) and 86% (36/42) of eyes achieved ≤0.5 D of residual astigmatism and manifest refraction spherical equivalent, respectively. On the modified VF-14 QOL, driving at night, reading small print, and reading a newspaper or book were the tasks that had the lowest percentages of subjects reporting no difficulty or a little difficulty. Conclusion: Implantation with trifocal and trifocal toric IOLs using intraoperative aberrometry can provide high refractive precision, leading to excellent visual performance and low visual task difficulty at all ranges (distance, intermediate, and near).

An intraocular lens (IOL) is a clear artificial lens that can be used to replace the natural lens in the eye when the natural lens becomes opaque (develops a cataract). Monofocal IOLs are designed to provide good vision to see distant objects; however, spectacles may still be needed to see objects clearly up close (such as reading a book or using a digital device). Trifocal IOLs are designed to provide good vision to see objects at distance and up close, however, the power of the IOL must be accurately determined for the best visual outcomes. Devices called biometers are used by cataract surgeons to measure the eye and determine the most appropriate lens power to implant. Most biometers are used prior to surgery, however one type, intraoperative aberrometry (IA), can be used during surgery to measure the eye and determine the most appropriate lens power. The purpose of this study was to evaluate patient outcomes and visual function following trifocal IOL implantation using IA. The results of this study suggest that implantation with trifocal IOLs using IA can provide high refractive accuracy and excellent visual outcomes.

Comparative evaluation of intraoperative aberrometry and Barrett's toric calculator in toric intraocular lens implantation.

Purpose: Barrett toric calculator (BTC) is known for its accuracy in toric IOL (tIOL) calculation over standard calculators; however, there is no study in literature to compare it with real-time intraoperative aberrometry (IA). The aim was to compare the accuracy of BTC and IA in predicting refractive outcomes in tIOL implantation. Methods: This was an institution-based prospective, observational study. Patients undergoing routine phacoemulsification with tIOL implantation were enrolled. Biometry was obtained from Lenstar-LS 900 and IOL power calculated using online BTC; however, IOL was implanted as per IA (Optiwave Refractive Analysis, ORA, Alcon) recommendation. Postoperative refractive astigmatism (RA) and spherical equivalent (SE) were recorded at one month, and respective prediction errors (PEs) were calculated using predicted refractive outcomes for both methods. The primary outcome measure was a comparison between mean PE with IA and BTC, and secondary outcome measures were uncorrected distance visual acuity (UCDVA), postoperative RA, and SE at one month. SPSS Version-21 was used; P < 0.05 considered significant. Results: Thirty eyes of 29 patients were included. Mean arithmetic and mean absolute PEs for RA were comparable between BTC (-0.70 ± 0.35D; 0.70 ± 0.34D) and IA (0.77 ± 0.32D; 0.80 ± 0.39D) (P = 0.09 and 0.09, respectively). Mean arithmetic PE for residual SE was significantly lower for BTC (-0.14 ± 0.32D) than IA (0.001 ± 0.33D) (-0.14 ± 0.32D; P = 0.002); however, there was no difference between respective mean absolute PEs (0.27 ± 0.21 D; 0.27 ± 0.18; P = 0.80). At one-month, mean UCDVA, RA, and SE were 0.09 ± 0.10D, -0.57 ± 0.26D, and -0.18 ± 0.27D, respectively. Conclusion: Both IA and BTC give reliable and comparable refractive results for tIOL implantation.

Intraoperative aberrometry versus preoperative biometry for intraocular lens power selection in patients with axial hyperopia.

Purpose: This study was conducted to evaluate the accuracy of intraoperative aberrometry (IA) in intraocular lens (IOL) power calculation and compare it with conventional IOL formulas. Methods: This was a prospective case series. Eyes with visually significant cataract and axial hyperopia (AL <22.0 mm) underwent IA-assisted phacoemulsification with posterior chamber IOL (Alcon AcrySof IQ). Postoperative spherical equivalent (SE) was compared with predicted SE to calculate the outcomes with different formulas (SRK/T, Hoffer Q, Haigis, Holladay 2, Barrett Universal Ⅱ and Hill-RBF). Accuracy of intraoperative aberrometer was compared with other formulas in terms of mean absolute prediction error (MAE), percentage of patients within 0.5 D and 1 D of their target, and percentage of patients going into hyperopic shift. Results: Sixty-five eyes (57 patients) were included. In terms of MAE, both Hoffer Q (MAE = 0.30) and IA (MAE = 0.32) were significantly better than Haigis, SRK/T, and Barrett Universal Ⅱ (P < 0.05). Outcomes within ±0.5 D of the target were maximum with Hoffer Q (80%), superior to IA (Hoffer Q > IA > Holladay 2 > Hill-RBF > Haigis > SRK/T > Barrett Universal Ⅱ). Hoffer Q resulted in minimum hyperopic shift (30.76%) followed by Hill-RBF (38.46%), Holladay 2 (38.46%), Haigis (43.07%), and then IA (46.15%), SRK/T (50.76%) and Barrett Universal Ⅱ (53.84%). Conclusion: IA was more effective (statistically significant) in predicting IOL power than Haigis, SRK/T, and Barrett Universal Ⅱ although it was equivalent to Hoffer Q. Hoffer Q was superior to all formulas in terms of percentage of patients within 0.5 D of their target refractions and percentage of patients going into hyperopic shift.

Impact of Global Optimization of Lens Constants on Absolute Prediction Error for Final IOL Power Selection When Using Intraoperative Aberrometry.

Purpose: To evaluate absolute prediction errors following phacoemulsification with implantation of a multifocal toric intraocular lens (IOL) using intraoperative aberrometry for IOL power selection and to compare findings with the globally optimized and manufacturer's recommended lens constants and regression coefficients. Methods: Data from the Optiwave Refractive Analysis (ORA SYSTEM) were analyzed retrospectively. Absolute prediction errors from surgeries performed before and after the first optimization of the manufacturer's recommended lens constant and non-optimized regression coefficients for the multifocal toric IOL (SND1T3-6) were compared. Optimization was based on outcomes of procedures performed using the ORA SYSTEM and archived in its database (AnalyzOR). Outcome measures included the proportion of eyes with absolute ORA SYSTEM prediction errors ≤0.25 D and ≤0.5 D and the mean and median absolute prediction errors. Results: The pre-optimization group included 1027 eyes operated on by 184 surgeons, and the optimized group included 419 eyes operated on by 143 surgeons. The proportions of eyes achieving absolute ORA SYSTEM prediction errors ≤0.25 D (52.5% vs 35.0%, p < 0.0001) and ≤0.50 D (83.1% vs 66.2%, p < 0.0001) were significantly higher in the optimized than in the pre-optimization group. The mean ± standard deviation (0.30 ± 0.25 D vs 0.43 ± 0.32 D, p < 0.0001) and median (0.24 D vs 0.36 D, p < 0.0001) absolute ORA SYSTEM prediction errors were significantly lower after than before optimization. Prediction errors following optimization were reduced more in eyes of average than of long and short axial lengths. Conclusion: Global optimization of the manufacturer's IOL lens constants and regression coefficients resulted in lower absolute prediction errors when compared with the initial manufacturer labeled lens constants and non-optimized regression coefficients. Reductions in absolute prediction error can result in lower postoperative residual refractive error, which can improve post-operative uncorrected visual acuity and provide the potential for greater patient satisfaction following cataract surgery.

Evaluation of Refractive Accuracy of ORA and the Factors Impacting Residual Astigmatism in Patients Implanted with Trifocal IOLs During Cataract Surgery: A Retrospective Observational Study.

Purpose: To assess the refractive accuracy of the intraoperative aberrometer Optiwave Refractive Analysis (ORA) and evaluate factors impacting residual astigmatism in eyes implanted with PanOptix (TFNT) trifocal intraocular lenses (IOLs) during cataract surgery. Patients and Methods: This retrospective study examined 180 eyes implanted with a toric or non-toric trifocal IOL during cataract surgery. The mean refractive prediction error (RPE), median absolute RPE, and percentage of eyes with an absolute RPE ≤0.25, ≤0.50, ≤0.75, and ≤1.00 diopter (D) were determined for ORA and each of the IOL power formulas (Sanders-|Retzlaff-Kraft/Theoretical [SRK/T], Barrett Universal II, and Haigis). Correlation analysis of postoperative residual astigmatism and factors associated with it was performed using Pearson's and Spearman correlations in eyes with non-toric trifocal IOLs. Results: After optimization, the median absolute RPE was 0.19 D, 0.25 D, 0.20 D, and 0.26 D in eyes measured using ORA and the SRK/T, Barrett Universal II, and Haigis formulas, respectively. An absolute RPE ≤0.50 D after optimization was noted in 92.8%, 83.3%, 88.3%, and 81.1% of the eyes using ORA and the SRK/T (p=0.0093), Barrett Universal II (p=0.2071), and Haigis (p=0.0018) formulas, respectively, showing significant differences between ORA and the SRK/T and Haigis formulas. The mean±standard deviation subjective residual astigmatism in non-toric IOL eyes (N=76) was 0.46±0.39 D and showed a strong positive correlation with preoperative objective refractive astigmatism (r=0.2925, p=0.0109), intraoperative ORA-measured astigmatism (r=0.5555, p<0.0001), postoperative objective refractive astigmatism (r=0.8188, p<0.0001), and postoperative total corneal astigmatism (TCA) (r=0.4051, p=0.0003) and a negative correlation with preoperative anterior corneal astigmatism (r=-0.3541, p=0.0017). Conclusion: ORA is a salient tool for improving the postoperative refractive accuracy of trifocal IOL power calculations and may help in determining the need for toric IOL use in astigmatic eyes with cataracts. Residual astigmatism correlated with objective refractive astigmatism, ORA-measured astigmatism, and postoperative TCA.

Refractive Outcomes Following Trifocal Intraocular Lens Implantation in Post-Myopic LASIK and PRK Eyes.

Purpose: To assess refractive outcomes of a trifocal intraocular lens (IOL) in post-myopic laser refractive surgery eyes. Methods: This was a retrospective chart review of 35 eyes (21 patients), with history of laser refractive surgery, who were implanted with a trifocal IOL. Surgeon's standard procedure included femtosecond laser (FLACS), digital registration, and intraoperative aberrometry (IA). The primary outcome measure was absolute prediction error. Secondary measures were refractive outcomes, postoperative residual astigmatism (PRA), monocular uncorrected visual acuity at distance (UDVA; 4m), intermediate (UIVA; 60cm), and near (UNVA; 40cm), and monocular best-corrected visual acuity at distance (BCVA; 4m). Results: At 3 months postoperatively, 71% and 68% of eyes had absolute prediction error 0.5 D or less with IA and preoperative planning respectively, which was not statistically significant (p > 0.05). The PRA was 0.5 D or less in 91% of eyes with IA and 56% of eyes with preoperative planning. The PRA differences between IA and preoperative planning were statistically significant (p < 0.002). The percentage of eyes 20/20 or better for monocular UCVA, BCVA, UIVA, and UNVA was 29%, 77%, 78%, and 66%, respectively. Absolute prediction error 0.5 D or less was significantly higher in post-LASIK eyes versus post-PRK eyes (p < 0.003), at 85% and 56% of eyes, respectively. Conclusion: Implantation with a trifocal IOL can provide acceptable refractive and visual outcomes with minimal residual astigmatism in post-myopic LASIK and PRK eyes.

Refractive Accuracy of Barrett True-K vs Intraoperative Aberrometry for IOL Power Calculation in Post-Corneal Refractive Surgery Eyes.

PURPOSE: To compare the refractive predictability of intraoperative aberrometry (IA, ORA, Alcon) and Barrett True-K/Universal II formulas for intraocular lens (IOL) power calculations in post-corneal refractive surgery and normal eyes. METHODS: Retrospective study of normal and post-corneal refractive surgery eyes that underwent cataract surgery with IA at tertiary academic center. Preoperatively, IOL power calculations were performed using Barrett Universal II (normal eyes) or Barrett True-K (post-corneal refractive surgery eyes) formulas. Intraoperatively, aphakic IA measurements were used for IOL power calculations. Mean absolute refractive prediction error (MAE) and the percentage of eyes with prediction error within ±0.50, ±0.75 and ±1.00 D were calculated. Refractive predictability was also evaluated in short, normal, and long eyes. RESULTS: Two hundred and seventy-three eyes were included in the analysis. No statistically significant differences were observed between the MAE of preoperative formulas and IA for post-hyperopic laser vision correction (LVC), post-myopic LVC, post-radial keratotomy (RK) and normal eyes. For prediction error within ±0.5 D in post-corneal refractive surgery eyes, range of agreement between Barrett True-K and IA ranged from 28% (7/25) of the time in post-RK eyes to 49% (40/81) of the time in post-hyperopic LVC; the corresponding value for Barrett Universal II/IA was 62% (64/103) in normal eyes. When there was disagreement, IA outperformed Barrett True-K in post-hyperopic LVC eyes and Barrett formula outperformed IA in post-myopic LVC, post-RK, and normal eyes. CONCLUSION: IA appears to be comparable to Barrett formulas for IOL power calculations in post-corneal refractive surgery and normal eyes. In post-hyperopic LVC, IA yields better results compared to Barrett True-K formula; in real-life scenarios, IA reveals statistical advantage over the Barrett True-K no history formula for eyes post-hyperopic LVC.

Clinical Outcomes of Monofocal Toric IOLs Using Digital Tracking and Intraoperative Aberrometry.

PURPOSE: To evaluate clinical outcomes of a toric IOL using digital tracking (DT) and intraoperative aberrometry (IA). METHODS: This was a retrospective, single surgeon study examining 151 eyes of 106 patients. Inclusion criteria were subjects who presented with visually significant cataracts (or as a candidate for clear lens extraction) and were implanted with a toric intraocular lens. Spherical equivalent prediction errors for IA and preoperative planning were calculated and compared. Preoperative and postoperative refractive data and monocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were also collected at 3 months postoperatively. RESULTS: Postoperative actual residual refractive astigmatism with IA was 0.50 D or less in 140 eyes (92.8%) and was 0.50 D or less in 88 eyes (58.3%) with back-calculations based on preoperative planning. The absolute spherical equivalent prediction error was 0.50 D or less in 135 eyes (89.4%) for IA compared to 123 eyes (85.4%) for preoperative planning. Postoperative monocular UDVA was 0.10 logMAR or better in 124 eyes (82.1%) and 0.00 logMAR or better in 90 eyes (59.6%). Postoperative CDVA was 0.10 logMAR or better in 147 eyes (97.4%) and 134 eyes (88.7%) were 0.00 logMAR or better. CONCLUSION: The results demonstrate that toric implantation with DT and IA can provide excellent refractive and visual outcomes.

Time Utilization and Refractive Prediction Enhancement Associated with Intraoperative Aberrometry Use During Cataract Surgery.

PURPOSE: To evaluate the time cost of intraoperative aberrometry (IA), to compare IA prediction error to the prediction error associated with conventional formulas using preoperative calculations (PC) and evaluate when IA provides clinically relevant benefit. METHODS: This is a retrospective study of eyes that underwent cataract phacoemulsification surgery with IA at an academic eye center. IA versus PC prediction error were compared amongst various preoperative and intraoperative characteristics. Additionally, a dichotomous variable indicating clinically relevant benefit of IA, where IA absolute prediction error was less than 0.5D and PC absolute prediction error greater than 0.5D, was associated with clinical factors. RESULTS: Five hundred eyes of 341 patients were included in the analysis. The quantitative difference between mean absolute prediction errors for IA versus PC was between 0.0D and 0.03D in most subgroups. For the 11.0% of eyes that had clinically relevant benefit to IA, the multivariable model identified the following strongest predictors: prior myopic corneal refractive surgery (Odds ratio (OR) 3.9, p<0.01 for myopic LASIK/PRK, OR 5.5, p=0.01 for radial keratotomy), toric or multifocal/EDOF lens implantation (OR 2.7, p=0.03 for toric monofocal lenses, OR 3.1, p=0.01 for EDOF/multifocal lenses), and short and long axial lengths (p<0.01). On average, IA implementation added 3.0 minutes to surgery (p<0.01). CONCLUSION: For greatest likelihood of a clinically meaningful improvement in outcomes despite increased surgical time, surgeons and patients should consider using IA for eyes with extremes in axial length, eyes with prior myopic corneal refractive surgery, or when implanting lenses with toric or extended-depth-of-focus/multifocal properties.

Intraoperative aberrometry in cataract surgery with topical versus peribulbar anesthesia.

Purpose: To study the effect of choice of anesthesia on the refractive outcomes of intraoperative aberrometry (IA) for intraocular lens power calculation in cataract surgeries. Methods: This prospective, interventional nonrandomized cohort study was conducted at a tertiary care hospital between March and August 2018. A total of 178 patients with age-related cataract were allocated into two groups. Group 1 received peribulbar anesthesia using a mixture of xylocaine 2% + adrenaline 0.125 mg/ml + hyaluronidase 15 IU/ml with a 23G, 32 mm needle, while Group 2 received topical anesthesia with proparacaine hydrochloride 0.05% drops. Intraoperative aphakic measurements and IOL power calculations were obtained in all patients with the optiwave refractive analysis (ORA) system. Analysis was performed to compare the baseline parameters and postoperative manifest refraction at month 1. Results: A total of 89 patients were included in group 1 and 89 in group 2. At baseline, the axial lengths (P = 0.66) and mean keratometry (P = 0.91) were comparable. The quality measure of captured wavefront data was comparable (0.25) between the groups. Also, the postoperative mean refractive spherical equivalents were comparable between the two groups (P = 0.98) at one month. Conclusion: IA can be utilized well for cataract surgeries performed under local anesthesia with good quality of captured wavefront, provided the eye can be aligned in centre with the fixation light of ORA.

Efficacy of astigmatic correction after femtosecond laser-guided cataract surgery using intraoperative aberrometry in eyes with low-to-moderate levels of corneal astigmatism.

PURPOSE: To evaluate the efficacy of astigmatic correction with two types of toric intraocular lenses (IOLs) after femtosecond laser-assisted cataract surgery (FLACS) in eyes with low-to-moderate corneal astigmatism using intraoperative aberrometry for optimizing the position of the toric IOL. METHODS: Retrospective study includes a total of 99 eyes of 73 patients with anterior keratomeric astigmatism ≤ 3 D and undergoing FLACS (Catalys, Johnson & Johnson Vision) with implantation of a monofocal (Ankoris, PhysIOL) or a multifocal toric IOL with the same platform (Pod FT, PhysIOL). In all cases, intraoperative aberrometry was used (Optiwave refractive analysis, ORA, system, Alcon). Visual and refractive outcomes were evaluated preoperatively and at 4 months after surgery with vector analysis of astigmatic changes. RESULTS: A total of 89.9%, 93.9% and 97.0% showed a postoperative sphere, cylinder and spherical equivalent within ± 0.50 D, respectively. Mean difference vector (DV) was 0.22 ± 0.27 D, mean magnitude of error (ME) was 0.13 ± 0.29 D, and mean angle of error (AE) was 1.52 ± 11.64°. Poor correlations of preoperative corneal astigmatism with DV (r = - 0.032, p = 0.833), ME (r = - 0.344, p = 0.001) and AE (r = - 0.094, p = 0.377) were found. Likewise, no statistically significant differences were found between monofocal and multifocal toric IOL subgroups in DV (p = 0.580), ME (p = 0.702) and AE (p = 0.499). CONCLUSIONS: The combination of FLACS and intraoperative aberrometry to optimize the position of a toric IOL allows a very efficacious correction of preexisting low-to-moderate corneal astigmatism.

Optiwave Refractive Analysis may not work well in patients with previous history of radial keratotomy.

PURPOSE: To report a case of significant hyperopic outcome (both eyes) following Optiwave Refractive Analysis (ORA) intraocular lens (IOL) power recommendation in a cataract patient with history of 8 cut radial keratotomy (RK) in each eye. OBSERVATIONS: It is hypothesized that increased intraocular pressure (IOP) from phacoemulsification could make the RK cuts swell, and change cornea shape intraoperatively. In this unique scenario, the corneal curvature readings from ORA could be quite different from preoperative readings or from stabilized postoperative corneal measurements. The change in corneal curvature could also affect the anterior chamber depth and axial length readings, skewing multiple parameters on which ORA bases recommendations for IOL power. CONCLUSIONS AND IMPORTANCE: ORA has been widely used among cataract surgeons on patients with history of RK, but it's validation, unlike for laser-assisted in-situ keratomileusis (LASIK) and photorefractive keratectomy (PRK), has yet to be established by peer reviewed studies. Surgeons should be cautious when using ORA on RK patients.

Clinical outcomes with distance-dominant multifocal and monofocal intraocular lenses in post-LASIK cataract surgery planned using an intraoperative aberrometer.

IMPORTANCE: Studies evaluating the clinical benefits of intraoperative aberrometry (IA) in cataract surgery are limited. BACKGROUND: The study was designed to determine whether IA improved clinical outcomes of post-laser in situ keratomileusis (LASIK) cataract surgery with different intraocular lenses (IOLs) implanted. DESIGN: A retrospective chart review of clinical outcomes from one surgeon at one surgical centre was conducted. It included post-LASIK cataract surgeries where IA was used for the confirmation of IOL power, with either a distant-dominant multifocal IOL or a monofocal IOL implanted. PARTICIPANTS: Records for 44 eyes of 31 patients were analysed. METHODS: Differences in visual acuity (VA) and refractions by lens type were compared, and the effects of IA were evaluated. MAIN OUTCOME MEASURES: Uncorrected distance VA and the percentage of eyes with a spherical equivalent refraction within 0.5D of the intended correction were the primary outcome measures. RESULTS: There was no statistically significant difference in the percentage of eyes with uncorrected distance VA of 20/25 or better between IOL groups (P = 0.41). More eyes in the multifocal group had a refraction within 0.50D of intended (P = 0.03). In 39% of cases, the preoperative and IA power calculations suggested the same IOL power. When not equal, the IA results were not significantly more likely to be 'best' (P = 0.08). CONCLUSIONS AND RELEVANCE: Results suggest that a history of previous LASIK is not a contraindication to use of distant-dominant multifocal IOLs. IA did not appear to improve clinical outcomes in post-LASIK eyes, although a positive trend was evident.