Comparison of the Visian ICL and Verisyse phakic intraocular lenses for myopia from 6.00 to 20.00 diopters.

PURPOSE: To compare visual and refractive outcomes between the Visian Implantable Collamer Lens (ICL) and Verisyse phakic intraocular lens. METHODS: Comparative interventional case series for myopia between 6.00 and 20.00 diopters (D). Thirty consecutive eyes of 16 patients had a Visian ICL implanted and 31 consecutive eyes of 19 patients had the Verisyse lens implanted. Outcomes measured at 3 months postoperatively included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and refractive predictability as well as adverse events. Preoperatively, the groups were no different in regard to age (P=.72) and spherical equivalent refraction (P=.38). RESULTS: Postoperative UCVA of 20/20 or better and 20/25 or better in the Visian ICL group was 67% and 96%, respectively, compared to 63% and 79%, respectively, in the Verisyse lens group (P=.10). Binocular UCVA of 20/20 or better and 20/25 or better in the Visian ICL group was 92% and 100%, respectively, and in the Verisyse group, 70% and 80%, respectively (P=.007). One and two lines gain of postoperative BSCVA in the Visian ICL group was 40% and 10%, respectively, which was statistically significantly better than the Verisyse group of 16% and 6%, respectively (P=.025). Postoperative deviation from target refraction was 0.038+/-0.39 D in the Visian ICL group and -0.38+/-0.89 D in the Verisyse lens group (P=.018). CONCLUSIONS: Monocular UCVA was similar for both groups, whereas binocular UCVA was better in the Visian ICL group. The Visian ICL group had more accurate refractive outcomes than the Verisyse lens group.

Wavefront-guided LASIK for the correction of primary myopia and astigmatism a report by the American Academy of Ophthalmology.

OBJECTIVE: To describe wavefront-guided (WFG) LASIK for the primary treatment of low to moderate levels of myopia and astigmatism and to examine the evidence on the safety and effectiveness of the procedure in comparison with conventional LASIK. METHODS: Literature searches conducted in 2004, 2005, 2006, and 2007 retrieved 209 unique references from the PubMed and Cochrane Library databases. The panel selected 65 articles to review, and of these, chose 45 articles that they considered to be of sufficient clinical relevance to submit to the panel methodologist for review. During the review and preparation of this assessment, an additional 2 articles were included. A level I rating was assigned to properly conducted, well-designed, randomized clinical trials; a level II rating was assigned to well-designed cohort and case-controlled studies; and a level III rating was assigned to case series, case reports, and poorly designed prospective and retrospective studies. In addition, studies that were conducted by laser manufacturers before device approval (premarket approval) were reviewed as a separate category of evidence. RESULTS: The assessment describes studies reporting results of WFG LASIK clinical trials, comparative trials, or both of WFG and conventional LASIK that were rated level II and level III. There were no studies rated as level I evidence. Four premarket approval studies conducted by 4 laser manufacturers were included in the assessment. The assessment did not compare study results or laser platforms because there were many variables, including the amount of follow-up, the use of different microkeratomes, and the level of preoperative myopia and astigmatism. CONCLUSIONS: There is substantial level II and level III evidence that WFG LASIK is safe and effective for the correction of primary myopia or primary myopia and astigmatism and that there is a high level of patient satisfaction. Microkeratome and flap-related complications are not common but can occur with WFG LASIK, just as with conventional LASIK. The WFG procedure seems to have similar or better refractive accuracy and uncorrected visual acuity outcomes compared with conventional LASIK. Likewise, there is evidence of improved contrast sensitivity and fewer visual symptoms, such as glare and halos at night, compared with conventional LASIK. Even though the procedure is designed to measure and treat both lower- and higher-order aberrations (HOAs), the latter are generally increased after WFG LASIK. The reasons for the increase in HOA are likely multifactorial, but the increase typically is less than that induced by conventional LASIK. No long-term assessment of WFG LASIK was possible because of the relatively short follow-up (12 months or fewer) of most of the studies reviewed.

Two cases of Z syndrome with the Crystalens after uneventful cataract surgery.

We report 2 cases of Z syndrome with the Crystalens AT50SE and AT52SE intraocular lenses (Eyeonics, Inc.) after uneventful cataract surgery. Both patients had subsequent neodymium:YAG laser capsulotomy treatment that remedied the complication. To our knowledge, these are the first reported cases of Z syndrome with the Crystalens AT50SE and AT52SE, a unique complication with this type of hinged accommodating intraocular lens.

Effect of nepafenac sodium 0.1% on delayed corneal epithelial healing and haze after photorefractive keratectomy: retrospective comparative study.

PURPOSE: To assess delayed epithelialization and corneal haze related to nepafenac ophthalmic suspension 0.1% (Nevanac) use after photorefractive keratectomy (PRK). SETTING: Private practice, Beverly Hills, California, USA. METHODS: This retrospective comparative chart review comprised 69 eyes (44 patients) that were divided into 2 treatment groups that were not statistically significantly different in age or preoperative spherical equivalent. The nepafenac group consisted of 34 eyes (22 patients) that received nepafenac 0.1%, moxifloxacin, and fluorometholone postoperatively. The non-nepafenac group included 35 eyes (22 patients) that received moxifloxacin and fluorometholone only. Patients were seen between 1 day and 5 days postoperatively for evaluation of epithelial healing and haze formation. Delayed epithelialization was defined as healing after day 5. All patients were followed for haze formation for a minimum of 3 months. RESULTS: Statistical analysis showed no difference between the nepafenac and non-nepafenac groups in delayed epithelialization (P = .61, chi-square test). Neither group had significant corneal haze. CONCLUSION: Nepafenac did not appear to delay corneal epithelial healing or contribute to haze formation after PRK.

Comparison of the effects of LASIK retreatment techniques on epithelial ingrowth rates.

PURPOSE: To compare the incidence of postoperative epithelial ingrowth using 3 different surgical LASIK retreatment techniques. DESIGN: Retrospective consecutive case series. PARTICIPANTS AND CONTROLS: Thirty consecutive eyes that underwent LASIK retreatments by a single surgeon. METHODS: The first 10 eyes underwent LASIK retreatment using the surgeon's routine surgical technique (forceps lift group), the next 10 retreated eyes had a bandage contact lens placed after surgery and removed the following day (contact lens group), and the next 10 patients had retreatment performed using a Pinelli spatula to cleave the circumference of the flap edge before lifting the flap and no contact lens placed after surgery (spatula cleaving group). The retreatment technique did not vary apart from these modifications. MAIN OUTCOME MEASURES: Incidence of postoperative epithelial ingrowth. RESULTS: The incidence of epithelial ingrowth was 40% in the contact lens group, 20% in the forceps lift group, and 10% in the spatula cleaving group. There was a trend toward a significant difference between the contact lens and spatula cleaving groups (P = 0.12). The patients with epithelial ingrowth showed a trend toward being older, with a mean age of 53+/-8.5 years compared with a mean age of 44+/-13 years for the patients without epithelial ingrowth (P = 0.07). Incidence of ingrowth was not related to the preoperative spherical equivalent. CONCLUSIONS: There was an increased incidence of epithelial ingrowth with use of an overnight bandage contact lens in our series. The Pinelli spatula may reduce trauma to the epithelium at the flap edge. The incidence of epithelial ingrowth was not related to the preoperative spherical equivalent. Increasing age may be a risk factor for epithelial ingrowth, but further study is warranted.

Comparison of single-segment and double-segment Intacs for keratoconus and post-LASIK ectasia.

PURPOSE: To evaluate the efficacy of single-segment Intacs and compare with double-segment Intacs in subjects with post-LASIK ectasia and keratoconus. DESIGN: Retrospective comparative analysis. METHODS: setting: Boxer Wachler Vision Institute, Beverly Hills, California, USA. study population: Thirty-seven eyes of 28 patients with keratoconus and post-LASIK ectasia classified into two groups: single-segment group (17 eyes, 11 patients) and double-segment group (20 eyes, 17 patients). Both groups were matched for age, visual acuity (uncorrected, UCVA; best spectacle-corrected, BSCVA), refractive error (sphere, cylinder, spherical equivalent), and keratometry (K) value (flat, steep, average) by t test for equality of means. intervention: Single- or double-segment Intacs procedure with axis of incision for insertion in the steep axis of manifest refraction. main outcome measure: Improvement of acuity, refractive error, K values, and inferior-superior (I-S) ratio. RESULTS: There was more improvement in UCVA in the single-segment group (nine lines) than the double-segment group (2.5 lines), P < .01; in BSCVA in the single-segment group (2.5 lines) than the double-segment group (<1 line), P < .01; in steep K values in the single-segment group (2.76 diopters +/- 2.68) than the double-segment group (0.93 diopters +/- 2.01), P = .02; and in I-S ratio in the single-segment group (9.51 +/- 7.49) than the double-segment group (4.22 +/- 4.82), P = .01; and greater cylinder decrease after Holladay vector analysis in the single-segment group (5.69 diopters +/- 3.10) than the double-segment group (1.58 diopters +/- 3.09), P < .01. CONCLUSIONS: Single-segment Intacs improved both UCVA and BSCVA by differential flattening of inferior meridian and steepening of superior meridian as reflected by change in I-S ratio.

Centration analysis of ablation over the coaxial corneal light reflex for hyperopic LASIK.

PURPOSE: To analyze postoperative topographic centration when the coaxially sighted corneal light reflex was used for laser centration in hyperopic LASIK. METHODS: Centration photographs of 21 eyes (12 patients) that underwent hyperopic LASIK with centration over the coaxially sighted corneal light reflex were reviewed to determine the distance from the entrance pupil center to the coaxially sighted corneal light reflex. Postoperative ablation centration was determined topographically at day 1 and 3 months by four different methods. The difference between the actual decentration and the decentration that would have occurred had the ablation been centered over the entrance pupil center was calculated. RESULTS: The mean deviation of the coaxially sighted corneal light reflex from the entrance pupil center preoperatively was 0.34 +/- 0.24 mm nasal or 4.5 +/- 3.0 degrees. At 1 day, the average decentration was 0.10 mm or 1.3 degrees temporal. The mean decentration that would have occurred if the ablation had been centered over the entrance pupil center was 0.44 mm or 5.5 degrees temporal. At 3 months, the average decentration was 0.07 mm or 0.25 degrees temporal. The mean decentration that would have occurred if the ablation had been centered over the entrance pupil center was 0.45 mm or 5.6 degrees temporal. Mean uncorrected visual acuity (logMAR) improved 3 lines from 0.54 +/- 0.14 (20/70) to 0.22 +/- 0.17 (20/32). No eye lost >2 lines of best spectacle-corrected visual acuity (BSCVA); 2 (10%) eyes lost 1 line of BSCVA at 3-month follow-up. CONCLUSIONS: Excellent centration in hyperopic ablation is possible even in eyes with positive angle kappa when the ablation is centered over the corneal light reflex.

Assessment of Levels of Ultraviolet A Light Protection in Automobile Windshields and Side Windows.

IMPORTANCE: Ultraviolet A (UV-A) light is associated with the risks of cataract and skin cancer. OBJECTIVE: To assess the level of UV-A light protection in the front windshields and side windows of automobiles. DESIGN: In this cross-sectional study, 29 automobiles from 15 automobile manufacturers were analyzed. The outside ambient UV-A radiation, along with UV-A radiation behind the front windshield and behind the driver's side window of all automobiles, was measured. The years of the automobiles ranged from 1990 to 2014, with an average year of 2010. The automobile dealerships were located in Los Angeles, California. MAIN OUTCOMES AND MEASURES: Amount of UV-A blockage from windshields and side windows. The average percentage of front-windshield UV-A blockage was 96% (range, 95%-98% [95% CI, 95.7%-96.3%]) and was higher than the average percentage of side-window blockage, which was 71% (range, 44%-96% [95% CI, 66.4%-75.6%]). The difference between these average percentages is 25% (95% CI, 21%-30% [P < .001]). A high level of side-window UV-A blockage (>90%) was found in 4 of 29 automobiles (13.8%). CONCLUSIONS AND RELEVANCE: The level of front-windshield UV-A protection was consistently high among automobiles. The level of side-window UV-A protection was lower and highly variable. These results may in part explain the reported increased rates of cataract in left eyes and left-sided facial skin cancer. Automakers may wish to consider increasing the degree of UV-A protection in the side windows of automobiles.

Establishing analysis parameters for spherical aberration after wavefront LASIK.

PURPOSE: To compare preoperative and postoperative spherical aberration, coma, and other higher order aberrations from wavefront LASIK at varying pupil analysis diameters and different myopic corrections, and to determine acceptable parameters for wavefront measurements. DESIGN: Nonrandomized retrospective chart review. PARTICIPANTS: Twenty-one eyes of 12 patients who had CustomCornea LASIK with the LADARVision 4000 (Alcon, Fort Worth, TX). METHODS: Wavefront analyses were performed before and 3 months after CustomCornea LASIK using a 6.5-mm central optical zone and blend zone to 9.0 mm. Wavefront measurements were made with pupil analysis diameters of 5.5, 6.0, 6.5, and 7.0 mm. Myopic corrections were divided into 3 spherical equivalent subgroups: low (<3 diopters [D]), medium (3-6 D), and high (>6 D). Main outcome measures were compared based on myopic subgroup within each analysis diameter. Results were analyzed with analysis of variance and paired t tests. MAIN OUTCOMES MEASURES: Spherical aberration, coma, and other higher order aberrations. RESULTS: There were no significant increases in coma or other higher order aberrations postoperatively or with larger analysis diameters. There was a significant increase in postoperative differences in spherical aberration between 6.5 and 7.0 mm for the >6-D myopic correction subgroup (P = 0.03). Differences between other 0.5-mm intervals and other subgroups were not significant. CONCLUSIONS: The largest difference between preoperative and postoperative spherical aberration occurred at the analysis diameter 0.5 mm greater than the laser optical zone for the subgroup with high myopic correction. To detect larger degrees of induced spherical aberrations, analysis diameters 0.5 mm larger than the central laser optical zone should be considered.

Functional optical zone after myopic LASIK as a function of ablation diameter.

PURPOSE: To analyze spherical aberrations in patients who had myopic laser in situ keratomileusis (LASIK) with different optical zones and varying degrees of attempted corrections. SETTING: Laser Refractive Center, University of California, Los Angeles, USA. METHODS: This retrospective analysis comprised 78 eyes of 56 consecutive patients who had LASIK for myopia with the Alcon LADARVision excimer laser. The preoperative and 3-month postoperative functional optical zones (FOZs), a measure of spherical aberrations, were assessed in each eye. The change in FOZs was analyzed by size of the primary optical zone and degree of attempted correction. RESULTS: The mean preoperative FOZ was 6.1 mm +/- 0.6 (SD) and the mean 3-month FOZ, 5.2 +/- 1.0 mm. The mean decrease was 0.9 +/- 1.0 mm (P < .0001). The mean decreases were 0.005 +/- 0.7 mm, 0.7 +/- 0.9 mm, and 1.6 +/- 0.9 mm in the low, moderate, and high attempted correction groups, respectively (P < .05), and 1.3 +/- 0.9 mm, 1.2 +/- 1.0 mm, 0.5 +/- 1.3 mm, and 0.3 +/- 0.7 mm in optical zone groups of 6.0 to 6.5 mm, 6.6 to 7.0 mm, 7.1 to 7.5 mm, and 7.6 to 8.0 mm, respectively (P < .05). CONCLUSIONS: Larger optical zones had fewer postoperative spherical aberrations. Higher attempted corrections had larger increases in spherical aberrations. Larger treatment diameters minimized postoperative spherical aberrations.

Effect of pupil size on visual function under monocular and binocular conditions in LASIK and non-LASIK patients.

PURPOSE: To compare binocular and monocular vision in patients treated with laser in situ keratomileusis (LASIK) and in non-LASIK patients. SETTING: Jules Stein Eye Institute, Los Angeles, California, USA. METHODS: This comparative cross-sectional study comprised 20 postoperative LASIK patients and 20 non-LASIK ametropic patients. LogMAR visual acuity, contrast sensitivity, and infrared pupillometry were tested. Outcome measures were better-eye monocular acuity, binocular acuity, better-eye contrast sensitivity, binocular contrast sensitivity, and pupil diameter under monocular and binocular conditions. RESULTS: Binocular visual acuity and contrast sensitivity were statistically significantly better than the visual acuity in the better eye (P =.0047 to <.0001) in both patient groups. Pupil diameter was statistically significantly smaller under the binocular condition than the monocular condition (P <.0001) in both groups. CONCLUSIONS: Monocular testing induced larger pupil diameters, which was associated with reduced vision compared to binocular measurements in LASIK and non-LASIK patients.

Evaluation of corneal functional optical zone after laser in situ keratomileusis.

PURPOSE: To evaluate the corneal functional optical zone (FOZ) after laser in situ keratomileusis (LASIK) using a primary 6.0 mm ablation diameter without a transition zone. SETTING: University-based practice. METHODS: In this retrospective study, 76 eyes of 53 patients who had LASIK for myopia were evaluated. The size of the preoperative and postoperative FOZ was compared in each eye. Preoperative refraction, attempted correction, and achieved correction were correlated with the preoperative and postoperative FOZ using regression analysis. RESULTS: After LASIK, the FOZ decreased a mean 1.2 mm +/- 0.67 (SD) (P < 0.0001). The size of the FOZ was correlated with the preoperative manifest refraction, attempted correction, and achieved correction (P <.0001). The FOZ reduction was significantly correlated with the preoperative manifest refraction, attempted correction, and achieved correction (P <.05). Before LASIK, there was no correlation between the FOZ and the preoperative manifest refraction (P = 0.9427). CONCLUSIONS: Spherical aberrations exist within the laser ablation zone and are related to the amount of myopic treatment. This has implications for patients with large pupil diameters under mesopic conditions. Future studies are necessary to understand the implications in patients with high refractive errors.

Feasibility of contact lens fitting on keratoconus patients with INTACS inserts.

PURPOSE: To demonstrate the feasibility of contact lens fitting in keratoconus patients with INTACS inserts. METHODS: A chart review was conducted of all patients with bilateral keratoconus who were treated with INTACS inserts on one eye and who were subsequently referred for contact lens fitting in a university based contact lens practice between April 2000 and April 2002. The study was a retrospective, non-comparative case series. The uncorrected and best spectacle corrected visual acuity (BSCVA) after INTACS implantation surgery, postoperative best contact lens-corrected visual acuity (BCLVA), number of diagnostic contact lenses used, number of contact lenses ordered within a 4-month follow-up period, contact lens complications encountered, final base curves, final lens powers, and final wearing times were determined. RESULTS: Three keratoconic patients meeting the selection criteria were found through the chart review. Prior to surgery, all patients had uncorrected visual acuity (UCVA) of 2.0 logMAR (counting fingers). This improved to a mean of 0.81+/-0.25 logMAR (20/125-1) after surgery. Mean BSCVA also improved from 0.51+/-0.30 logMAR (20/60-2) to 0.30+/-0.16 logMAR (20/40). The mean postoperative best contact lens-corrected visual acuity was 0.02+/-0.10 logMAR (20/20-1). The number of diagnostic lenses ranged from 1 to 7. The numbers of contact lenses ordered during the 4-month follow up period ranged from 1 to 3. Two eyes were fitted with larger than usual lens designs made of rigid gas-permeable material and one eye was fitted with a toric soft lens. The final lens power ranged from +1.25 to -21.0D with a mean spherical equivalent of -7.46+/-11.89 D. Final wearing times ranged from 2.5 to 12.0h. CONCLUSION: Fitting contact lenses on keratoconus patients who have INTACS inserts is feasible and has a role in augmenting their vision.

Factors that correlate with improvement in vision after combined Intacs and trans-epithelial corneal crosslinking.

AIM: To analyse factors that correlate with best corrected visual acuity (BCVA) improvement after Intacs and trans-epithelial corneal collagen crosslinking with riboflavin-carboxymethylcellulose. METHODS: A 3-year retrospective study of 14 eyes that underwent trans-epithelial crosslinking and same day Intacs. RESULTS: The mean preoperative BCVA and spherical equivalent were significantly related to BCVA postoperatively. CONCLUSION: Poorer preoperative BCVA and spherical equivalent were associated with greater improvement in postoperative BCVA.

Optimizing the vault of collagen copolymer phakic intraocular lenses in eyes with keratoconus and myopia: comparison of 2 methods.

PURPOSE: To compare 2 methods for optimizing the final central vault of a collagen copolymer posterior chamber phakic intraocular lens (pIOL) (Visian Implantable Collamer Lens) in eyes with keratoconus and myopia. SETTING: Private practice, Beverly Hills, California, USA. DESIGN: Comparative interventional study. METHODS: The length of the pIOL to implant in keratoconic eyes with myopia was selected based on the white-to-white (WTW) distance or the sulcus-to-sulcus (STS) distance using the pIOL manufacturer's protocol. The final central vault distance was compared a minimum of 3 months postoperatively. RESULTS: The pIOL length was based on WTW measurements in 8 eyes of 6 patients and on STS measurements in 8 eyes of 5 patients. There was no significant difference between the 2 groups in the mean preoperative WTW distance, STS distance, or manifest refraction spherical equivalent (MRSE) (P = .22, P = .37, and P = 1.00, respectively). The mean postoperative vault was 1.03 corneal thickness ± 0.72 (SD) in the WTW group and 1.18 ± 0.35 corneal thickness in the STS group (P = .61). The vault distance was less than 1.0 corneal thickness in 3 eyes (37.5%) in the WTW group and 1 eye (12.5%) in the STS group. A small postoperative vault was associated with a high preoperative MRSE (P = .03). CONCLUSIONS: The WTW and STS methods both provided adequate final central pIOL vault in keratoconic eyes with myopia. The STS calculations gave greater final vault and higher vault predictability, although the difference between the 2 methods was not statistically significant.

A comparison of CustomCornea myopia algorithms for wavefront-guided laser in situ keratomileusis.

OBJECTIVE: To determine whether the new CustomCornea M3 (myopic astigmatism) algorithm places additional pulses in the periphery to counter excimer laser peripheral ablation inefficiency. METHODS: Analysis of 25 myopic eyes of 18 patients that were within the approved indications for both the myopic astigmatism (M3) and myopic sphere (A7) algorithms. We analyzed ablation depth at peak and 4-mm, 6-mm, and 7-mm zone diameters for both the A7 and M3 algorithms. RESULTS: The M3 algorithm programmed for more of an ablation at the peak and peripheral zones than the A7 algorithm (P < .001). Even accounting for the additional peak ablation, there was significantly greater ablation in the periphery with the M3 algorithm compared with the A7 algorithm (P < .001). The mean (SD) manifest sphere was -4.09 (1.90) diopters (D), the mean (SD) manifest cylinder was -0.60 (0.52) D, and the mean (SD) manifest spherical equivalent was -4.39 (1.92) D. The manifest sphere ranged from -1.00 to -7.50 D, the manifest cylinder from 0.00 to -1.25 D, and the manifest spherical equivalent from -1.50 to -8.25 D. CONCLUSION: The new CustomCornea M3 algorithm is programmed to perform additional ablation in the periphery to counter decreased pulse efficacy and the potential for induced spherical aberration.

Use of large optical zones with the LADARVision laser for myopia and myopic astigmatism.

PURPOSE: To analyze the visual acuity, contrast sensitivity, and target deviations of patients who underwent laser in situ keratomileusis (LASIK) for spherical and astigmatic myopia with up to 8.0-mm laser optical zones. DESIGN: A retrospective noncomparative interventional case series. PARTICIPANTS: Three hundred fifty-two eyes of 186 patients in a refractive surgery practice. METHODS: Chart review of consecutive patients who underwent LASIK for spherical and astigmatic myopia with the Autonomous LADARVision excimer laser. MAIN OUTCOME MEASURES: The preoperative and the 3-month postoperative visual acuity and contrast sensitivity, as well as the target deviation, were assessed for each eye. The change in best spectacle-corrected visual acuity (BSCVA), best spectacle-corrected contrast sensitivity (BSCCS), and target deviation were analyzed by size of optical zone. RESULTS: For spherical myopes, uncorrected visual acuity (UCVA) was 20/20 or better in 55.7% of eyes. The mean deviation from target was -0.19 +/- 0.64 diopters (D), with 75.3% within +/-0.50 D of the target. None of the eyes lost more than two lines of BSCVA. A loss of three or more patches (levels) of BSCCS was seen in 2.7% of eyes, whereas a loss of four or more patches of BSCCS was seen in 1.1%. For astigmatic myopes, UCVA was 20/20 or better in 61.9% of eyes. The mean deviation from target was -0.17 +/- 0.55 D, with 67.5% within +/-0.50 D of the target. No eye lost more than two lines of BSCVA. A loss of three or more patches of BSCCS was seen in 4.3% of eyes, whereas a loss of four or more patches of BSCCS was seen in 1.2%. CONCLUSIONS: Larger optical diameters did not adversely affect BSCVA and BSCCS. Postoperative target deviation with the nomogram used was accurate with larger optical zones.