Precision refraction methodology for LASIK enhancement after trifocal intraocular lens implantation: clinical outcomes and technique.

PURPOSE: To evaluate the postoperative outcomes of laser in situ keratomileusis (LASIK) enhancements performed on eyes implanted with trifocal intraocular lenses (IOLs).

SETTING

Shinagawa LASIK Center, Tokyo, Japan.

DESIGN

Retrospective, consecutive case series.

METHODS

59 cases (89 eyes) underwent femtosecond laser-assisted cataract surgery with trifocal IOL implantation between October 2014 and May 2021 and were followed for a minimum of 3 months after LASIK enhancements. A new systematic 5-step refraction methodology was used to accurately identify multiple focal points created by trifocal IOLs and determine optimal enhancement targets. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity, uncorrected intermediate visual acuity, and uncorrected near visual acuity (UNVA) were evaluated at distance (5 m), intermediate (70 cm), and near (30 cm) at precataract surgery, pre-enhancement, and 3-month, 6-month, and 1-year postenhancement.

RESULTS

At 1-year post-LASIK enhancement, the mean manifest refraction spherical equivalent improved from +0.35 ± 0.75 diopters (D) to -0.05 ± 0.36 D ( P < .0001), with 80.9% of eyes achieving ±0.50 D of emmetropia. The percentage of eyes with ≤0.50 D cylinder increased from 37.1% to 83.3%. UDVA of 20/20 or better was achieved in 83.3% of eyes, with 56.3% achieving J1 UNVA.

CONCLUSIONS

LASIK enhancements after trifocal intraocular lens implantation demonstrated both safety and efficacy in improving visual outcomes. A systematic approach to measuring refractive error, accounting for the multifocal nature of these IOLs, is crucial for optimal outcomes. This methodology can be applied to various trifocal IOL designs to enhance visual results and patient satisfaction.