Presbyopia-correcting intraocular lenses in eyes with corneal conditions: an update.

PURPOSE OF REVIEW: Modern presbyopia-correcting intraocular lenses (IOLs) offer a potential solution to address the rising postoperative demand and expectations for spectacle independence following cataract surgery. However, IOL calculation and selection becomes more complex when presented with previous corneal refractive surgery (CRS) or co-existing corneal conditions. This review explores the use of presbyopia-correcting IOLs in eyes with co-existing corneal conditions or surgically altered corneas.

RECENT FINDINGS: Careful consideration and selection is required in patients with co-existing corneal conditions who desire spectacle independence. Presbyopia-correcting IOLs have been shown to be safe and provide good uncorrected vision in eyes with previous CRS. Modern biometry formulas have improved predictability in eyes with previous CRS, though evidence related to presbyopia-correcting IOLs is limited. Pinhole IOLs may be suitable for eyes with irregular/aberrated corneas. Further evidence regarding presbyopia-correcting IOLs is required in eyes with dry eye disease, keratoconus, and corneal graft. Knowledge of the range of available IOLs are key to optimizing visual quality and achieving spectacle independence.

SUMMARY: Patients with prior CRS or co-existing corneal disease(s) present unique challenges when considering presbyopia-correcting IOLs. While promising options are available, successful outcomes depend on careful patient selection, thorough corneal assessment, and realistic management of patient expectations.