Therefore, this study assessed the distribution of preoperative objective angle alpha and angle kappa measurements of patients deciding to undergo multifocal refractive lens surgery based on a positive MCLT. However, the extent to which these theoretical considerations translate into real-world practice is unclear. From a theoretical viewpoint, the concordance between the two approaches should be rather high, as patients with large angle alpha and angle kappa would not tolerate the test very well, while patients with normal angle values would. While some anecdotal evidence suggested that a preoperative multifocal contact lens test (MCLT) could be useful to support patients’ decision-making for multifocal IOL surgery, little is known about the relationship between a positive MCLT and the corresponding alpha or kappa angle values. As an alternative or add-on examination, preoperative multifocal contact lens test as an indicator for tolerance of multifocal IOL has been proposed. Preoperative consultations ask for a careful analysis of patient’s lifestyle and expectation as well as thorough examination. From the analysis of a smaller sample, Fu and colleagues suggested to select patients for multifocal IOL implantation if they presented with an angle alpha or angle kappa distance smaller than 0.5mm. Recently, Karhanova and colleagues proposed measuring the angle kappa and angle alpha in preoperative examinations. As a result, ophthalmologists called for an objective preoperative measurement to allow the identification of patients with an increased risk for postoperative glare and halo. Extreme values of these parameters lead to higher order aberrations resulting in decreased visual quality. Research into causes of a poor visual outcome identified a large deviation between the visual axis, pupillary axis, and the optical center of the multifocal IOL as important clinical parameters. Some patients complain about disturbing side effects such as glare and halo phenomena. Assessment and patient selection for multifocal IOL implantation is a clinical challenge. Most patients achieve an improvement not only in distance but also near visual acuity leading to higher spectacle independence and patient’s quality of life. Multifocal intraocular lenses (IOL) are increasingly used in the management of presbyopia treatment. One-year visual acuity improvement was substantial and independent from angle sizes. One-half of patients with low preoperative angle values refrained from surgery due to a negative MCLT result. Conclusionįour out of five patients with a positive MCLT also had correspondingly small angle values. UCVA of eyes ( n=24) with high alpha but low kappa sizes improved less (−0.31 logMAR (SD 0.13 p=0.019)). Eyes with both small angle alpha and kappa sizes improved by 0.78 logMAR (SD 0.56), as did eyes with high (≥0.5mm) angle sizes (0.82 logMAR (SD 0.53). In the 1-year follow-up, UCVA improved by 0.68 logMAR (SD 0.51 p<0.001) from baseline. Of 146 eyes (73 patients) who refrained from surgery due to a negative MCLT, 71 eyes (48.6%) had both angles small (<0.5mm). Of them, 12 eyes (17%) had an angle alpha and angle kappa ≥ 0.5mm. In 71 eyes (38 patients), MCLT was positive. Mean age was 56.4 years (SD 5.6) and 46.9% were female. Two hundred seventeen eyes (111 patients) were included. We assessed the preoperative distribution of angle values within MCLT positive and negative patient groups. Visual outcome (UCVA) was obtained in the 1-year follow-up. Only patients with a positive MCLT underwent surgery. All patients also performed a 1-week MCLT. Alpha and kappa angles were measured using the iTrace aberrometer. To assess the preoperative objective angle alpha and angle kappa measurements of patients deciding to undergo multifocal refractive lens surgery based on a subjective positive multifocal contact lens test (MCLT).
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