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Alteration of the degree of amblyopia in adults after either a

premium IOL implantation, or a hyperopic excimer laser treatment

Klinika ocni a esteticke chirurgie in Zlin, Czech Republic

Authors: Katerina Buusova Smeckova, M.D., MBA

As. professor Zdenek Smecka, M.D., CSc.

None of the authors has a financial interest on presented data.

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PurposeRetrospective study summarizing and comparing

the change of BCVA between 2 groups of adult patients with amblyopia 3 months after the procedure.

First group underwent a standard refractive lens exchange with the implantation of the premium IOL (AcrySof ReSTOR Aspheric SN6AD1).

The second group underwent a standard excimer laser ablation with Carl Zeiss MEL 80 (either LASIK, PRK or Epi-LASIK).

„In the absence of an organic lesion, a difference in BCVA of two Snellen lines or more (or >1 log unit) is indicative of amblyopia. „ Jack J. Kanski, Clinical Ophthalmology, 6th Edition, Butterworth Heinemann, 2007

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Setting / Venue

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MethodsRetrospective, non-randomised, unmasked study of 2

groups of 50 adult patients each with amblyopia (initial BCVA [0,1;0,7]). Each group was divided into 3 equal subgroups based on the severity of amblyopia.

Prior the surgery Dsf, Dcyl, BCVA measurements and eye examination was performed.

Group A underwent a standard uncomplicated bilateral RLE (one surgeon, one phaco device, 2,2mm incision, SN6AD1 IOL).

Group B underwent a standard uncomplicated bilateral hyperopic excimer laser treatment (LASIK, Epi-LASIK, PRK, one surgeon, Carl Zeiss MEL 80).

Outcome measurements have been performed 3 months after surgery: Dsf, Dcyl of a non-dominant eye and BCVA. Any complications were recorded.

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Results I.: Change in BCVAIOL Excimer laser

0

0.2

0.4

0.6

0.8

1

1.2

BCVA preop. BCVA postop.

0

0.2

0.4

0.6

0.8

1

1.2

BCVA preop. BCVA postop.

13% of eyes had postop. BCVA 1,0.

8% of eyes had postop. BCVA 1,0.

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Results II.: Change in BCVA- Subgroup BCVA less than 0,5

IOL Excimer laserAverage change of BCVA 0,35. Average change of BCVA 0,13.

21%

7%

71%

Unchanged WorseImproved

11%

89%

Unchanged WorseImproved

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Results III.: Subgroup BCVA equal to 0,5

IOL Excimer laserAverage change of BCVA 0,19. Average change of BCVA 0,11.

21%

7%

71%

Unchanged WorseImproved

48%

4%

48%

Unchanged WorseImproved

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Results IV.: Subgroup BCVA more than 0,5

IOL Excimer laserAverage change of BCVA 0,08. Average change of BCVA 0,12.

8%

31%

62%

Unchanged WorseImproved

57%

43%

Unchanged WorseImproved

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Results V.: Total

IOL Excimer laserAverage change of BCVA 0,15. Average change of BCVA 0,12.

13%

13%

74%

Unchanged WorseImproved

46%

3%

50%

Unchanged WorseImproved

Results VI. IOL Excimer Laser

10

BCVAbefore surgery

Postop BCVA 20/20 • 8%

• 13%

• 0,12 difference• 0,15 difference

• 0,60+/-0,23[0,1;1,0]

• 0,61+/-0,22[0,3;1,0]

•0,46+/-0,16[0,1;0,7]

•0,48+/-0,15[0,1;0,7]

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Other correction means

1. Holmes, Repka, Kraker & Clarke (2006). "The treatment of amblyopia". Strabismus 2. Polat, U; Polat, Uri; Ma-Naim, Tova; Belkin, Michael; and Sagi, Dov (27 April 2004). "Improving

vision in adult amblyopia by perceptual learning". PNAS

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ConclusionsThe probability of an improvement is in the

inverse proportion to the initial BCVA.

With the respect, that the vision may worsen (15%RLE, 5% laser) and that the probability of BCVA 20/20 is low- 13% (group-IOL), 8% (group-excimer laser), patients with amblyopia may benefit from both RLE and excimer laser treatment.