Precision refraction methodology for LASIK enhancement after trifocal IOL implantation: Clinical outcomes and technique.

Purpose: To evaluate the postoperative outcomes of LASIK enhancements performed on eyes implanted with trifocal intraocular lenses.

Setting: Shinagawa LASIK Center, Tokyo, Japan.

Design: Retrospective, consecutive case series.

Methods: A total of 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 novel systematic five-step refraction methodology was employed to accurately identify multiple focal points created by trifocal IOLs and determine optimal enhancement targets. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA) were evaluated at distance (5 m), intermediate (70 cm), and near (30 cm) at pre-cataract surgery, pre-enhancement, and 3 months, 6 months, and 1 year post-enhancement.

Results: At 1 year post-LASIK enhancement, the mean manifest refraction spherical equivalent improved from +0.35 diopters (D) ± 0.75 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 following 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.