1037: Trifocal IOL with white cataract

Trifocal IOLs require refractive accuracy. We need to be able to deliver close to a plano outcome without much residual refractive error in order to provide the best performance of these diffractive, light-splitting IOLs. The challenge with a white cataract is that it can preclude measuring the axial length with optical coherence biometry, which is more accurate than the ultrasound A-scan. So how can we get refractive accuracy for this case?

Some may suggest the use of intra-operative aberrometry, but let’s be honest with each other: it is simply an auto-refractor and the accuracy is just not there. Just ask yourself why you must input the axial length, keratometry, AC depth, refraction, and even your predicted IOL calculations in order for this “magical aberrometer” to give you a reading. When you step on your bathroom scale, does it require you to first input your height and waist circumference before giving the measure of your weight? Of course not. So if intra-operative aberrometry is so accurate, then why ever do IOL biometry and IOL calculations ahead of time? Just keep a large inventory of all IOL powers and then simply measure the eyes in the aphakic state while on the OR table. And… now you get my point.

In this case, the patient’s other eye had a cataract that was not as bad and we were able to use that to help us. And it worked, the patient achieved a great (and precise) refractive outcome.

Click to learn how we ensured refractive accuracy in this case:


  1. I’ve become a better surgeon and physician following and reading your messages and videos. Thank you so much Dr Devgan

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