We have all seen it before: thousands of small, white, refractile bodies floating in the vitreous cavity with seemingly little effect on the patient’s vision. Asteroid hyalosis occurs in a small percentage of our patients and most of the time is of little consequence. But given that the vitreous cavity is full of these particles, can we still use a trifocal IOL or extended depth of focus (EDOF) IOL in these eyes? This video goes into more detail to discuss the issues and the limitations. Can you guess which IOL I chose?
I think the paradigm is changing a bit on Asteroid Hyalosis awareness. I was always taught that Asteroid does not affect vision but I’ve certainly seen my share of patients now over the years with decreased quality of vision from AH and I’ve done enough vitrectomies on these patients now to appreciate their awareness of the improvement in vision. I would avoid Silicone IOLs in these folks as there is a greater risk of calcification of those lenses in the presence of AH. Because of the way the asteroid opacities scatter light and disrupt the complex wavefront of diffractive lenses I would avoid diffractive IOLs with AH unless the surgical plan is to combine with a PPV and I have done that with good results. It is quite easy to do a PPV and completely remove asteroid if a PVD is already present and you have a proper posterior viewing system/vitrectomy set up. The Asteroid “stains” the vitreous like triamcinolone does!
great input — thank you!
I prefer to make a posterior capsulorhexis and do Vitrectomy in case of moderate to severe form of AH in presence of PVD.