Bioptics: where do things stand?

PURPOSE OF REVIEW: Bioptics treats complex refractive errors by combining refractive techniques with different mechanisms of action, usually using an intraocular implant (a phakic or pseudophakic intraocular lens) followed by a corneal procedure (laser ablation, intrastromal implant).

RECENT FINDINGS: In myopia and hyperopia, bioptics with phakic intraocular lenses or refractive lens exchange and subsequent excimer laser yields improved predictability and unchanged safety, compared with sole intraocular lens surgery. Complications are related mainly to intraocular lenses. In keratoconus and pellucid marginal degeneration, intracorneal rings have been successfully combined with phacoemulsification or with phakic intraocular lenses in a limited number of eyes. In the author's series, angle-supported phakic intraocular lenses were implanted in 12 eyes to correct a mean regression of -8 D after excimer laser (reverse bioptics), achieving a mean spherical equivalent of -0.3 D, mean best spectacle-corrected visual acuity of 0.7, and mean uncorrected visual acuity of 0.5, with 83% of eyes within 0.5 D of spherical equivalent.

SUMMARY: Bioptics improves vision and halos and adds no particular risks to phakic or pseudophakic intraocular lens implantation in either myopia or hyperopia. Reverse bioptics, with phakic intraocular lenses or refractive lens exchange, can be used to correct regressed corneal surgery.