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Borkenstein AF, Borkenstein EM, Omidi P, Langenbucher A. Evaluating impact of Nd: YAG laser associated defects on optical quality of hydrophilic and hydrophobic intraocular lenses using visualization of light propagation and USAF test targets. BMC Ophthalmol 2022; 22:494. [PMID: 36527032 PMCID: PMC9756656 DOI: 10.1186/s12886-022-02738-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy is a well-accepted, safe, and effective measure in the treatment of posterior capsule opacification. However, iatrogenic intraocular lens damage is a relatively common side effect that happens due to inappropriate focusing during the procedure. This experimental study analyzes the impact of YAG-pits to obtain qualitative information. METHODS Acrylic, monofocal hydrophilic and hydrophobic intraocular lenses (IOLs) with 6.0 mm optic and the with the same power (21D) were studied. First, all measurements were done with unmodified IOLs. Damage was intentionally created, performing YAG-pits (n = 5) in the central area of the lens optic (3.0 mm) using a photodisruption laser with the same energy level of 1.8 mJ. To simulate the cruciate pattern, the 5 defects were created in a cross shape within the 3.0 mm optical zone. Afterwards, all laboratory measurements were repeated: These included the United States Air Force (USAF) resolution test chart to study the imaging performance of the IOL, light field measurements to show the course of the rays behind the IOL and the modulation transfer function (MTF) measurements were analyzed. RESULTS Evaluating USAF showed that unmodified lenses produced a sharper image. Damaged lenses led to a more blurred image and to the impression of a lower contrast with a kind of halo/glare effect. The light field measurement showed that YAG-pits led to a kind of dispersion and scattering effect, which was higher in hydrophobic IOLs. MTF showed a deterioration in damaged hydrophilic and hydrophobic IOLs, respectively. CONCLUSION Our experimental study confirms that YAG-pits can reduce imaging quality of intraocular lenses. These defects behave as a new Huygens source, distribute a spherical wave that additionally illuminate the background of the USAF target. It can be assumed that material properties of the IOL (water content, refractive index) play an important role and affect results. The impact level is strongly dependent on the number, size and position of YAG-pits within the optic. LIMITATION Only monofocal IOLs have been investigated so far, further tests with various IOL optics have to follow. In addition, simulating the circular pattern of YAG capsulotomy is necessary.
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Affiliation(s)
- A. F. Borkenstein
- Borkenstein & Borkenstein private practice, Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010 Graz, Austria
| | - E. M. Borkenstein
- Borkenstein & Borkenstein private practice, Privatklinik der Kreuzschwestern Graz, Kreuzgasse 35, 8010 Graz, Austria
| | - P. Omidi
- grid.11749.3a0000 0001 2167 7588Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Saar 66424 Homburg, Deutschland
| | - A. Langenbucher
- grid.11749.3a0000 0001 2167 7588Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Saar 66424 Homburg, Deutschland
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2
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Elsner R, Sievers J, Kunert M, Reiss S, Bohn S, Schünemann M, Stolz H, Guthoff R, Stachs O, Sperlich K. The Rostock Method for Qualitative and Quantitative Evaluation of Intraocular Lenses. Klin Monbl Augenheilkd 2022; 239:1440-1446. [PMID: 36493765 DOI: 10.1055/a-1953-7302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND For quantitative and qualitative evaluation of the imaging properties of IOLs, axial cross-sectional images can be obtained from the 3-dimensional light distribution by means of an optical bench, as is known from light sheet recordings in fluorescein baths. This paper presents a new image-processing algorithm to enhance the quality of generated axial cross-sectional images, and the two methods are then compared. MATERIAL AND METHODS The 3-dimensional point spread function of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec AG, Jena, Germany) was recorded on an optical bench developed in Rostock for different pupil diameters. A specially adapted image processing algorithm was then applied to the measurements, allowing through-focus curves to be generated. In addition, cross-sectional images of the IOLs studied were acquired using the light sheet method in a fluorescein bath. RESULTS The study clearly shows the superiority of the newly developed method over the light sheet method in terms of image quality. In addition to the individual focal points, fine focal structures as well as halos can be made visible in the cross-sectional images obtained using the new method. In the generated through-focus curves, 3 intensity peaks can be identified, which represent the near, intermediate and far focus of the tested MIOL and cannot be represented by light sheet methods. CONCLUSION The interaction of the optical bench with the developed image processing algorithm allows a more detailed understanding of the image formation and false light phenomena of IOLs, which was restricted by the technical limitations of the existing light sheet method. In addition, other quantities such as the through-focus curve can be derived quantitatively.
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Affiliation(s)
- Ricardo Elsner
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland.,Interdisziplinäre Fakultät Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Jan Sievers
- Institut für Physik, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - Martin Kunert
- Klinik für Augenheilkunde, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Deutschland
| | - Stefan Reiss
- Labor für Sehhilfen - Bereich Optik und Technik der Brille, Berliner Hochschule für Technik, Berlin, Deutschland
| | - Sebastian Bohn
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland.,Interdisziplinäre Fakultät Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Melanie Schünemann
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland.,Interdisziplinäre Fakultät Leben, Licht & Materie, Universität Rostock, Deutschland
| | | | - Rudolf Guthoff
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland.,Interdisziplinäre Fakultät Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Oliver Stachs
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland.,Interdisziplinäre Fakultät Leben, Licht & Materie, Universität Rostock, Deutschland
| | - Karsten Sperlich
- Klinik und Poliklinik für Augenheilkunde, Universitätsmedizin Rostock, Deutschland.,Interdisziplinäre Fakultät Leben, Licht & Materie, Universität Rostock, Deutschland
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3
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Baur ID, Auffarth GU, Yan W, Łabuz G, Khoramnia R. Visualization of Ray Propagation through Extended Depth-of-Focus Intraocular Lenses. Diagnostics (Basel) 2022; 12:2667. [PMID: 36359510 PMCID: PMC9689910 DOI: 10.3390/diagnostics12112667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 10/14/2023] Open
Abstract
Extended depth-of-focus (EDoF) presbyopia-correcting intraocular lens (IOL) models differ in their optical design and performance. In the laboratory, we compared the ray propagation and light intensity profiles of four IOLs: the non-diffractive AcrySof IQ Vivity (Alcon Inc., Fort Worth, TX, USA) and two diffractive models, Symfony ZXR00 (Johnson & Johnson Vision, Jacksonville, FL, USA) and AT Lara 829 MP (Carl Zeiss Meditec, Berlin, Germany). A fourth lens, the monofocal AcrySof IQ SN60WF (Alcon Inc.) acted as the control. We projected a 520 nm laser light through each submerged lens in a bath of fluorescein solution. A camera mounted on a microscope captured the light that emerged from the IOL. We recorded the IOLs' point spread function (PSF) to determine the presence of unwanted visual effects. The ray propagation visualization and light intensity profile of the monofocal control showed one distinct focus, while the AcrySof IQ Vivity demonstrated an extended focus area. We observed two distinct foci with each diffractive IOL. We found a lower level of light spread beyond the PSF center for the AcrySof IQ Vivity compared to the diffractive IOLs. In conclusion, we could confirm the extended range of focus for all the EDoF IOL models. However, the non-diffractive AcrySof IQ Vivity appears to have a smoother transition from a far to an intermediate range. We discuss whether, in clinical use, the higher level of spurious light we found in the diffractive designs may translate into increased dysphotopsia.
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Sievers J, Elsner R, Bohn S, Schünemann M, Stolz H, Guthoff RF, Stachs O, Sperlich K. Method for the generation and visualization of cross-sectional images of three-dimensional point spread functions for rotationally symmetric intraocular lenses. BIOMEDICAL OPTICS EXPRESS 2022; 13:1087-1101. [PMID: 35284182 PMCID: PMC8884235 DOI: 10.1364/boe.446869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
Cross-sectional images of three-dimensional point spread functions of intraocular lenses are used to study their image formation. To obtain those, light sheet-based methods are established. Due to the non-negligible thicknesses of the light sheets, the image quality of the cross-sectional images is constrained. To overcome this hurdle, we present a dedicated evaluation algorithm to increase image quality in the post-processing step. Additionally, we compare the developed- with the light sheet method based on our own investigations of a multifocal diffractive intraocular lens conducted in an in-house designed optical bench. The comparative study showed the clear superiority of the newly developed method in terms of image quality, fine structure visibility, and signal-to-noise ratio compared to the light sheet based method. However, since the algorithm assumes a rotationally symmetrical point spread function, it is only suitable for all rotationally symmetrical lenses.
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Affiliation(s)
- Jan Sievers
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
- Institute of Physics, Martin–Luther–University Halle–Wittenberg, 06120 Halle (Saale), Germany
| | - Ricardo Elsner
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
| | - Sebastian Bohn
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
| | - Melanie Schünemann
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
| | - Heinrich Stolz
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
- Institute of Physics, University of Rostock, 18055 Rostock, Germany
| | - Rudolf F. Guthoff
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
| | - Oliver Stachs
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
| | - Karsten Sperlich
- Department of Ophthalmology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Life, Light & Matter, University of Rostock, 18055 Rostock, Germany
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5
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Son HS, Łabuz G, Khoramnia R, Yildirim TM, Choi CY, Knorz MC, Auffarth GU. Visualization of Forward Light Scatter in Opacified Intraocular Lenses and Straylight Assessment. Diagnostics (Basel) 2021; 11:diagnostics11081512. [PMID: 34441445 PMCID: PMC8393541 DOI: 10.3390/diagnostics11081512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 08/20/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Qualitative visualization of forward light scatter and quantitative straylight measurement of intraocular lenses (IOLs). Methods: We analyzed two calcified IOL-explants, the Euromaxx ALI313Y (Argonoptics GmbH) and the LS-312 MF30 (Oculentis BV), one IOL with artificially induced glistenings (PC-60AD, Hoya), and one control (CT Asphina 409MP, Carl Zeiss Meditec AG) free of any opacification. Analysis included light microscopy, qualitative light scatter visualization using ray propagation imaging technique, and quantitative straylight measurement using C-Quant (Oculus). Results: More light scattering effect—visible as increased light intensity outside the IOL’s main focus—was evident in all opacified IOLs than the control. The highest straylight levels were observed in the Euromaxx (289.71 deg2/sr), which showed extensive granular deposits throughout its optic, followed by the MF30 (78.58 deg2/sr), which only showed opacification in its center. The glistenings-IOL demonstrated numerous microvacuoles within the optic and had straylight levels of 22.6 deg2/sr, while the control showed the lowest straylight levels (1.7 deg2/sr). Conclusions: Ray propagation imaging technique allowed qualitative assessment of off-axis veils of light that result from increased forward light scattering. Straylight was increased in all opacified lenses compared to the clear control lens. The IOL opacifications are significant sources of glare.
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Affiliation(s)
- Hyeck-Soo Son
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Grzegorz Łabuz
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Ramin Khoramnia
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Timur M. Yildirim
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
| | - Chul Young Choi
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Korea
| | - Michael C. Knorz
- FreeVis LASIK Center, Medical Faculty Mannheim of the University of Heidelberg, 68167 Mannheim, Germany;
| | - Gerd U. Auffarth
- The David J. Apple International Laboratory for Ocular Pathology and International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, 69117 Heidelberg, Germany; (H.-S.S.); (G.Ł.); (R.K.); (T.M.Y.); (C.Y.C.)
- Correspondence:
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6
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Quint WH, Tadema KCD, de Vrieze E, Lukowicz RM, Broekman S, Winkelman BHJ, Hoevenaars M, de Gruiter HM, van Wijk E, Schaeffel F, Meester-Smoor M, Miller AC, Willemsen R, Klaver CCW, Iglesias AI. Loss of Gap Junction Delta-2 (GJD2) gene orthologs leads to refractive error in zebrafish. Commun Biol 2021; 4:676. [PMID: 34083742 PMCID: PMC8175550 DOI: 10.1038/s42003-021-02185-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/04/2021] [Indexed: 12/20/2022] Open
Abstract
Myopia is the most common developmental disorder of juvenile eyes, and it has become an increasing cause of severe visual impairment. The GJD2 locus has been consistently associated with myopia in multiple independent genome-wide association studies. However, despite the strong genetic evidence, little is known about the functional role of GJD2 in refractive error development. Here, we find that depletion of gjd2a (Cx35.5) or gjd2b (Cx35.1) orthologs in zebrafish, cause changes in the biometry and refractive status of the eye. Our immunohistological and scRNA sequencing studies show that Cx35.5 (gjd2a) is a retinal connexin and its depletion leads to hyperopia and electrophysiological changes in the retina. These findings support a role for Cx35.5 (gjd2a) in the regulation of ocular biometry. Cx35.1 (gjd2b) has previously been identified in the retina, however, we found an additional lenticular role. Lack of Cx35.1 (gjd2b) led to a nuclear cataract that triggered axial elongation. Our results provide functional evidence of a link between gjd2 and refractive error. Quint et al. use zebrafish lines deficient in one of two orthologs of the Gap Junction Delta-2 (GJD2) gene, which is associated with myopia by genome-wide association studies. They link gjd2 with refractive error and report evidence to suggest that gjd2a plays a role in ocular biometry whilst gjd2b, previously found in the retina, possesses an additional lenticular role.
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Affiliation(s)
- Wim H Quint
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Kirke C D Tadema
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erik de Vrieze
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rachel M Lukowicz
- Institute of Neuroscience, University of Oregon, Eugene, United States
| | - Sanne Broekman
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Beerend H J Winkelman
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cerebellar Coordination and Cognition, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Melanie Hoevenaars
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Erwin van Wijk
- Department of Otorhinolaryngology, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, Netherlands
| | - Frank Schaeffel
- Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany.,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland
| | - Magda Meester-Smoor
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adam C Miller
- Institute of Neuroscience, University of Oregon, Eugene, United States
| | - Rob Willemsen
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands.,Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Ophthalmology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Adriana I Iglesias
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands. .,Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands.
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Comparison of Post-Cataract Surgery Visual Outcomes and Quality of Life in Patients Bilaterally Implanted with Multifocal Intraocular Lenses. Ophthalmol Ther 2020; 10:101-113. [PMID: 33245545 PMCID: PMC7886923 DOI: 10.1007/s40123-020-00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction The present study compared visual outcomes in eyes with bilateral implantation of two multifocal intraocular lenses (MFIOLs)—the Eyecryl™ ACTV diffractive multifocal IOL (group 1) and AcrySof® IQ ReSTOR® multifocal IOL (group 2). Methods This was a prospective, two-group observational longitudinal study of 118 eyes from 59 patients conducted at Laxmi Eye Institute, Panvel, India. We evaluated the patients at 1, 3, and 6 months. We assessed visual acuity, contrast sensitivity, higher-order aberrations, reading speed, defocus curve, stereopsis, quality of life (QOL), and adverse events in these participants. Results The median (interquartile range) best-corrected distance visual acuity was 0.18 (0, 0.18) in group 1 and 0.18 (0, 0.18) in group 2 at 1, 3, and 6 months; the difference was not statistically significant (p = 0.48). The binocular defocus curve in both groups showed two peaks at 0.0 to −0.5 D and at −2.5 D. The mean (95% confidence interval) critical print size was significantly different between groups 1 and 2 at low illumination (0.918 [0.905, 0.931] vs 1.154 [1.128, 1.180]; p = 0.004). Contrast sensitivity was significantly better in group 1 under mesopic conditions but not under scotopic conditions. Though total QOL did not differ significantly between groups, the psychosocial quality of life was significantly better in group 1. About 23% of patients in group 2 reported unwanted images, compared with 0% in group 1 (p = 0.01). Conclusion We found that the Eyecryl and AcrySof groups were comparable for best-corrected visual acuity, photopic contrast sensitivity, defocus curve, reading parameters, stereopsis, and quality of vision. However, the Eyecryl group had better mesopic contrast and a lower proportion of unwanted images. Psychosocial quality of life was significantly better in the Eyecryl group; however, satisfaction was similar between groups. The cost of one of the lenses is less than the other. Thus, individuals with limited resources may opt for the Eyecryl™ ACTV, with similar visual outcomes.
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