Objective optical quality in eyes with customized selection of aspheric intraocular lens implantation

A comparative study of two presbyopia-correcting intraocular lenses combining bifocal and extended depth-of-focus profiles

OBJECTIVE

To compare the visual performance of two presbyopia-correcting intraocular lenses (IOLs) that combine both bifocal and extended depth-of-focus profiles, Artis® Symbiose® Plus (Symbiose Plus; Cristalens Industrie, Lannion, France) and Tecnis® Synergy® (Synergy; Johnson & Johnson Vision, Santa Ana, CA, USA).

METHODS

The medical records of patients with cataract bilaterally implanted with either Symbiose Plus or Synergy between January 2022 and January 2023 were assessed. The principal measures of postoperative findings included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near (40 and 33 cm) visual acuity (UNVA), objective optical quality (OOQ) parameters, distance-corrected defocus curve analysis, and surveys of subjective satisfaction.

RESULTS

Total of 96 eyes from 48 patients were enrolled. Each group was equally composed of 24 patients, 48 eyes. There were no significant differences between the two groups on baseline characteristics. Both IOLs displayed excellent binocular UDVA, CDVA, and UNVA (40 and 33 cm) with no statistical difference (p = 0.467(UDVA), p = 0.584(CDVA), p = 0.096(40-cm UNVA), and p = 0.621(33-cm UNVA)). However, with regard to UIVA, the Synergy group showed significantly superior results (p < 0.001). In contrast, the Symbiose Plus group showed significantly better results on OOQ parameters and patient-reported quality of vision survey outcomes (both p < 0.001).

CONCLUSIONS

Both IOLs provided a decent continuous range of vision from near to far distance.

Clinical outcomes of a new four-haptic hydrophobic presbyopia-correcting intraocular lens

A new presbyopia-correcting intraocular lens (IOL) combining bifocal and extended-depth-of-focus profiles (Symbiose: Artis Symbiose Plus; Cristalens Industrie, Lannion, France) was introduced. We compared the output with that of a standard monofocal IOL (PL E: Artis PL E). The two four-haptic hydrophobic IOLs were made of the same material from the same company. Cataract patients bilaterally implanted with either PL E or Symbiose between November 2021 and August 2022 were reviewed. The principal measures of the postoperative results were uncorrected distance visual acuity (UDVA); corrected distance VA (CDVA); uncorrected intermediate VA; uncorrected near VA; objective optical quality; and distance-corrected defocus curves. This study included forty-eight patients (96 eyes), with 22 and 26 patients (44 and 52 eyes, respectively) being implanted with PL E and Symbiose, respectively. All patients received the same type of IOL implanted in both eyes. The average age of patients was 70.9 ± 7.1 and 60.0 ± 8.5 years in PL E and Symbiose groups, respectively, with significantly younger patients in Symbiose group (p < 0.001). Both IOLs displayed excellent UDVA and CDVA with no statistical difference (p = 0.081 (monocular UDVA), p = 0.599 (monocular CDVA), p = 0.204 (binocular UDVA), and p = 0.145 (binocular CDVA)). In comparison with PL E group, Symbiose group showed significantly superior postoperative intermediate and near VA (p < 0.001). PL E group showed significantly superior objective optical quality compared with Symbiose group (p < 0.001). Symbiose provides a continuous range of vision that ensures a seamless transition from far to near with no discontinuity. It also delivers a smooth defocus curve with a larger landing area than the PL E. But the objective optical quality was better in PL E.

Intense pulsed-light treatment improves objective optical quality in patients with meibomian gland dysfunction

BACKGROUND

To evaluate changes in objective optical quality following intense pulsed light (IPL) treatment combined with meibomian gland (MG) expression (MGX) in patients with MG dysfunction (MGD).

METHODS

This retrospective cross-sectional study included MGD-related dry eye disease (DED) patients who received IPL treatment between March and December 2021 at Kim's Eye Hospital, Seoul, Republic of Korea. Each patient underwent four sessions of IPL treatment using Lumenis M22 (Lumenis Ltd., Yokneam, Israel) and MGX at three-week intervals.

RESULTS

This study included 90 eyes from 45 patients with MGD. The mean age was 52.3 ± 16.1 years (range, 20-75 years), and 53.3% (24/45) of patients were female. Compared with the baseline, all clinical symptoms and signs significantly improved after IPL treatment combined with MGX. All optical quality parameters obtained with an optical quality analysis system (OQAS: Visiometrics, Castelldefels, Spain) have improved significantly over the baseline (p < 0.001).

CONCLUSIONS

In patients with MGD, IPL treatment combined with MGX improved the objective optical quality and clinical signs and symptoms of DED.

Visual function assessment of Chinese cataract patients after individual aspheric intraocular lens implantation according to preoperative cornea spherical aberration

BACKGROUND: Aspheric intraocular lens (IOLs) implantation has been widely applied in cataract surgery. However, there is no consensus on the optimal guidance for the operations in IOLs implantation. OBJECTIVE: This study evaluated the visual function of Chinese cataract patients six months after cataract surgery with two different guiding ideologies. METHODS: We evaluated 50 patients (61 eyes) with implantation of different aspheric IOLs (SN60WF IOLs, ZCB00 IOLs, PY-60AD IOLs, AO IOLs) 6 months after cataract surgery. Twenty-four patients (30 eyes) under individual implantation were ascribed to group 1 and 26 patients (31 eyes) with randomized implantation were ascribed to the control group (group 2). Postoperatively parameters included monocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), total spherical aberration Z (4, 0) at 5 mm pupil size, and patient satisfaction. The quality of life after operation was assessed through the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). RESULTS: Six months after cataract operation, the contrast sensitivity with glare of group 1 at 2.5∘ was 0.697 ± 0.027, and 0.532 ± 0.049 in group 2. Besides, there was no significant difference at any other special frequency. The mean spherical aberration Z (4, 0) at 5 mm pupil size in group 1 was 0.015 ± 0.028 um, and in group 2 was 0.043 ± 0.109 um, with a significant difference (p< 0.01). The mean scores obtained from NEI VFQ-25 were not significantly different. CONCLUSION: It is effective to implant aspheric IOLs individually according to preoperative corneal spherical aberration. Patients obtained better contrast sensitivity with glare at 2.5∘, but there was no significant difference in BCVA, contrast sensitivity at other special frequency, and subjective visual function.

Visual quality analysis using the Chinese Catquest-9SF scale following different spherical aberration IOL implantation

Purpose

Based on the Chinese version of the Catquest-9SF scale, the contrast sensitivity meter and wavefront aberrometer were used to evaluate the visual quality of cataract patients implanted with different spherical aberrations IOL.

Design

Retrospective Observational Study.

Methods

Patients who had the lens implantation in our department from January 2020 to December 2021 were enrolled. All patients underwent uncorrected visual acuity, best corrected visual acuity and slit lamp microscope, high-order aberrations and contrast sensitivity test. The KR-1W wavefront analyzer (Topcon Medical System, Tokyo, Japan) was used to measure wavefront aberrations post-operation. The Chinese Catquest-9SF scale was used to score the postoperative visual satisfaction of the patients.

Results

145 patients were screened according to the exclusion criteria, including 51 patients in the zero aspherical IOL (SOFTEC HD) group, 42 patients in the negative aspherical IOL (ZCB00) group, and a total of 52 patients in the spherical IOL (HQ-201HEP) group. The score was the highest in the zero spherical aberration group, followed by the negative spherical aberration group with the lowest scores in the spherical IOL group. Higher-order aberrations are relatively low in eyes implanted with the zero spherical aberration group. Contrast sensitivity with spherical lenses under glare-free and glare conditions was lower than those with aspheric lenses, and at higher frequencies the zero-aberration aspheric lens performed the best.

Conclusion

The Chinese Catquest-9SF scale provides an indication of visual quality after aspheric IOL implantation.

Comparative analysis of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and bifocal profiles with a standard monofocal intraocular lens

Background

Recently, a new presbyopia-correcting intraocular lens (IOL) that combines extended depth-of-focus and bifocal profiles (ZFR00: Tecnis® Synergy®, Johnson & Johnson Vision, Santa Ana, CA, USA) has been established and several studies have been reported. We attempted to compare the performance with a standard IOL (ZCB00: Tecnis® monofocal, Johnson & Johnson Vision, Santa Ana, CA, USA) manufactured using the same material from the same company, which has been extensively used worldwide.

Methods

The medical records of patients undergoing cataract surgery with ZCB00 or ZFR00 implantation between March 2021 and September 2021 and with available 3-month visit data were reviewed. Uncorrected near, intermediate, and distance visual acuity (VA), corrected distance VA, and optical quality were the main outcome measures.

Results

This study included forty-six patients (64 eyes), with twenty-one patients (32 eyes) implanted with ZCB00 and twenty-five patients (32 eyes) implanted with ZFR00. The average age of the patients was 66.0 ± 10.1 (range: 40 to 82) and 65.1 ± 4.7 (range: 59 to 77) years in the ZCB00 and ZFR00 groups, respectively. The preoperative characteristics did not differ significantly between the two groups. Compared to the ZCB00 group, the ZFR00 group demonstrated significantly superior intermediate and near VA (p < 0.001) at 3 months postoperatively. The ZFR00 group showed significantly lower objective measured optical quality than that in the ZCB00 group.

Conclusions

The ZFR00 exhibited a continuous range of vision and a smooth defocus curve, while the ZCB00 provided superior objective optical quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02516-6.

Presbyopia-Correcting Intraocular Lenses Implantation in Eyes After Corneal Refractive Laser Surgery: A Meta-Analysis and Systematic Review

Purpose

To assess the efficacy, safety, and predictability of presbyopia-correcting intraocular lenses (IOLs) in cataract patients with previous corneal refractive surgery.

Methods

A systematic literature search was performed to identify studies evaluating the clinical outcomes of presbyopia-correcting IOLs implantation in cataract surgery after laser refractive surgery. Outcomes were efficacy, safety and predictability parameters.

Results

The authors identified 13 studies, involving a total of 128 patients and 445 eyes. Presbyopia-correcting IOLs were effective at improving distance, intermediate and near visual acuity aftercataract surgery. The proportion of post-laser surgery eyes with uncorrected distance visual acuity (UDVA) ≥ 20/25 was 0.82 [95% confidence interval (CI), 0.74-0.90] and the pooled rates of spectacle independence at near, intermediate, and far distances were 0.98 (95% CI, 0.94-1.00), 0.99 (95% CI, 0.95-1.00) and 0.78 (95% CI, 0.65-0.94) respectively. The percentage of participants who suffered from halos and glare was 0.40 (95% CI, 0.25-0.64) and 0.31 (95% CI, 0.16-0.60), respectively. The predictability had a percentage of 0.66 (95% CI, 0.57-0.75) and 0.90 (95% CI, 0.85-0.96) of eyes within ±0.5 diopters (D) and ±1.0 D from the targeted spherical equivalent.

Conclusions

Presbyopia-correcting IOLs provide satisfactory results in terms of efficacy, safety and predictability in patients with previous corneal refractive surgery, but have a higher risk of photopic side effects such as halos and glare.

Characteristics of Corneal Higher-Order Aberrations in Congenital Ectopia Lentis Patients

Purpose

The purpose of this study was to investigate the characteristics of corneal higher-order aberrations (HOAs) in patients with congenital ectopia lentis (CEL).

Methods

Clinical characteristics and HOAs of 60 patients with CEL and 75 healthy controls at Zhongshan Ophthalmic Center in China were retrospectively analyzed. The Q value and the corneal HOAs in the CEL group and the controls were measured by using Pentacam and compared value between the CEL and control groups. The correlation between HOAs and age was investigated using the Pearson correlation analysis.

Results

The Q value of anterior corneal surface in the CEL group was larger than that in the controls (−0.41 ± 0.17 vs. −0.32 ± 0.13, P = 0.001); the total corneal horizontal coma in the CEL group were larger than that in the controls (0.24 ± 0.18 vs. −0.05 ± 0.14, P < 0.001); both the primary spherical aberrations of the anterior and total corneal surface were lower in the CEL group than that in the controls (for anterior corneal surface: 0.15 ± 0.08 vs. 0.27 ± 0.08 µm, P < 0.001; for total corneal surface: 0.10 ± 0.09 vs. 0.23 ± 0.09 µm, P < 0.001), the anterior and total corneal horizontal coma were negatively associated with age, whereas the anterior and total corneal spherical aberrations were positively associated with age in patients with CEL.

Conclusions

Patients with CEL had higher corneal horizontal coma and lower corneal vertical coma primary spherical aberrations than healthy controls.

Translational Relevance

These findings are informative for the clinical managements in patients with CEL.

Effect of misalignment at different orientations associated with angle κ on optical performance of aspheric intraocular lenses with different surface designs

Intraocular lens (IOL) misalignment and angle κ have had significant negative impact on post-operative quality of vision. ZEMAX software has been used to imitate the optical performance of pseudophakic eyes with different IOL surface designs at different orientations of IOL misalignment (decentration of 0.4 mm and tilt of 7°, and with the existence of 0.5 mm angle κ). We found that an aspheric balanced curve optic surface maintained better optical performance via inducing less coma aberration. Coma aberration played an unexpectedly important role in the optical performance. With angle κ, the impact of IOL misalignment on visual quality was associated with the orientation of decentration and tilt, indicating that the coma compensation also took effect in pseudophakic eyes. Due to the high incidence of post-operative IOL misalignment, our results provide evidence of the importance of considering personalized angle κ before cataract surgery for patients.

Optical and visual quality comparison of implantable collamer lens and femtosecond laser assisted laser in situ keratomileusis for high myopia correction

AIM

To compare clinical outcomes and refractive stability of implantable collamer lens (ICL) implantation and femtosecond laser assisted laser in situ keratomileusis (FS-LASIK) for high myopia correction.

METHODS

The Optical Quality Analysis System (OQAS) was used to evaluate clinical outcomes objectively after operation for high myopia correction. We compared the two procedures in terms of 1-year changes in uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), safety index, efficacy index, spherical equivalent, modulation transfer function (MTF) cutoff frequency, strehl ratio (SR) and objective scatter index (OSI).

RESULTS

At 1y postoperatively, the safety indices were 1.33±0.27 in ICL group, and 1.17±0.24 in FS-LASIK group. 39.58% in the ICL group and 27.59% in the FS-LASIK group gained CDVA in 2 lines or better than that in preoperative CDVA. The efficacy indices were 1.28±0.22 in ICL group, and 1.13±0.26 in FS-LASIK group. The changes of spherical equivalent from 1wk to 1y postoperatively was -0.12±0.37 D in ICL group, and -0.79±0.58 D in FS-LASIK group (P<0.05). Spherical equivalent within ±0.50 D was achieved in 97.92% in ICL group and 68.97% in FS-LASIK group. MTF cutoff frequency were higher with ICL as compared to FS-LASIK (P<0.05) at each postoperative follow-up stage; for postoperative 1mo later, SR was statistically significant difference between two groups (P<0.05); with no statistically significant difference in OSI between two groups (P>0.05) in postoperative 3mo later.

CONCLUSION

ICL implantation and FS-LASIK procedures both provide good safety and predictability in high myopia correction. ICL implantation provides better clinical outcomes and refractive stability than FS-LASIK.

Optical Quality Assessment in Patients with Unilateral Congenital Ptosis: A Matched Case-Control Study

Background. To evaluate the differences in the corneal higher-order aberrations (HOAs) and optical quality of the ptosis eyes compared with the normal fellow eyes in the unilateral congenital ptosis patients. Methods. A matched case-control study was performed in 17 pairs of eyes in 17 unilateral congenital ptosis patients. The ptosis eye was enrolled in the ptosis group while the normal fellow eye was enrolled in the normal group. The HOAs obtained from Pentacam HR and the optical quality parameters obtained from Optical Quality Analysis System (OQAS) were compared between the two groups. Results. There were significant differences in a vertical coma and vertical trefoil on the anterior corneal surface between the ptosis group and the normal group $\left(p<0.05\right)$ . The OQAS parameters in the ptosis group were significantly different from those in the normal group $\left(p<0.05\right)$ . The vertical fissure height (VFH) showed a significant correlation with the total HOAs, 3rd HOAs, and vertical coma on the anterior corneal surface $\left(p<0.05\right)$ . Conclusions. Compared with the normal fellow eyes, the ptosis eyes showed significantly degraded optical quality. The eyelid position was important for the changes of corneal HOAs in the ptosis eyes. The reasons for the discrepancy of the OQAS parameters between the ptosis eyes and normal fellow eyes were multiple.

Agreement between subjective and predicted high and low contrast visual acuities with a double-pass system

PURPOSE

To evaluate the agreement between subjective high and low contrast visual acuity (VA) and predicted values from double-pass system measurements in healthy candidates to laser refractive surgery.

METHODS

Ninety-two eyes measured during the preoperative screening to laser refractive surgery were included in this retrospective analysis. High contrast subjective visual acuity (HCVA) and low contrasts at 20% (LCVA20) and 9% (LCVA9) were compared with the predicted VA obtained with a commercial double-pass system (OQAS) at the same levels of contrast, 100% (OV100), 20% (OV20), and 9% (OV9). The agreement was evaluated with Bland-Altman analysis computing the limits of agreement (LoAs) and the correlations with the spearman rho.

RESULTS

An underestimation of VA was obtained with the double-pass system for the highest contrast. Differences between predictive and subjective measurements were statistically significant for 100% contrast (- 0.08 logMAR, p < 0.0005), but not for 20% (- 0.03 logMAR, p = 0.07) and 9% (- 0.02 logMAR, p = 0.9) of contrasts. The LoAs increased with the decrease of contrast from 0.29 with 100% to 0.39 logMAR with 9% of contrast. A weak correlation was obtained between subjective and predicted VA (rho ≤ 0.33) that was only significant for 100% (p = 0.001) and 20% (p = 0.004) contrasts.

CONCLUSION

Mean differences between methods were reasonably small so mean results obtained for predicted VA in OQAS studies can be considered as reliable, at least in healthy subjects and for low contrast. However, limits of agreement were considerably poor which means that OQAS cannot replace individual subjective measurements of VA in clinical practice.

Optical quality in low astigmatic eyes with or without cylindrical correction

PURPOSE

To investigate whether optical quality could be improved by cylindrical correction for low astigmatic eyes with different amounts and axis orientations in patients with myopia up to - 3.00 diopters (D).

METHODS

A cross-sectional study enrolling healthy young eyes with 0 to - 3.00 D myopia and - 0.50 to - 0.75 D myopic astigmatism was implemented. With a repeated-measures design, outcome measures were sequentially obtained for each subject under two correction modalities: spherocylindrical correction and spherical correction. Subjective refraction was used to determine the refractive prescriptions accordingly in the two correction modalities to obtain optimal subject-reported visual acuity. Primary outcomes were optical quality parameters including objective scatter index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR), and a simulated contrast visual acuity-optical quality analysis system (OQAS) values (OV) obtained by a double-pass system. Corrected distance visual acuity (CDVA) was measured as a secondary outcome. Outcome comparisons between the two correction modalities were performed by grouping in different amounts (- 0.50 D, - 0.75 D) and axes (with the rule, WTR; against the rule, ATR; oblique, OBL) of astigmatism.

RESULTS

A total of 194 eyes of 194 subjects were evaluated. Significantly better CDVA were shown by spherocylindrical correction for all types of astigmatism except for - 0.50 D WTR astigmatism (P = 0.831). For eyes with - 0.50 D WTR astigmatism, better outcome was only shown in OSI with spherocylindrical correction (P = 0.019). For eyes with - 0.50 D ATR and OBL astigmatism, spherocylindrical correction demonstrated better outcomes in all parameters except for SR (P > 0.05). For eyes with - 0.75 D astigmatism, significantly better outcomes in all optical quality parameters were shown with spherocylindrical correction regardless of the axis (P < 0.05).

CONCLUSIONS

Eyes with ATR or OBL myopic astigmatism may benefit in optical quality and visual acuity by combining a cylindrical correction even with a low amount down to - 0.50 D. However, optical quality and visual acuity improvement are limited for WTR astigmatic eyes when the amount of astigmatism is less than - 0.75 D.