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Łabuz G, Yan W, Baur ID, Khoramnia R, Auffarth GU. Comparison of Five Presbyopia-Correcting Intraocular Lenses: Optical-Bench Assessment with Visual-Quality Simulation. J Clin Med 2023; 12:jcm12072523. [PMID: 37048607 PMCID: PMC10095001 DOI: 10.3390/jcm12072523] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/16/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Presbyopia correction through implantation of a trifocal intraocular lens (IOL) is a modality offered to both cataract and refractive-lens exchange patients. To maximize postoperative satisfaction, IOL selection needs to be made based on patients’ requirements aligned with the available technology. Five Trifocal IOLs were assessed in this study, and their differentiating features were identified: Triumf POD L GF, AT Lisa Tri, Tecnis Synergy, AcrySof IQ PanOptix, and Acriva Trinova Pro C. The optical quality was assessed using the modulation-transfer-function principle. Simulated defocus curves were derived from a non-linear formula. Far-focus simulated visual acuity (simVA) was 0.03 logMAR or better for all the studied IOLs, showing minimal differences. However, each IOL’s intermediate focus position differed across a range from 61 cm to 80 cm; and for the near focus, it was 36 cm to 44 cm. Triumf demonstrated improved intermediate point at the expense of the near focus resulting in a lower predicted near VA. PanOptix exhibited the shortest range of vision without a clear distinction between intermediate and near-point. The remaining lenses presented three foci of comparable optical quality and, thus, simVA performance. Each model, however, revealed a different aperture-change response. Trinova function improved at intermediate but was worse at near for larger pupils. The opposite was observed for AT Lisa. Synergy’s optical quality change was predominantly associated with lower pupil diameter. In conclusion, the trifocal IOLs can be differentiated according to their secondary-foci position, light-energy distribution, and pupil-size-related behavior. The observed differences may translate directly into a clinical effect showing that the trifocal IOLs vary in their ability to deliver optimal vision at different distances, with some providing improved intermediate while others favor reading distance. The knowledge gained through this objective testing can support IOL selection, postoperative patient counselling and increase the chance of spectacle independence after surgery.
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Alarcon A, Canovas C, Koopman B, Pande MV, Koch DD, Piers P. Optical bench evaluation of the effect of pupil size in new generation monofocal intraocular lenses. BMC Ophthalmol 2023; 23:112. [PMID: 36941624 PMCID: PMC10026412 DOI: 10.1186/s12886-023-02839-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND A new generation of enhanced monofocal IOLs has been introduced to slightly increase the depth of focus as compared to standard monofocal IOLs. The purpose of this study is to evaluate the effect of pupil size on the through-focus optical performance of three new enhanced monofocal IOLs, designed to improve the range of vision as compared to standard monofocal IOLs. METHODS Optical bench testing in white light was performed for different pupils, using an average cornea eye. Distance image quality was evaluated using Modulation Transfer Function (MTF) measurements. Through-focus Visual Acuity (VA) was simulated from these measurements (sVA). Three enhanced monofocal IOLs (ICB00, ISOPure, and RayOne-EMV) and three standard monofocal IOLs: two aspheric (ZCB00 and SN60WF) and one spherical (AAB00) were included. RESULTS The enhanced monofocal IOLs provided an improvement in the intermediate sVA as compared to standard monofocal IOLs. For ICB00, the improvement was independent of the pupil size, while for the ISOPure and RayOne-EMV, the intermediate sVA improved with increased pupil size. Similar to the spherical monofocal IOL, the ISOPure and RayOne-EMV showed a strong correlation between improvement in intermediate sVA and reduction of distance sVA and MTF, and increasing pupil size. ICB00 provided the same distance sVA as the aspheric monofocal IOLs and the lowest variability in MTF with pupil size. CONCLUSION Optical bench results showed that the ISOPure and RayOne-EMV provide similar performance to a spherical monofocal IOL, with a strong pupil dependency for distance and intermediate vision. The other enhanced monofocal IOL, ICB00, provided a sustained improvement in simulated intermediate VA and maintained distance image quality comparable to that of the standard aspheric monofocal IOLs, even for larger pupils.
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Affiliation(s)
- Aixa Alarcon
- Johnson and Johnson Vision, Groningen, Netherlands.
| | | | - Bram Koopman
- Johnson and Johnson Vision, Groningen, Netherlands
| | - Milind V Pande
- Vision Surgery & Research Centre, North Ferriby, East Yorkshire, UK
| | - Douglas D Koch
- Cullen Eye Institute, Baylor College of Medicine, Houston, US
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Assessment of the image quality of extended depth-of-focus intraocular lens models in polychromatic light. J Cataract Refract Surg 2021; 46:108-115. [PMID: 32050240 DOI: 10.1097/j.jcrs.0000000000000037] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The use of monochromatic light in the assessment of intraocular lenses (IOLs) has been criticized for not representing the real-world situation. This study aimed to measure and compare the image quality of 3 extended depth-of-focus (EDOF) IOL models in monochromatic and polychromatic light. SETTING David J Apple Laboratory, Heidelberg, Germany. DESIGN In vitro study. METHODS An optical metrology instrument was used to study image quality metrics of diffractive IOLs with chromatic aberration correction (Symfony and AT Lara) and a refractive lens (Mini Well). The modulation transfer function (MTF) was measured in green and polychromatic light at a 2.0 mm, 3.0 mm, and 4.0 mm aperture. The EDOF IOL's tolerance to defocus was tested against a monofocal lens. RESULTS The mean MTF of the EDOF IOL at far distance was decreased in polychromatic compared with monochromatic light. The largest effect was found in the refractive lens; however, at intermediate distance, only small differences occurred. In their tolerance to defocus, the EDOF IOLs were superior to the monofocal IOL. The diffractive IOL had higher MTFs than that of the refractive IOL at 2 primary foci, the refractive IOL's optical quality varied less with defocus at 3.0 mm. The refractive lens was the most susceptible to changes in aperture size. CONCLUSION The diffractive EDOF IOL was more resistant to chromatic effects than the refractive IOL. The EDOF IOLs provided an extended through-focus performance compared with the monofocal IOL, but differences in optical design, particularly pupil dependency, should be considered when refining IOL selection for patients.
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Breyer DRH, Beckers L, Ax T, Kaymak H, Klabe K, Kretz FTA. [Current Review: Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses]. Klin Monbl Augenheilkd 2020; 237:943-957. [PMID: 32797470 DOI: 10.1055/a-1111-9380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Presbyopia and cataract patients' wish to be increasingly independent of spectacles after surgery and this is one of the main drivers for the development of multifocal intraocular lenses (MIOL) and extended depth of focus (EDOF) intraocular lenses (IOL). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract refractive surgeons to help address this need. There is not one single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOL and EDOF IOL, their optics, and their impact on our patients' quality of vision have to be fully understood if we have to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOL/EDOF IOL, in order to help surgeons find an appropriate solution for each of their individual patients.
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Affiliation(s)
- Detlev R H Breyer
- Breyer, Kaymak und Klabe Augenchirurgie, Düsseldorf.,I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf.,Augenheilkunde, International Vision Correction Research Centre Network (IVCRC.net), Universität Heidelberg
| | - Lena Beckers
- Breyer, Kaymak und Klabe Augenchirurgie, Düsseldorf.,I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf.,Augenheilkunde, International Vision Correction Research Centre Network (IVCRC.net), Universität Heidelberg
| | - Timon Ax
- Breyer, Kaymak und Klabe Augenchirurgie, Düsseldorf.,I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf.,Augenheilkunde, International Vision Correction Research Centre Network (IVCRC.net), Universität Heidelberg
| | - Hakan Kaymak
- Breyer, Kaymak und Klabe Augenchirurgie, Düsseldorf.,I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf.,Augenheilkunde, International Vision Correction Research Centre Network (IVCRC.net), Universität Heidelberg
| | - Karsten Klabe
- Breyer, Kaymak und Klabe Augenchirurgie, Düsseldorf.,I. I. O., Internationale Innovative Ophthalmochirurgie, Düsseldorf.,Augenheilkunde, International Vision Correction Research Centre Network (IVCRC.net), Universität Heidelberg
| | - Florian Tobias Alwin Kretz
- Augenheilkunde, International Vision Correction Research Centre Network (IVCRC.net), Universität Heidelberg.,Augenheilkunde, Precise Vision Augenärzte, PVK Precise Vision GmbH, Rheine
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Vega F, Millán MS, Garzón N, Altemir I, Poyales F, Larrosa JM. Visual acuity of pseudophakic patients predicted from in-vitro measurements of intraocular lenses with different design. BIOMEDICAL OPTICS EXPRESS 2018; 9:4893-4906. [PMID: 30319910 PMCID: PMC6179423 DOI: 10.1364/boe.9.004893] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/26/2018] [Accepted: 08/03/2018] [Indexed: 05/09/2023]
Abstract
The optical quality of a set of IOLs (modeling set: one monofocal and two bifocals) was assessed through focus by the area under the modulation transfer function (MTFa) metric and related to the visual acuity (VA) defocus curves of pseudophakic patients implanted with said IOLs. A non-linear relationship between the MTFa and clinical VA was obtained with an asymptotic limit found to be the best VA achievable by the patients. Two mathematical fitting functions between clinical VA and MTFa were derived with high correlation coefficients (R2≥0.85). They were applied to the MTFa obtained from a different set of IOLs with advanced designs (trial set: one extended range of vision -ERV-, one trifocal ERV and one trifocal apodized) to predict VA versus defocus of patients implanted with these IOLs. Differences between the calculated VA and the clinical VA for both fitting models were within the standard deviation of the clinical measurements in the range of -3.00 D to 0.00 D defocus, thus proving the suitability of the MTFa metric to predict clinical VA performance of new IOL designs.
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Affiliation(s)
- Fidel Vega
- Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya, BarcelonaTech, Violinista Vellsolà 37, 08222 Terrassa, Spain
| | - Maria S Millán
- Departament d'Òptica i Optometria, Universitat Politècnica de Catalunya, BarcelonaTech, Violinista Vellsolà 37, 08222 Terrassa, Spain
| | - Nuria Garzón
- IOA Madrid, Innova Ocular, Galileo 104, 28003 Madrid, Spain
| | - Irene Altemir
- Miguel Servet University Hospital, Ophthalmology Department, Paseo Isabel La Católica, 1-3 50009 Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Edificio CIBA, Planta 0 Avda. San Juan Bosco, 1-3 50009 Zaragoza, Spain
| | | | - Jose Manuel Larrosa
- Aragon Institute for Health Research (IIS Aragón), University of Zaragoza, Edificio CIBA, Planta 0 Avda. San Juan Bosco, 1-3 50009 Zaragoza, Spain
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Breyer DRH, Kaymak H, Ax T, Kretz FTA, Auffarth GU, Hagen PR. Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses. Asia Pac J Ophthalmol (Phila) 2017; 6:339-349. [PMID: 28780781 DOI: 10.22608/apo.2017186] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/26/2017] [Indexed: 12/18/2022] Open
Abstract
Presbyopia and cataract patients' desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal intraocular lenses (MIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract-refractive surgeons to help address this need. There is not 1 single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOLs and EDOF IOLs, their optics, and their respective impact on our patients' quality of vision have to be fully understood to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOLs/EDOF IOLs to help surgeons find an appropriate solution for each of their individual patients.
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Affiliation(s)
| | - Hakan Kaymak
- Breyer, Kaymak, Klabe Augenchirurgie, Düsseldorf, Germany
| | - Timon Ax
- Breyer, Kaymak, Klabe Augenchirurgie, Düsseldorf, Germany
| | | | | | - Philipp R Hagen
- Internationale Innovative Ophthalmochirurgie GbR, Düsseldorf, Germany
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