variations in refractive analysis with different diffractive multifocal intraocular lenses using...
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Variations in refractive analysis with different diffractive multifocal intraocular lenses using different wavefront analyzers
Mami Yoshino, Hiroko Bissen-Miyajima, Shinichi Oki,
Keiichiro Minami, Kunihiko Nakamura Department of Ophthalmology
Tokyo Dental College Suidobashi Hospital, Tokyo, JapanNaoyuki Maeda
Department of Ophthalmology Osaka University Medical School, Osaka, JapanYoshino, Bissen-Miyajima, Oki, Minami and
Nakamura: No financial InterestMaeda: Research grant recipient from Topcon Corp.
PURPOSE
It is still under discussion whether the Hartman-Shack wavefront analyzer represents real wavefront aberration of the multifocal intraocular lens (MF-IOL) implanted eye. This study evaluated the refractions of diffractive MF-IOL implanted eyes using two wavefront analyzers with manifest refraction.
SUBJECTS 15 eyes of 8 patients who received diffractive MF-IOL
METHODS
Manifest Refraction
Refraction by wavefront analyzer1. KR-9000PW (Topcon, Japan)2. WaveScan (AMO, US)
VS: 0.9 (1.2 x +0.75D sph. cyl. -0.75 D)
Spherical refraction
Cylindrical refraction
To verify if the wavefront analyzer results represent real wavefront aberration, refraction data were compared with those with manifest
Wavefront Analyzer
KR-9000PW WaveScan
Wavefront sensor Hartmann-Shack Hartmann-ShackNo of spots (7 mm pupil)
169 points 240 points
Wavelength at measure
840 nm 785 nm
Centering point Corneal apex Pupil center (scotopic)
Examination room Room light Dim light (5cd/m2 )Pupil Dilated ScotopicRefraction Spectacle plane Spectacle plane
Optical zone: 4 mm & 6 mm
WaveScan
Optical zone: 5.94±0.75 mm
Hartmann-Shack spot images and evaluation
ZM900 SA60D3
Spots were doubled
Spots were clearer in the
center
ZM900 SA60D3
Analysis difficult due to spot irregularity
Spots were doubled
or not clear
Evaluation was possible in all eyes tested
3 eyes failed for evaluation
KR-9000PW
Manifest Wavefront Difference
p value (Wilcoxon)
Sphere (D)Total 0.27±0.52 0.52±0.49 0.25±0.3
0p<0.05
ZM900 0.17±0.33 0.57±0.25 0.40±0.13
p<0.01
SA60D3 0.42±0.74 0.45±0.75 0.04±0.36
p=0.917
Cylinder (D)
Total -0.62±0.43 -0.98±0.45 0.36±0.38
p<0.01
ZM900 -0.47±0.46 -0.70±0.31 0.22±0.32
p=0.086
SA60D3 -0.83±0.30 -1.10±0.69 0.58±0.40
p<0.05
RESULTS : KR-9000PW
Manifest Wavefront Difference P value (Wilcoxon)
Sphere (D)Total 0.27±0.5
21.04±0.51 0.71±0.56 p<0.05
ZM900 0.17±0.33
1.07±0.50 0.88±0.41 p<0.05
SA60D3 0.42±0.53
0.98±0.53 0.34±0.62 p=0.273
Cylinder (D)Total 0.62±0.4
3-
0.94±0.600.32±0.41 p<0.01
ZM900 0.47±0.46
-0.69±0.37
0.16±0.29 p<0.05
SA60D3 0.83±0.30
-1.45±0.36
0.64±0.52 p=0.144
RESULTS : WaveScan
The difference of spherical and cylindrical refractions between manifest and wavefront were within 0.5D.
Coincidence in refraction may support that Hartmann-Shack analyzer measures distance wavefront of diffractive MF-IOL properly.
DISCUSSION : Reliability of refraction with Hartmann-Shack analyzer
Cyrindrical refraction was very close between KR-9000PW and WaveScan.
With KR-9000PW, spherical refraction was closer to manifest.
DISCUSSION :Differences between 2 wavefront analyzers
Differences between 2 multifocal IOLs Hartmann-Shack images were clearer and easier
to be analyzed in eyes with ZM900.
CONCLUSION In this preliminary study, the difference
between the wavefront refraction and manifest refraction can be influenced by the design of the diffractive MF-IOL and the characteristics of the wavefront analyzer.
These effects should be considered for not only 2nd order aberration, but also higher order aberration in eyes with diffractive MF-IOLs.
REFERENCES1. Rocha KM, Chalita MR, Souza CE, el al. Postoperative
wavefront analysis and contrast sensitivity of a multifocal apodized diffractive IOL (ReSTOR) and three monofocal IOLs. J Refract Surg. 2005;21:S808-12.
2. Zelichowska B, Rekas M, Stankiewicz A, et al. Apodized diffractive versus refractive multifocal intraocular lenses: optical and visual evaluation. J Cataract Refract Surg. 2008;34:2036-42.
3. Campbell CE. Wavefront measurements of diffractive and refractive multifocal intraocular lenses in an artificial eye. J Refract Surg. 2008;24:308-11.
4. Charman WN, Montés-Micó R, Radhakrishnan H. Problems in the measurement of wavefront aberration for eyes implanted with diffractive bifocal and multifocal intraocular lenses. J Refract Surg. 2008;24:280-6.
5. Jendritza BB, Knorz MC, Morton S. Wavefront-guided excimer laser vision correction after multifocal IOL implantation. J Refract Surg. 2008;24:274-9
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