Insights on optical and visual performance with rotational asymmetric multifocal intraocular lenses

Session Details

Session Title: Pseudophakic IOLs: Multifocal II

Session Date/Time: Tuesday 13/09/2016 | 08:00-10:30

Paper Time: 09:18

Venue: Auditorium C6

First Author: : S.Marcos SPAIN

Co Author(s): :    A. Radhakrishnan   C. Dorronsoro   V. Akondi   P. Perez-Merino           

Abstract Details

Purpose:

Optical and visual performance of a rotational asymmetric multifocal IOL, the Oculentis MPlus, was evaluated through the use of ray tracing techniques and simultaneous vision simulators. In particular we explored: (1) the optical aberrations of patients implanted with the MPlus IOL; (2) Perceived visual quality with a simulated Oculentis MPlus IOL, in comparison with rotational symmetric designs; (3) Change of perceived visual quality of a simulated MPlus IOL with IOL orientation; (4) Relationships between predicted optical and measured perceived quality with the simulated MPlus IOL.

Setting:

Visual Optics & Biophotonics Lab, Institute of Optics, Madrid, Spain.

Methods:

Optical aberrations were estimated by virtual ( custom model eyes) and by experimental laser ray-tracing in one MPlus implanted patient. The MPlus was simulated in a two-channel simultaneous vision simulator provided with a spatial light modulator. Subjects judged the perceived image quality (PVC) in a preference pattern paradigm while viewing a face image. In one experiment (n=5, cyclopleged) subjects compared the MPlus against 10 rotationally symmetric (concentric or hybrid) bifocal designs. In a second experiment (n=20, cyclopleged) subjects compared PVC across 8 orientations. Subjects’ native aberrations were measured using Hartmann-Shack aberrometry. Through-focus VisualStrehl was used as optical quality metric.

Results:

Standard wavefront reconstruction from the spot-diagrams erroneously estimates presence of coma. Custom analysis of the ray-tracing spot-diagrams allows reconstruction of the IOL phase map bifocal defocus terms and the patient’s aberrations separately. Perceived image quality with the Mplus IOL simulated design significantly exceeded the other designs in 4/5 subjects at far and 3/5 subjects at near. Perceived image quality with the Mplus IOL simulated design varied across orientations, and was strongly biased in 8/20 subjects; 14/20 subjects at far and 13/20 subjects at near preferred a nasal/temporal orientation of the near segment. There was a highly significant correlation (p<0.0001) between measured perceived visual quality and predicted optical quality (estimated from native aberrations + IOL phase map)

Conclusions:

Rrotationally asymmetric multifocal IOLs exceed in perceived visual quality other rotationally symmetric bifocal designs, confirming optical predictions. Optical performance simulated is well predicted by superposition of the subject’s corneal aberration and the bifocal defocus phase map, which is well retrieved (no coma) by proper analysis of the spot diagram. In the presence of the subject’s aberrations, choice of the optimal orientation of the IOL improves perceived visual quality in the majority of subjects, as confirmed by simultaneous vision simulations. Best orientation can be estimated by optical simulations based on the combination of subjects aberration and IOL pattern.

Financial Disclosure:

... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented