Refractive vs diffractive optics for enhanced-depth-of-focus intraocular lenses (EDOF IOL): comparison of visual outcome and photopsia

Session Details

Session Title: Pseudophakic IOLs: Enlarged Depth of Focus

Session Date/Time: Tuesday 10/10/2017 | 08:30-10:30

Paper Time: 08:30

Venue: Room 3.1

First Author: : P.Hagen GERMANY

Co Author(s): :    D. Breyer   H. Kaymak   K. Klabe   F. Kretz   G. Auffarth        

Abstract Details

Purpose:

This retrospective quality management investigation comprises results for patients after bilateral EDOF IOL implantation with respect to binocular defocus curves and the postoperative occurrence of photopsia. Thereby, we highlight differences between variants with refractive and diffractive optical designs.

Setting:

All MIOL implantations were performed at the Breyer-Kaymak-Klabe Eyesurgery in Duesseldorf, Germany. The considered EDOF IOLs are the refractive Comfort (Oculentis) and the diffractive Symfony (AMO). Their choice was motivated by the fact that their mean postoperatively measured distance-corrected monocular defocus curves almost coincide.

Methods:

All patients underwent bilateral cataract surgery or refractive lens exchange. Target refraction was either emmetropia in both eyes or -1.5D+-0.5D in the non-dominant eye (blended vision). For all implantation variants (at least 15 patients per group), binocular defocus curves were measured 3 month after surgery and the area under the curve (MIOL-capacity) was calculated. Photopsia were assessed with an interactive graphical simulation software (Halo & Glare Simulator, CZM) and categorized as {“none”, ”mild”, “moderate”, “severe”}. Furthermore, a patient questionnaire (Quality of Vision) was evaluated.

Results:

In case of Comfort EV, BV, Symfony EV, and BV binocular UDVA was 0.00+-0.09, -0.03+-0.07, -0.01+-0.05, and 0.06+-0.11, respectively. The values for MIOL-capacities were 85%, 95%, 93%, and 100%. Halo and glare were reported in all groups. The values for refractive variants were comparable to phakic eyes {'none”=29%, 'mild'=60%, 'moderate'=11%, 'severe'=0%}. Values for the diffractive EDOF IOL, however, were significantly higher. The patient questionnaire revealed that satisfaction with the quality of vision can be high even if photopsia are perceived as strong in terms of size and intensity.

Conclusions:

Our analysis indicates that, although both designs display very good binocular vision over a broad range of distances, refractive optics might cause less perception of photopsia. We suppose that the reason for this lies in the characteristic ring-type surface structure of diffractive IOLs, that causes more light scattering. In total, assessing postoperative photopsia is important since surveys have identified it to be the dominant reason for MIOL explantation.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, travel has been funded, fully or partially, by a competing company, travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, receives consulting fees, retainer, or contract payments from a competing company