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Vision in a night-time driving simulator: comparison between two types of monofocal intraocular lenses

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First Author: T.Röck GERMANY

Co Author(s):    U. Schiefer   J. Ungewiss   U. Bartz-Schmidt   M. Wörner           

Abstract Details

Purpose:

To compare (low contrast) visual acuity (VA) and contrast sensitivity (CS) at various distances in a driving simulator under nighttime conditions in patients with bilateral IOL implants: TECNIS EYHANCE IOL (Johnson&Johnson, USA) vs. conventional monofocal IOL (CLAREON, Alcon, USA). NOTE: logVA can be converted to logMAR by inverting the sign.

Setting:

Competence Center “Vision Research”, University of Applied Sciences, Aalen, FRG, Dept. of Ophthalmology, University of Tübingen, FRG, Blickshift GmbH, Stuttgart, FRG

Methods:

High-contrast distant visual acuity (HC-DVA; lightbox, Visus, FRG), low contrast distant VA (LC-DVA, Freiburg Visual Acuity Test) and mesopic CS without/with glare (Optovist, Vistec, FRG) were assessed in subjects after binocular IOL implantation, wearing best correcting monofocal distant spectacle lenses (Zeiss/FRG). These patients completed a straight lane in a fixed-base driving simulator (A4, Audi, FRG; Velvet projectors, Zeiss, FRG). For threshold assessment (modified best PEST thresholding strategy) of VA and CS, 8-position Landolt Cs were presented at four locations with different distances. The halo size (median radial distance) was measured with moving Landolt Cs, emanating from the static glare source.

Results:

Results are presented as median/interquartile range: EYHANCE data first, [CLAREON data in brackets]: Five [six] subjects, aged 69.6/8.3 [71.1/13.0] years were enrolled. Clinical (binocular) tests: log HC-DVA was -0.11/0.39 [0.00/0.51], log LC-DVA -0.78/0.52 [-0.80/0.54]; mesopic log CS without 0.50/0.31 [0.30/0.65], with glare 0.20/0.15 [0.20/0.5]. Driving simulator (binocular tests): log VA thresholds for right road side, dashboard, navigation screen and interior rear-view mirror were -0.50/0.06 [-0.57/0.22], -0.81/0.07 [-0.91/0.14], -0.80/0.17 [-0.92/0.27], -0.50/0.11 [-0.63/0.26] and related log CS thresholds 1.53 /0.67 [1.00/0.81], 0.82/0.11 [0.61/0.19] (log CS exceeding 0.75: potential ceiling effect), 0.71/0.14 [0.50/0.15], 0.87/0.07 [0.81/0.11]. The halo size was 5.83°/1.13° [6.51°/2.20°].

Conclusions:

According to the clinical (Optovist) results, fitness for nighttime driving can be assumed in 4/5 patients with TECNIS EYHANCE IOLs and 5/6 patients with CLEAREON IOLs, respectively. A night-time driving simulator is an excellent tool for benchmarking vision-related characteristics of IOLs under well-standardized, close-to-reality driving conditions: For intermediate distances (dashboard, navigation screen) the EYHANCE IOL exceeds the CLAREON IOL in terms of median log VA or median log CS by at least 0.1 log unit (1 line). A follow-up trial with a markedly increased sample size is scheduled to verify the advantages of the EYHANCE IOL, observed in this study.

Financial Disclosure:

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