First Author: N.Tarfaoui FRANCE
Co Author(s): Y. Nochez J. Gicquel P. Pisella
Purpose:
The challenge of modern cataract surgery remains the best presbyopic treatment to compensate near vision and to enhance spectacles independance. Several solutions were proposed: myopic monovision, multifocal or accommodative intraocular lenses. The purpose of our study is to evaluate monocular and binocular near vision and depth of focus using two differents aspheric monofocal intraocular lenses (IOL) profiles.
Setting:
Naoual TARFAOUI(1), Yannick NOCHEZ(1,2), Jean-Jacques GICQUEL(3), Pierre-Jean PISELLA(1,2)
1Service dOphtalmologie, CHU Bretonneau, 2, Boulevard Tonnellé, 37000 Tours, France
2Faculté de Médecine Franēois Rabelais, 10 Boulevard Tonnellé, BP3223, 37032 Tours Cedex 1, France
3Service dOphtalmologie, CHU de la Milétrie, Rue de la Milétrie 86000 Poitiers, France
Key-words: aspheric intraocular lenses, depth of focus, multifocality, cataract surgery.
Methods:
This study included 40 eyes (20 patients). Data were collected 6 month post-operatively. The reference group (28 eyes, 14 patients) received a generating -0.18 µm of spherical aberration (SA) aspheric intraocular lens in each eye (Acrismart 36A®, Carl Zeiss Meditec) whereas the aspheric-optimized group (12 eyes, 6 patients) received on the dominant eye an AcriSmart 36A® and on the other eye a zero-aspheric intraocular lens (Acrismart 46 LC®, Carl Zeiss Meditec).
Inclusion criteria were a 0.15-0.30 µm corneal asphericity and a monocular postoperative visual acuity superior or equal to 20/20.
Reported visual outcomes were best corrected monocular and binocular distance Snellen visual acuity and uncorrected mono and binocular near visual acuity. A monocular and binocular defocus curve was performed in order to evaluate different intermediate visual abilities. Through-focus defocus curve was evaluated from +0.00 Diopter (D) and - 4.00 D by -0.25D step. A corneal and total higher-order aberrations (KR1®, Topcon) evaluation was assessed.
Stereoscopic vision was performed using TNO stereo test.
Results:
Residual postoperative spherical equivalent was not different between the reference aspheric group and the aspheric-optimized group (-0.825D ± 0.40 versus -0.59D ± 0.41; p = 0.11). Noncorrected distance visual acuity and best corrected distance visual acuity were not different between the two group (respectively p = 0.16 and p = 0.82).
Uncorrected binocular near acuity were not statistically different (mean between Jaeger 3 and J4 in the reference group versus between J2 and J3 in the aspheric-optimized group; p=0.156). However, aspheric-optimized group had a better near and intermediate visual acuity during the defocus curve (between -2.0D and -4.0D of defocus) (p < 0.05): respectively 20/32 versus 20/40 with -2.0D of defocus (p=0.048) and 20/80 for the aspheric-optimized group versus 20/125 for the reference group (p=0.0074) with -4.0D of defocus.
Aspheric-optimized group did not have lower stereoscopic vision while comparing frequency of patients with conserved TNO stereo test (superior or equal to 120 seconds).
Conclusions:
Postoperative Spherical aberration (SA) could create pseudo-multifocality. Zero postoperative residual total SA, using aspheric negative IOL preserved distance visual quality with decreased depth-of-focus however some residual total SA could increase depth-of-focus. In our study, the aspheric-optimized group using the two different aspheric profiles seems to get an enhanced depth-of-focus with better near and intermediate visual performance, without any disturbed distance vision.
Moreover, stereoscopic outcomes were not penalized in this aspheric-optimized group as it could be dread in myopic monovision patients.
Some prospective studies of dominance with adaptative optics would be great to evaluate the link between spherical aberration, higher order aberrations profile and generated binocular depth-of-focus. FINANCIAL DISCLOSURE?: No
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