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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

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slide1

Variations in refractive analysis with different diffractive multifocal intraocular lenses using different wavefront analyzers

MamiYoshino, Hiroko Bissen-Miyajima, Shinichi Oki,

Keiichiro Minami, Kunihiko Nakamura

Department of Ophthalmology

Tokyo Dental College Suidobashi Hospital, Tokyo, Japan

Naoyuki Maeda

Department of Ophthalmology

Osaka University Medical School, Osaka, Japan

Yoshino, Bissen-Miyajima, Oki, Minami and Nakamura: No financial Interest

Maeda: Research grant recipient from Topcon Corp.

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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.

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SUBJECTS

15 eyes of 8 patients who received diffractive MF-IOL

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METHODS

To verify if the wavefront analyzer results represent real wavefront aberration, refraction data were compared with those with manifest

Manifest Refraction

VS: 0.9 (1.2 x +0.75D sph. cyl. -0.75 D)

Spherical refraction

Refraction by wavefront analyzer

Cylindrical refraction

  • KR-9000PW (Topcon, Japan)
  • WaveScan (AMO, US)
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Hartmann-Shack spotimages and evaluation

KR-9000PW

WaveScan

ZM900

SA60D3

ZM900

SA60D3

Spots were doubled

Spots were clearer in the center

Spots were doubled

or not clear

Analysis difficult due to spot irregularity

Optical zone: 4 mm & 6 mm

Optical zone:5.94±0.75 mm

Evaluation was possible in all eyes tested

3 eyes failed for evaluation

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RESULTS: 

KR-9000PW

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RESULTS:

WaveScan

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DISCUSSION:

Reliability of refraction with Hartmann-Shack analyzer

  • 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.
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DISCUSSION:

Differences between 2 wavefront analyzers

  • Cyrindrical refraction was very close between KR-9000PW and WaveScan.
  • With KR-9000PW, spherical refraction was closer to manifest.

Differences between 2 multifocal IOLs

  • Hartmann-Shack images were clearer and easier to be analyzed in eyes with ZM900.
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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.
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REFERENCES

  • 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.
  • 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.
  • Campbell CE. Wavefront measurements of diffractive and refractive multifocal intraocular lenses in an artificial eye. J Refract Surg. 2008;24:308-11.
  • 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.
  • Jendritza BB, Knorz MC, Morton S. Wavefront-guided excimer laser vision correction after multifocal IOL implantation. J Refract Surg. 2008;24:274-9