effect of ocular deviation on pupil size with implanted multifocal intraocular lens

Effect of Ocular Deviation

on Pupil size with Implanted Multifocal I

ntraocular Lens

Yoshihiko Iida, MD Kimiya Shimizu, MDMisae Ito, CO

Kitasato UniversityThe authors have no Financial Interest.

Kitasato University School of MedicineKitasato University School of Medicine

Department of OphthalmologyDepartment of Ophthalmology

Background

• Multifocal intraocular lenses(IOL) are increasingly used to correct presbyopia.

• We experienced unsatisfactory results in a patient who underwent bilateral implantation of refractive multifocal IOLs, and considered that ocular deviation may influence pupil size.

We report a patient with unsatisfactory results, and evaluate the effect of ocular deviation on pupil size using implanted IOLs.



54-year old female

Preoperative data :

Vd = 0.04 ( 0.3 x -5.00Vs = 0.04 ( 0.4 x -6.00 )

( ) Cyl-1.00 Ax 80 )

Hirschberg : orthophoria

Alternate prism cover test : 14⊿X’(Near), 4⊿X (Far)

Pupil size (monocular vision) : R) 4.0 mm, L) 4.4 mm

1. Case report

Selected the use of refractive multifocal IOL

(APCT)



Near

2.1mm

3.4mm

Far

Implanted refractive multifocal IOL

Bil) PEA + IOL was performed

IOL : Array SA40N (AMO)L) 12.0 D

IOL design

R) 11.5 D



Course

Far : Vd = 1.2 x IOL

At 3 months postop.

BV = 1.2 x IOLVs = 1.2 x IOL

Near : BV = 0.4 x IOLVd = 1.0 x IOL Vs = 0.9 x IOL

Binocular uncorrected visual acuity(UCVA) was worsethan monocular UCVA.

APCT : 16⊿X’(Near)

With spectacle lenses of 3Δ base-in to each eye

BV = 1.0 x IOL Binocular near UCVA was improved.



1) Far vision / Binocular

FarBV = 1.2 x IOL 2.8 mm2) Near vision / Monocular

Vd=1.0 x IOL Vs=0.9 x IOL 3.1 mm

Evaluation of the Pupil size (1)



3) Near vision / Binocular

NearBV = 0.4 x IOL 2.4 mm


2) Near vision / Monocular

Vd=1.0 x IOL Vs=0.9 x IOL 3.1 mm




3) Near vision / Binocular

NearBV = 0.4 x IOL 2.4 mm4) Near vision / Binocular + 3⊿base in

NearBV = 1.0 x IOL 2.7 mm



4 8 12 14 Exophoria angle(⊿)00

1

2

3

4

5

Pup

il d

iam

eter

(m

m)

p=0.0017, R2 = 0.4679

Pupil diameter was negatively correlated with exphoria angle.

n=17

Dominant eye

2. Effect of ocular deviation on pupil size in near vision

17 exphoric patients implanted with IOL

Near vison



BinocularNearBV = 0.4

Binocular + 3 ⊿ base inNearBV = 1.0

Near : 3.4mm Near : 3.4mm

Discussion

Far : 2.1mmFar : 2.1mm

pupil diameter 2.4 mmpupil diameter 2.4 mm pupil diameter 2.7 mmpupil diameter 2.7 mm

With spectacle prism lenses for the decrease of exophoria angle, the pupil diameter was increased and the binocular near UCVA was raised.



Exophoria

Discussion

When large exophoria angle, excess miosis might be caused by fusional convergence.

Poor near visual acuity with refractive multifocal IOL.

Orthophoria

convergence

miosis excess miosis



Conclusions

• Ocular deviation affects pupil size.

• Ocular deviation is an important factor in the selection of patients with refractive multifocal IOLs.

effect of ocular deviation on pupil size with implanted multifocal intraocular lens

Documents