Visual performance of patients implanted with progressive PAD

Bi-Flex M analyzed by the Qvision iPad Multifocal Lens Analyzer.

Fernández J, MD, PhD

Rodríguez-Vallejo M, OD, PhD

Tauste A, OD, PhD

Martínez J, OD

Piñero DP, OD, PhD

Authors:

Diopters (D) Distance

-4.00 25 cm

-3.50 28 cm

-3.00 33 cm

-2.50 40 cm

-2.00 50 cm

-1.50 67 cm

-1.00 1 m

-0.50 2 m

0.00 Infinite

+0.50 Infinite

+1.00 Infinite

-0.50D

-1.00

0.00D

-2.00D

-1.50D

INTRODUCTION to DEFOCUS CURVES

Some disadvantages of the conventional method:

✓Each clinician has different decision criteria.

✓The patient can memorize the letters or optotypes.

✓The clinician may take a long time for completing

the defocus curve.

✓The clinician spends a long time recording all the

visual acuities for each defocus lens.

INTRODUCTION to DEFOCUS CURVES

CDAVCDSC

INTRODUCTION to DEFOCUS CURVES

METHODS

41 eyes without any complication

9 eyes with complications

6 eyes with anterior capsule tear

3 eyes with corneal erosion

25 implanted subjects

Complications or Adverse Events not related with the IOL

5 men and 20 women

Mean age 69.7 ± 7.4 [56 to 83]

Corneal astigmatism ≤ 0.75 D

METHODS

1 month follow-up

Monocular standardized reports

Binocular defocus curves with MLA

3 month follow-up

Monocular defocus curves with MLA

Factors for optimizing the performance

Eyes with complicationswere excluded from the analysis

RESULTS Binocular defocus curve comparison

Confounding variable, subjects were significantly older 74 ± 6 vs 68 ± 5 in the complications group (p = 0.03)

1 month

ACCURACY or PREDICTABILITY

Kane JX et al. J Cataract Refract Surg. 2016;42(10):1490-1500.

Comparison 7 equations

OLCI OLCR

Cooke DL, Cooke TL. J Cataract Refract Surg. 2016;42(8):1157-1164.

Mean Lax 23.81 mm; from 20.87 to 29.44 mm; N=1079

No lens thickness Lens thickness

PhacoOptics

Mean 0.40 D

± 0.5 D: 75.1%

Comparison 9 equations

1 month

ACCURACY or PREDICTABILITY

Comparison 9 equations

Adjusted to intended refraction

mean ± sd-0.15 ± 0.33

median (iqr)0 (0.23)

* Manifested spherical equivalent – Target spherical refraction

SRK-T 1 month

Refractive cylinder after surgery

EFFICACY (monocular far distance) 1 month

mean ± sd0.10 ± 0.16

median (iqr)0.1 (0.13)

mean ± sd0.00 ± 0.08

median (iqr)0.00 (0.03)

UDVA

CDVA

Far distance

EFFICACY (monocular intermediate distance) 1 month

mean ± sd0.20 ± 0.14

median (iqr)0.2 (0.2)

mean ± sd0.22 ± 0.16

median (iqr)0.2 (0.2)

UIVA

CIVA

67 cm of distance

EFFICACY (monocular near distance) 1 month

mean ± sd0.09 ± 0.10

median (iqr)0.1 (0.1)

mean ± sd0.08 ± 0.10

median (iqr)0.1 (0.1)

UNVA

CNVA

40 cm of distance

EFFICACY (lines of difference Uncorrected vs Corrected) 1 month

Distance Intermediate Near

Good tolerance to the residual refractive error at 67 cm and 40 cm

Multifocal lens analyzer defocus curves

n=18 n=20

Binocular 1 month follow-up Monocular 3 month follow-up

Binocular summation improves close to 1 line of visual acuity at all distances

Monocular defocus curves correlations 3 month

• Visual Acuity Defocus Curve

Area under the curve above 0.3 logMAR

Distance Intermediate Near Total

Monocular defocus curves correlations 3 month

No significant differences were found but older subjects presented poorer defocus curves

• Total area: r= -0.51, p=0.03

• Far area: r= -0.49, p=0.04

• Intermediate area: r= -0.11 p=0.64

• Near area: r= -0.61 p=0.006

Area under the curve was correlated with age

at far and near

IOL decentration versus pupil center 3 month

15 % Nasal decentatrion 0.3 mm

40% Close to pupil center < 0.3 mm

45% Temporal decentration 0.3 mm

RE

RE

RE

15% Superior decentration 0.3 mm

45% Close to pupil center < 0.3 mm

40% Inferior decentration 0.3 mm

HORIZONTAL VERTICAL

IOL decentration versus pupil center 3 month

RE

RE

RE

HORIZONTAL VERTICAL

CenteredNasal Temporal

Inte

rmed

iate

AU

C

Inte

rmed

iate

AU

C

CenteredInferior Superior

Harrer A, et al. J Cataract Refract Surg. 2017; 43: 1015–9.

Kappa angle is at temporal location from pupil

Conclusions

Predictability: mean spherical equivalent residual error of -0.15 ± 0.33 D and 88% of eyes in ± 0.50 D

Monocular Efficacy: logMAR Far Intermediate Near

Uncorrected 0.1 0.2 0.09

Corrected 0.0 0.2 0.08

The intermediate and near vision remain almost similar with and withoutbest correction

Binocular defocus curves were around one line of visual acuity better thanmonocular defocus curves.

Younger patients achieved better results in terms of visual acuity defocus curves.