Energy Distribution between Distance and Near Images in Apodized Diffractive Multifocal Intraocular Lenses

Vega, F.; Alba-Bueno, Francisco; Millán, Marı́a S.

doi:10.1167/iovs.10-7123

Cited by 55 publications

(70 citation statements)

References 27 publications

(36 reference statements)

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“…The effect of the type of IOL on straylight has been studied in the literature, especially for diffractive multifocal IOLs versus monofocal IOLs. 23,26,28,30,33 Optically, these IOLs are very different with respect to design and light distribution 37,38 ; however, the literature has not been clear about the differences in straylight. De Vries et al 23 and Peng et al 33 found a considerable increase in straylight in a multifocal IOL subpopulation compared with their monofocal IOL counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…26 This might be in line with in vitro studies testing multifocal IOLs, underlining that the aperture has a substantial impact on optical performance. 38,39 Clinical reports of the effect of pupil size on straylight after multifocal IOL implantation have not been published until now; thus, further studies are needed to determine its potential effects.…”

Section: Discussionmentioning

confidence: 99%

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Ocular straylight in the normal pseudophakic eye

Łabuz¹,

Reus²,

Berg³

2015

Journal of Cataract and Refractive Surgery

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PURPOSE:To assess normal values for straylight in the pseudophakic eye as a function of age and to develop a model to predict the improvement in straylight after lens extraction based on preoperative straylight levels.SETTING: Rotterdam Ophthalmic Institute, Rotterdam, the Netherlands. DESIGN:Review with retrospective cross-study analysis.METHODS: A literature review was performed to identify relevant papers on straylight and pseudophakia with no patient comorbidities. Sixteen papers met the eligibility criteria and were included in the analysis. The postoperative results were used to define the norm for straylight in pseudophakia. Straylight improvement after lens replacement was assessed by evaluation of preoperative and postoperative values. The age effect was incorporated to determine a model for straylight improvement. RESULTS:The mean postoperative straylight value derived from 16 studies (1869 eyes) was 1.21 log units G 0.21 (SD). Age dependence could be assessed from 13 studies (1533 eyes), resulting in the straylight age-norm curve in pseudophakic eyes as follows: Straylight value Z 0.0044 Â age C 0.89 with G 0.42 log units of 95% confidence interval. A strong correlation was observed between preoperative straylight and its improvement after lens extraction, yielding the following relationship: Straylight improvement Z 1.04 Â preoperative straylight value À 0.006 Â age À 0.84. CONCLUSION:A norm for straylight in the pseudophakic eye was developed that is considerably different from the previously published norm for the phakic eye. The new pseudophakic norm can be used clinically to predict the straylight value after lens replacement and as a reference criterion for clinical studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ocular straylight in the normal pseudophakic eye

Łabuz¹,

Reus²,

Berg³

2015

Journal of Cataract and Refractive Surgery

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“…[15] For these reasons it is necessary to characterize in-vitro the optical performance of these new trifocal IOLs not only in terms of metrics like the Modulation Transfer Function [16,17] but also determining the energy distribution among the foci and its variation with the pupil diameter. [11,18] The aim of this paper is to experimentally determine, for the first time to best of our knowledge, the energy efficiency of the far, intermediate and near foci of the AT LISA tri 839MP trifocal IOL as a function of the pupil size. To this end, the IOL is placed in the ISO model eye, [19] which uses an aberration-free achromatic doublet as the artificial cornea.…”

Section: Introductionmentioning

confidence: 99%

Energy efficiency of a new trifocal intraocular lens

Vega

Alba-Bueno

Millán

2014

J. Eur. Opt. Soc.-Rapid Publ.

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The light distribution among the far, intermediate and near foci of a new trifocal intraocular lens (IOL) is experimentally determined, as a function of the pupil size, from image analysis. The concept of focus energy efficiency is introduced because, in addition to the theoretical diffraction efficiency of the focus, it accounts for other factors that are naturally presented in the human eye such as the level of spherical aberration (SA) upon the IOL, light scattering at the diffractive steps or the depth of focus. The trifocal IOL is tested in-vitro in two eye models: the aberration-free ISO model, and a so called modified-ISO one that uses an artificial cornea with positive spherical SA in instead. The SA upon the IOL is measured with a Hartmann-Shack sensor and compared to the values of theoretical eye models. The results show, for large pupils, a notorious reduction of the energy efficiency of the far and near foci of the trifocal IOL due to two facts: the level of SA upon the IOL is larger than the value the lens is able to compensate for and there is significant light scattering at the diffractive steps. On the other hand, the energy efficiency of the intermediate focus for small pupils is enhanced by the contribution of the extended depth of focus of the near and far foci. Thus, while IOLs manufacturers tend to provide just the theoretical diffraction efficiency of the foci to show which would be the performance of the lens in terms of light distribution among the foci, our results put into evidence that this is better described by using the energy efficiency of the foci.

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“…4 The unwanted effect of the light in the out-of-focus image may be visually disturbing, depending on 2 factors: the distance along the optical axis between these 2 images (the greater the distance between the 2 separate focal points along the optical axis, the greater will be the diffusion or blur circle surrounding the primary focus), and their relative energy distribution (the energy of the distant and near images is a function of pupil size). 5 As a consequence, contrast sensitivity and undesirable optical effects such as glare and/or halos may be worse in eyes implanted with a multifocal rather than a monofocal IOL. [6][7][8] Although disability glare or straylight determined using the C-Quant Q1 related to the implant of diffractive multifocals have been fairly well established, halos induced by a glare source have been scarcely addressed in this setting.…”

mentioning

confidence: 99%

Disk halo size measured in individuals with monofocal versus diffractive multifocal intraocular lenses

Puell

Pérez-Carrasco

Hurtado-Ceña

et al. 2015

Journal of Cataract and Refractive Surgery

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PURPOSE:To compare disk halo size in response to a glare source in eyes implanted with an aspheric apodized diffractive multifocal intraocular lens (IOL) or aspheric monofocal IOL.SETTING: Rementeria Ophthalmological Clinic, Madrid, Spain.DESIGN: Prospective randomized masked study. METHOD:Halo radius was measured using a vision monitor (MonCv3) with low-luminance optotypes in 39 eyes that had cataract surgery and the bilateral implant of an Acrysof Restor SN6AD1 multifocal IOL or Acrysof IQ monofocal IOL 6 to 9 months previously. The visual angle subtended by the disk halo radius was calculated in minutes of arc (arcmin). Patient complaints of halo disturbances were recorded. Monocular uncorrected distance visual acutity (UDVA) and corrected distance visual acuity (CDVA) were measured using high-contrast (96%) and lowcontrast (10%) logMAR letter charts. RESULTS:The study comprised 39 eyes of 39 subjects (aged 70 to 80 years); 21 eyes had a multifocal IOL and 18 eyes a monofocal IOL. Mean halo radius was 35 arcmin larger in the multifocal IOL group than the monofocal group (P < .05). Greater halo effects (P < .05) were reported in the multifocal IOL group. Mean monocular high-contrast UDVA and low-contrast UDVA did not vary significantly between groups, whereas mean monocular high-contrast CDVA and low-contrast CDVA were significantly worse at 0.12 and 0.13 logMAR (P < .01) in the multifocal than in the monofocal IOL group, respectively. A significant positive correlation (r Z 0.72, P < .001) was detected by multiple linear regression between the halo radius and low-contrast UDVA in the multifocal IOL group. CONCLUSIONS:The diffractive multifocal IOL gave rise to a larger disk halo size, which was correlated with a worse low-contrast UDVA. The authors have no commercial or proprietary interests in the devices used in this study or manufacturing companies. J Cataract Refract Surg 2015; -:---Q 2015 ASCRS and ESCRSCurrent diffractive multifocal intraocular lenses (IOLs) provide satisfactory distance, intermediate, and near visual acuity, reducing spectacle dependency.1 However, adverse subjective visual phenomena, such as glare and halos, are often reported by patients with multifocal IOLs, especially when driving at night. 1Theoretical optical design predictions suggest that multifocal IOLs will induce more light scatter than monofocal IOLs.2 In a refractive-diffraction IOL designed to simultaneously yield focused images of near and far objects, 3 forward scattered light from a glare source forms a veil of luminance over the retina.Disk halos form because the out-of-focus image has a larger diameter than the sharp image on the retina. 4 The unwanted effect of the light in the out-of-focus image may be visually disturbing, depending on 2 factors: the distance along the optical axis between these 2 images (the greater the distance between the 2 separate focal points along the optical axis, the greater will be the diffusion or blur circle surrounding the primary focus), and their relative energy distribution (the ene...

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Energy Distribution between Distance and Near Images in Apodized Diffractive Multifocal Intraocular Lenses

Abstract: For large pupils, the energy efficiency of the distance image is strongly affected by the level of SA, although aspheric IOLs perform slightly better than their counterparts with a spherical design. For small pupils, there are no differences between the spherical and aspheric IOLs.

Cited by 55 publications

References 27 publications

Ocular straylight in the normal pseudophakic eye

Ocular straylight in the normal pseudophakic eye

Energy efficiency of a new trifocal intraocular lens

Disk halo size measured in individuals with monofocal versus diffractive multifocal intraocular lenses

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