Refractive accuracy with light-adjustable intraocular lenses

Villegas, Eloy A.; Alcón, Encarna; Rubio, E.; Marı́n, José Marı́a; Artal, Pablo

doi:10.1016/j.jcrs.2013.10.046

Cited by 24 publications

(11 citation statements)

References 19 publications

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“…In recent years, aberrometry has become a crucial tool in the clinical practice of ophthalmology and optometry. Aberrometers provide a clinical characterization of the ocular optics by measuring objective refraction,6, 7 from lower-order aberrations (LOAs), and higher-order aberrations (HOAs) 8 . Furthermore, aberrometers based on the Hartmann-Shack principle help detect ocular diseases, such as keratoconus and cataract, by analyzing HOAs and Hartmann-Shack images 4, 5…”

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Assessment of subjective refraction with a clinical adaptive optics visual simulator

Hervella

Villegas

Prieto

et al. 2019

Journal of Cataract and Refractive Surgery

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PurposeTo clinically validate an adaptive optics visual simulator (VAO) that measures subjective refraction and visual acuity.SettingOptics Laboratory, University of Murcia, Murcia, Spain.DesignProspective case series.MethodsUsing the adaptive optics visual simulator, 2 examiners measured the subjective refraction and visual acuity in healthy eyes of volunteers; 1 examiner also used a trial frame as a gold standard. The interexaminer reproducibility and agreement with the gold standard were estimated using the following statistical parameters: limits of agreement from Bland-Altman analysis, significance between differences (P value), and intraclass correlation coefficient (ICC).ResultsSeventy-six eyes of 38 volunteers were measured. Interexaminer reproducibility for subjective refraction was excellent (ICC ≥0.96; P > .05), with low 95% confidence interval (CI) values for the power vectors M (spherical equivalent of the given refractive error), J0 (Jackson cross-cylinder, axes at 180 degrees and 90 degrees), and J45 (Jackson cross-cylinder, axes at 45 degrees and 135 degrees) (±0.51 diopter [D], ±0.14 D, and ±0.14 D, respectively). No significant differences in subjective refraction and visual acuity were found between the visual simulator and gold standard (P > .05), with 95% CIs for M, J0, and J45 (subjective refraction) of ±0.67 D, ±0.14 D, and ±0.16 D, respectively, and a ±0.10 logarithm of the minimum angle of resolution (visual acuity).ConclusionSubjective refraction results using the adaptive optics visual simulator agreed with those of the gold standard and can be used as the baseline for visual simulation of any optical corneal profile or intraocular lens design for refractive surgery patients.

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Assessment of subjective refraction with a clinical adaptive optics visual simulator

Hervella

Villegas

Prieto

et al. 2019

Journal of Cataract and Refractive Surgery

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“…After the postoperative refraction has stabilized, the LAL enables residual spherical and cylindrical errors to be corrected or adjusted. [ 20 21 22 ] When the LAL is exposed to the targeted ultraviolet light, a photoinitiator is activated, resulting in selective polymerization of macromers in the lens. The unpolymerized macromers then diffuse to the treated area, producing a predictable shape change that alters the refractive power of the lens.…”

Section: Methods Proposed For Intraocular Lens Power Calculation In P...mentioning

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Intraocular lens power calculations in eyes with previous corneal refractive surgery: Challenges, approaches, and outcomes

Wang¹,

Koch²

2022

Taiwan J Ophthalmol

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In eyes with previous corneal refractive surgery, difficulties in accurately determining corneal refractive power and in predicting the effective lens position create challenges in intraocular lens (IOL) power calculations. There are three categories of methods proposed based on the use of historical data acquired prior to the corneal refractive surgery. The American Society of Cataract and Refractive Surgery postrefractive IOL calculator incorporates many commonly used methods. Accuracy of refractive prediction errors within ± 0.5 D is achieved in 0% to 85% of eyes with previous myopic LASIK/photorefractive keratectomy (PRK), 38.1% to 71.9% of eyes with prior hyperopic LASIK/PRK, and 29% to 87.5% of eyes with previous radial keratotomy. IOLs with negative spherical aberration (SA) may reduce the positive corneal SA induced by myopic correction, and IOLs with zero SA best match corneal SA in eyes with prior hyperopic correction. Toric, extended-depth-of-focus, and multifocal IOLs may provide excellent outcomes in selected cases that meet certain corneal topographic criteria. Further advances are needed to improve the accuracy of IOL power calculation in eyes with previous corneal refractive surgery.

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“…Some trends suggest future avenues not only for customized IOL selection but also for customized IOL design (149). For example, light-adjustable IOLs aim to intraoperatively fine-tune IOL power (by changing in situ the shape of the IOL by application of UV irradiation) (150). As 3D printing or other technologies for rapid production of opticalgrade (and sterilized) IOLs may become available in the future (151), à la carte prescription of IOLs, specifically designed for a subject by applying optical design optimization techniques to custom computer eye models and visual simulations, can be envisioned.…”

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Simulating Outcomes of Cataract Surgery: Important Advances in Ophthalmology

Marcos

Martinez-Enriquez

Viñas

et al. 2021

Annu. Rev. Biomed. Eng.

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As the human eye ages, the crystalline lens stiffens (presbyopia) and opacifies (cataract), requiring its replacement with an artificial lens [intraocular lens (IOL)]. Cataract surgery is the most frequently performed surgical procedure in the world. The increase in IOL designs has not been paralleled in practice by a sophistication in IOL selection methods, which rely on limited anatomical measurements of the eye and the surgeon's interpretation of the patient's needs and expectations. We propose that the future of IOL selection will be guided by 3D quantitative imaging of the crystalline lens to map lens opacities, anticipate IOL position, and develop fully customized eye models for ray-tracing-based IOL selection. Conversely, visual simulators (in which IOL designs are programmed in active elements) allow patients to experience prospective vision before surgery and to make more informed decisions about which IOL to choose. Quantitative imaging and optical and visual simulations of postsurgery outcomes will allow optimal treatments to be selected for a patient undergoing modern cataract surgery. Expected final online publication date for the Annual Review of Biomedical Engineering, Volume 23 is June 2021. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

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Refractive accuracy with light-adjustable intraocular lenses

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 24 publications

References 19 publications

Assessment of subjective refraction with a clinical adaptive optics visual simulator

Assessment of subjective refraction with a clinical adaptive optics visual simulator

Intraocular lens power calculations in eyes with previous corneal refractive surgery: Challenges, approaches, and outcomes

Simulating Outcomes of Cataract Surgery: Important Advances in Ophthalmology

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