Variations%20in%20refractive%20analysis%20with%20different%20diffractive%20multifocal%20intraocular%20lenses%20using%20different%20wavefront%20analyzers - PowerPoint PPT Presentation

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Variations%20in%20refractive%20analysis%20with%20different%20diffractive%20multifocal%20intraocular%20lenses%20using%20different%20wavefront%20analyzers

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Title: Variations%20in%20refractive%20analysis%20with%20different%20diffractive%20multifocal%20intraocular%20lenses%20using%20different%20wavefront%20analyzers


1
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 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.
2
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.
3
SUBJECTS
15 eyes of 8 patients who received diffractive
MF-IOL
MF-IOL ZM900 (AMO) SA60D3 (Alcon)
No. of eyes (patients) 9 (5) 6 (3)
Gender (MaleFemale) 14 03
Age (years) 66.05.3 59.714.7
Corneal astigmatisms 0.5 D 0.5 D
Time of evaluation 3-14 months post-op 3-14 months post-op
4
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
  1. KR-9000PW (Topcon, Japan)
  2. WaveScan (AMO, US)

5
Wavefront Analyzer KR-9000PW WaveScan
Wavefront sensor Hartmann-Shack Hartmann-Shack
No of spots (7 mm pupil) 169 points 240 points
Wavelength at measure 840 nm 785 nm
Centering point Corneal apex Pupil center (scotopic)
Examination room Room light Dim light (5cd/m2 )
Pupil Dilated Scotopic
Refraction Spectacle plane Spectacle plane
6
Hartmann-Shack spot images and evaluation
WaveScan
KR-9000PW
ZM900
SA60D3
ZM900
SA60D3
Spots were doubled
Spots were clearer in the center
Analysis difficult due to spot irregularity
Spots were doubled or not clear
Optical zone 4 mm 6 mm
Optical zone 5.940.75 mm
Evaluation was possible in all eyes tested
3 eyes failed for evaluation
7
RESULTS
KR-9000PW
Manifest Wavefront Difference p value (Wilcoxon)
Sphere (D)
Total 0.270.52 0.520.49 0.250.30 plt0.05
ZM900 0.170.33 0.570.25 0.400.13 plt0.01
SA60D3 0.420.74 0.450.75 0.040.36 p0.917
Cylinder (D)
Total -0.620.43 -0.980.45 0.360.38 plt0.01
ZM900 -0.470.46 -0.700.31 0.220.32 p0.086
SA60D3 -0.830.30 -1.100.69 0.580.40 plt0.05
8
RESULTS
WaveScan
Manifest Wavefront Difference P value (Wilcoxon)
Sphere (D)
Total 0.270.52 1.040.51 0.710.56 plt0.05
ZM900 0.170.33 1.070.50 0.880.41 plt0.05
SA60D3 0.420.53 0.980.53 0.340.62 p0.273
Cylinder (D)
Total 0.620.43 -0.940.60 0.320.41 plt0.01
ZM900 0.470.46 -0.690.37 0.160.29 plt0.05
SA60D3 0.830.30 -1.450.36 0.640.52 p0.144
9
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.

10
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.

11
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.

12
REFERENCES
  1. 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. 200521S808-12.
  2. Zelichowska B, Rekas M, Stankiewicz A, et al.
    Apodized diffractive versus refractive multifocal
    intraocular lenses optical and visual
    evaluation. J Cataract Refract Surg.
    2008342036-42.
  3. Campbell CE. Wavefront measurements of
    diffractive and refractive multifocal intraocular
    lenses in an artificial eye. J Refract Surg.
    200824308-11.
  4. 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. 200824280-6.
  5. Jendritza BB, Knorz MC, Morton S.
    Wavefront-guided excimer laser vision correction
    after multifocal IOL implantation. J Refract
    Surg. 200824274-9
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