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

Abstract

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...

Visual performance in a flight simulator: multifocal intraocular lenses in pilots

“…This may be due to the very low luminance levels used in the Mesotest test (0.032 cd/m 2 ) in our study. The MIOL group also had significantly larger halo areas than the monofocal group, which is in accordance with previous reports of self-reported glare sensitivity, 11 as well as increased halo size 12 ; these differences may reflect the problems reported by MIOL patients with night-time driving. 2 …”

From Presbyopia to Cataracts: A Critical Review on Dysfunctional Lens Syndrome

“…In another study, Palomo-Álvarez et al [ 91 ] included subjects with cataract above level 2 of LOCS III obtaining a mean radius of 2.40 log arcmin (251 arcmin). The mean halo radii with monofocal IOL was 190 arcmin and with a + 3.00 D multifocal IOL was 225 arcmin [ 108 ]. Considering the values reported by these previous studies, we can consider that a cataract grade 2 is necessary to avoid exceeding the halo radii of the preoperative stage after cataract surgery with implantation either of monofocal or multifocal IOLs.…”

Relationships Between Haloes and Objective Visual Quality in Healthy Eyes

“…Complaints about haloes commonly occur after cataract and refractive surgeries. 4 – 8 However, haloes exist before the surgeries without any complaints. 9 For refractive and cataract patients to be adequately informed about postoperative haloes, a preoperative haloes measurement may be an option.…”