Retinal image quality with multifocal, EDoF, and accommodative intraocular lenses as studied by pyramidal aberrometry

Abstract

Background To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer. Methods This study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group); (b) 19 Miniwell; (c) 24 LENTIS Mplus LS-313 MF30; d) 33 LENTIS Mplus LS-313 MF15; (e) 17 AkkoLens Lumina; (f) 31 AT LISA Tri 839MP; (g) 20 Precizon Presbyopic; (h) 20 AcrySof IQ PanOptix; (i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer. Results AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10; P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001). Conclusions Far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.

Retinal Optical Quality of Multifocal Refractive and Monofocal Intraocular Lenses

“…Our study group recently provided an extensive evaluation of postoperative optical effect for far based on PSF Strehl ratio obtained with a PWS-based aberrometer in pseudophakic eyes implanted with different IOLs [6]. This evaluation has never been explored before with all the implanted lenses together.…”

“…Only eyes with mean pre-operative keratometry between 42.5 and 45 D, spherical aberration between ±0.25 µm, corneal HOA of <0.5 µm, and angle kappa of less than 0.4 mm were included in the study. Cases with intraocular complications that could affect IOL performance or IOL stability were excluded, as well as any capsular changes that would increase the risk of decentration or tilt of the IOL, such as zonular weakness or pseudoexfoliation syndrome [6]. All procedures adhered to the tenets of the Helsinki Declaration of the World Medical Association and were conducted based on of the Ethical Board Committee approval of our institution.…”

“…In all cases, three consecutive acquisitions were obtained and the following aberrometric parameters were analyzed: total root-meansquare (RMS), LOA RMS, HOA RMS, and PSF Strehl Ratio. Briefly, as described in our previous study [6], for the measurement of retinal image quality based on PSF Strehl Ratio, the second-order aberrations were eventually excluded in the analysis of the PSF Strehl Ratio (PSFw2) by decomposing the wave-front in terms of Zernike.…”

“…Our research group recently evaluated in vivo the optical quality for a far distance of the eye with different types of premium IOLs based on a multifocal, both refractive and diffractive, extended depth of focus (EDoF), or accommodative optic, using a new pyramidal wavefront-based sensor (PWS) aberrometer. [6] The PWS aberrometer has several Photonics 2021, 8, 559 2 of 7 characteristics that help in the interpretation of the aberrometric data in pseudophakic patients implanted with multifocal IOLs, overcoming the limits of the otherwise commonly used Hartmann-Shack (HS) method, the Tscherning principle, or Ray-tracing [7][8][9].…”

“…For HS, usually we have 1000-2000 lenses with a resolution of 250-1250 micron. Osiris, on the contrary, has a resolution of 41 microns (45,000 samples at the maximum pupil size) [6].…”