Effect of interaction of macroaberrations and scattered light on objective quality of vision in pseudophakic eyes with aspheric monofocal intraocular lenses.

PURPOSE: To assess the impact of wavefront ocular aberrations on objective vision quality and depth of focus in pseudophakic patients. SETTING: University Hospital Bretonneau of Tours, Francois Rabelais Medicine Faculty of Tours, France. DESIGN: Cohort study. METHODS: Consecutive eyes having implantation of an aspheric monofocal intraocular lens (IOL) (Acri.Smart) were studied. Aberrometry measurements were performed under mesopic conditions with a 6.0 mm pupil using a Wavescan aberrometer. Objective evaluation of optical vision quality was performed using the Optical Quality Analysis System II. The 3 measurements were the modulation transfer function values (MTF cutoff); objective depth of focus, which was computed as the focus range at which Strehl ratio did not fall below 50% of the maximum; and the objective scatter index. RESULTS: Fifty-four eyes (30 patients) were enrolled. Six months postoperatively, MTF cutoff values were increased with decreasing total ocular spherical aberration, ocular trefoil, and 2nd-order astigmatism (P<.05). Objective depth of focus was positively correlated with 2nd-order astigmatism (r(2) = 0.171, P<.001) and total spherical aberration (r(2) = 0.091, P=.028). Objective scatter was more beneficial for depth of focus, with a significantly positive correlation with this parameter (r(2) = 0.28, P=.002), than compromising of optical quality (no significant correlation with MTF measurements in same multiple regression analysis). CONCLUSION: Three ocular aberrations (2nd-order astigmatism, trefoil, spherical aberration) seemed to interact with objective contrast sensitivity and depth of focus, whereas residual spherical aberration exerted opposite effects on image quality in individual patients.

Effect of residual ocular spherical aberration on objective and subjective quality of vision in pseudophakic eyes.

PURPOSE: To determine the level of residual spherical aberration that gives the best objective and subjective quality of image after cataract surgery with intraocular lens (IOL) implantation. SETTING: Department of Ophthalmology, CHU Bretonneau, Tours, France. DESIGN: Cohort study. METHODS: Six months after microincision (1.8 mm) cataract surgery with aspheric IOL implantation, total aberrations were computed using a Wavescan aberrometer. The modulation transfer function (MTF), Strehl ratio, and objective index of scattering were measured using the Objective Quality Analysis System. Objective depth of focus was computed as the focus range at which the Strehl ratio did not fall below 50% of maximum. Subjective depth of focus was calculated as the difference between the vergence of the punctum remotum and that of the punctum proximum. RESULTS: Thirty patients (54 eyes) were evaluated. The MTF cutoff values were higher with decreasing total ocular spherical aberration (r = 0.56; P < .05). Objective and subjective depth of focus were positively correlated with total spherical aberration (r = 0.26 and r = 0.46, respectively; P < .05). CONCLUSIONS: A final spherical aberration of zero obtained by compensation of IOL asphericity gave the greatest improvement in objective quality of vision and better MTF contrast. However, a final target ocular spherical aberration between 0.07 µm and 0.10 µm should be considered to be the best compromise between subjective depth of focus and objective contrast sensitivity. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Measurement of corneal aberrations for customisation of intraocular lens asphericity: impact on quality of vision after micro-incision cataract surgery.

AIMS: To compare the quality of vision of patients with customised aspheric intraocular lenses (IOL) versus patients implanted with zero-aberration IOL after a 1.8 mm micro-incision cataract surgery (MICS). METHODS: Fourty-three eyes were divided into two groups: 17 eyes (reference group) received zero aberration Acri.Smart 46LC and 26 eyes received a customised-aspheric IOL: either aspherical Acri.Smart 36A, generating a -0.18 microm SA compensation equivalent, or zero-aberration Acri.Smart 46LC. IOL asphericity was individually selected according to the corneal spherical aberration (SA) in order to produce a residual ocular SA close to +0.10 microm. Refraction, best-corrected visual acuity (BCVA), contrast sensitivities, ocular wavefront aberrations and objective quality of vision assessment were analysed 6 months after MICS. RESULTS: Postoperative BCVA was similar in both groups (p=0.58). Mesopic contrast sensitivities were significantly better in the custom group at intermediate and high spatial frequencies (p<0.001), while photopic contrast sensitivities were similar. Total SA was significantly lower in the custom group (Z(4)(0)=0.085+/-0.075 vs 0.261+/-0.091 microm, p<0.001), whereas no difference was found in preoperative corneal SA. Modulation transfer function cut-off frequency was higher in the custom group than in the reference group (34.3+/-8.1 vs 23.57+/-8.6 cycles per degree, respectively; p=0.008). CONCLUSION: Individual selection of IOL asphericity with a preoperative corneal SA measurement allowed control of final ocular SA. Such customisation improves mesopic contrast sensitivity, and leads to better objective quality of vision.

Comparative study of aspheric intraocular lenses with negative spherical aberration or no aberration.

PURPOSE: To compare the quality of vision with an aspheric intraocular lens (IOL) with no aberration and an IOL with negative spherical aberration. SETTING: Bretonneau University Hospital, Tours, France. METHODS: Patients scheduled for cataract surgery were randomly chosen to bilaterally receive a SofPort Advanced Optics IOL with no aberration (no-aberration IOL group) or a Tecnis Z9000 IOL with negative spherical aberration (negative-aberration IOL group). Six-month postoperative outcomes included patient-centered visual disability assessed with the Activities of Daily Vision Scale (ADVS), contrast sensitivity testing, and wavefront aberration analysis. RESULTS: There was no difference in the overall ADVS score between the 2 groups (P = 0.07); however, the negative-aberration IOL group had a better night-driving score (mean 82.7 +/- 15.1 [SD] versus 66.4 +/- 7.6) (P<.001) and the no-aberration IOL group had a better corrected near-vision score (mean 96.5 +/- 6.2 versus 86.2 +/- 13.2) (P<.001). Mesopic contrast sensitivity was significantly better in the negative-aberration IOL group at intermediate and high frequencies; the no-aberration IOL group performed better under photopic conditions at intermediate frequencies. There was significantly higher spherical aberration (mean 0.11 +/- 0.05 microm versus 0.01 +/- 0.06 microm; P = .001) and lower 3rd-order coma (mean 0.09 +/- 0.06 microm versus 0.15 +/- 0.06 microm; P<.001) in the no-aberration IOL group than in the negative-aberration IOL group, which had better MTF. CONCLUSIONS: Bilateral implantation of an IOL with no aberration resulted in better quality of near vision. A negative spherical aberration IOL provided better night-driving vision and improvements in mesopic contrast sensitivity and MTF.

Quality of vision after cataract surgery after Tecnis Z9000 intraocular lens implantation: effect of contrast sensitivity and wavefront aberration improvements on the quality of daily vision.

PURPOSE: To compare ocular performance and quality of vision in pseudophakic eyes with an aspherical intraocular lens (IOL) or a conventional spherical IOL. SETTING: Bretonneau University Hospital, Tours, France. METHODS: Twenty patients (40 eyes) were randomly divided in 2 equal groups to bilaterally receive the aspherical Tecnis Z9000 IOL (AMO) or the spherical CeeOn Edge 911 IOL (AMO). Contrast sensitivity was measured and ocular wavefront analysis performed before surgery and 6 months after. Patients completed the Activities of Daily Vision Scale (ADVS) to evaluate patient-centered visual outcomes. Other examinations included refraction before and after mydriasis and pupil diameter. RESULTS: The mean postoperative best corrected visual acuity (logMAR) was 0.03 +/- 0.05 (SD) in the Tecnis group and 0.01 +/- 0.05 in the CeeOn Edge group (P = .41). Refractive evaluation with mydriasis showed a mean myopic shift as low as -0.02 +/- 0.36 diopter (D) in the Tecnis group and -0.51 +/- 0.37 D in the CeeOn Edge group (P = .001). Mesopic contrast sensitivity at high spatial frequencies was significantly better in the Tecnis group (P<.001), while contrast sensitivity under photopic and glare conditions was not different between the 2 groups. Spherical aberration was significantly lower in the Tecnis group, which had a mean Z(4)(0) of 0.01 +/- 0.06 microm, than in the CeeOn Edge group, which had a mean Z(4)(0) of 0.16 +/- 0.12 microm (P<.001). The global score on the ADVS was not statistically different between groups; however, quality of distance vision was better in the Tecnis group than in the CeeOn Edge group (mean 99.0 +/- 2.0 versus 89.2 +/- 3.4) (P<.001). CONCLUSION: Implantation of an aspherical IOL with a negative spherical aberration resulted in reduced ocular spherical aberration and improved mesopic contrast sensitivity and led to better subjective quality of vision.

Ophthalmologic side effects during alpha-interferon therapy for viral hepatitis.

BACKGROUND/AIMS: Ophthalmologic side effects have been reported during interferon therapy, particularly retinal lesions and neurovisual impairment. The aim of this prospective study was to assess the nature and the frequency of such lesions during alpha-interferon therapy for viral hepatitis. METHODS: Between 1995 and 2003, 156 patients treated with standard or pegylated alpha-interferon, with or without ribavirin, had a regular ophthalmologic examination before and during treatment. No patient had signs of retinopathy before treatment. Cotton-wool spots were found in 31 patients and retinal hemorrhage in nine patients during treatment (24% of patients). These lesions remained asymptomatic and disappeared in all patients. A previous history of arterial hypertension (RR 4.60, 95% CI 1.95-10.85), age above 45 years (RR 2.80, 95% CI 1.36-5.85), and use of pegylated alpha-interferon (RR 2.75, 95% CI 1.41-5.38) were significantly associated with retinopathy. Neurovisual impairment was present in 31 patients (20%) before treatment and in 74 patients (47%) during treatment. CONCLUSIONS: In conclusion, this study showed that signs of retinopathy and neurovisual impairment were common in patients receiving alpha-interferon therapy but were rarely symptomatic. It suggests that alpha-interferon may usually be continued in asymptomatic patients as long as there is careful fundoscopic examination.