Improving quality of vision with an anterior surface modified prolate intraocular lens: A prospective clinical trial

AIM: To compare the optical performance of the anterior surface modified prolate Tecnis Z9000 IOL with the standard 911A IOL in terms of contrast sensitivity outcomes. · METHODS: The Tecnis Z9000 silicone IOL shares the same basic characteristics with the 911A IOL including a 12.0mm overall diameter, 3-piece equiconvex 6.0mm optic and angulated cap C polyvinylidene fluoride haptics. This is a randomized prospective study that involved ten consecutive patients (20 eyes) with bilateral cataracts. Each patient underwent phacoemulsification and received randomly the Tecnis Z9000 IOL in one eye and the control (911A IOL) in the fellow eye within 6 weeks period of one another. Contrast sensitivity was measured after six postoperative weeks. The collected data were analyzed through using Mann Whitney U test. · RESULTS: The mean pre-operative best spectacle corrected Snellen visual acuity in the eyes that were randomly selected to receive the Tecnis IOL was 6/8.5 (0.70) and in the eye selected to receive the 911A IOL was 6/9.4(0.64). Postoperatively all 20 eyes achieved best corrected Snellen visual acuity of 6/6 (1.0). Postoperative contrast sensitivity testing showed statistically significant differences (P <0.05) between the two IOLs at 12 and 18 cpd under photopic, at 1.5 and 3 cpd under mesopic, and at 1.5 and 3 cpd under mesopic with glare conditions. · CONCLUSION: The Tecnis Z9000 IOL proved to have statistically significant superior contrast sensitivity to the 911A IOL at high spatial frequencies under photopic conditions and at low spatial frequencies under mesopic and mesopic with glare conditions.     

人工晶状体前表面非球面化改良能够改善视觉质量

目的:根据对比敏感度结果比较前表面改良的非球面Tecnis Z9000 IOL和标准的911A IOL的光学性能.方法:Tecnis Z9000硅凝胶IOL和911A IOL具有共同的基本特征包括12mm总长度、三片直边双凸6mm的光学直径和成角的聚丙乙烯C襻.对连续10例双侧白内障患者(20眼)进行了随机前瞻研究,所有患者都接受了白内障超声乳化手术并随机于1眼植入Tecnis Z9000IOL,另1眼在术后6wk内植入911A IOL作为对照,术后6wk进行对比敏感度检查,所得数据采用秩和检验进行比较.结果:随机植入Tecnis IOL组的术前平均最佳Snellen矫正视力为6/8.5(0.70),植入911A I0L组为6/9.4(0.64),所有20眼术后最佳矫正视力都达到了6/6(1.0).术后对比敏感度分析发现两组在12和18 cpd(明视)、1.5和3 cpd(暮视)以及1.5和3 cpd(暮视伴眩光)均有统计学差异(P＜0.05)结论:Tecnis Z9000 I0L被证明其对比敏感度在明视高空间频率和暮视低空间频率方面均显著优于911A IOL.     

Visual acuity and contrast sensitivity comparison between Tecnis and AcrySof SA60AT intraocular lenses: A multicenter randomized study

PURPOSE: To evaluate best corrected visual acuity (BCVA) and photopic and mesopic contrast sensitivity in pseudophakic patients implanted either with the aspheric intraocular lens (IOL) designed to correct for corneal spherical aberration or with a conventional IOL. SETTING: Three surgical centers participated this prospective randomized masked comparative study. METHODS: Thirty eyes of 30 patients after aspheric lens implantation (Pfizer/Pharmacia Tecnis Z9000) were compared with 30 eyes of 30 age-matched patients after conventional lens implantation (Alcon AcrySof SA60AT). Two to three months after surgery, best spectacle corrected distance visual acuity was measured using the Early Treatment Diabetic Retinopathy Study chart. Contrast sensitivity was measured by sinusoidal grating charts for distance at photopic (85 cd/m(2)) and mesopic (6 cd/m(2)) luminance level with optical correction in place. Tested spatial frequencies were 1.5, 3, 6, 12, and 18 cycles per degree (cpd). RESULTS: The mean BCVA was -0.053 +/- 0.044 logMAR in eyes with the aspheric Tecnis IOL and 0.006 +/- 0.059 logMAR in eyes with the conventional AcrySof IOL (P=.0001). Eyes with the aspheric IOL showed better contrast sensitivity at spatial frequencies of 3 cpd (P<.05) and 6, 12, and 18 cpd (P<.01) in photopic and in mesopic conditions. Peak improvement occurred at 18 cpd and was 36% (0.29 log units) in photopic and 54% (0.27 log units) in mesopic conditions. CONCLUSIONS: The aspheric Tecnis IOL yielded better BCVA and better distance contrast sensitivity than the conventional IOL. The differences were clinically significant for higher spatial frequencies. The results give some suggestions for further studies.     

Prospective randomized trial of an anterior surface modified prolate intraocular lens

PURPOSE: We compare the contrast sensitivity obtained with an anterior surface modified prolate intraocular lens with the contrast sensitivity obtained with a standard spherical intraocular lens. METHODS: Patients presenting for cataract surgery in one eye were randomized to receive either the Tecnis Z9000 intraocular lens (Pharmacia) or the AMO AR40e Opti-Edge intraocular lens (AMO). Sine wave grating contrast sensitivity testing under mesopic and photopic conditions served as the principal outcome measure. RESULTS: The Tecnis Z9000 intraocular lens provided statistically significantly better contrast sensitivity at 1.5 and 3 cycles per degree under mesopic conditions and at 6, 12 and 18 cycles per degree under photopic conditions. CONCLUSION: The use of a modified prolate intraocular lens during cataract surgery has the potential to improve contrast sensitivity under both mesopic and photopic conditions.     

Tecnis Z9000人工晶状体植入术后的视功能改变

目的:评价非球面人工晶状体(intraocular lens,IOL)TecnisZ9000对提高年龄相关性白内障患者术后视功能的作用。方法:选取年龄相关性白内障患者34例36眼,其中18眼为Tecnis Z9000组,18眼为传统球面人工晶状体组。检查术后3mo最佳矫正远视力,不同亮度环境及有、无散瞳条件下的对比敏感度(contrast sensitivity,CS)。结果:手术后3mo最佳矫正远视力Tecnis Z9000组为0.89±0.17,球面人工晶状体组为0.76±0.16,两组差异有显著性(P<0.05)。正常瞳孔下,两组晶状体在不同空间频率(1.5,3,6,12,18c/d)、不同照明条件下CS无显著差别。散瞳后Tecnis组亮环境(亮度为85cd/m2)下的12,18c/dCS及暗环境(亮度为3cd/m2)下1.5,3c/dCS均分别与同条件下的球面人工晶状体组比较差异有显著性。结论:白内障术后早期,Tecnis Z9000可提高最佳矫正远视力和对比敏感度,改善术眼视功能。     

Prospective randomized study of clinical performance of 3 aspheric and 2 spherical intraocular lenses in 250 eyes

PURPOSE: To compare the quality of vision with aspheric and spherical intraocular lenses (IOLs) in pseudophakic patients. METHODS: This prospective, comparative, randomized study included 250 eyes of 125 patients with bilateral cataracts. Patients were randomly assigned to receive either IOLs with a spherical biconvex optic (Acrysof SN6OAT [Alcon] or Sensar AR40e [Advanced Medical Optics, AMO]) or IOLs with an aspheric optic (Acrysof IQ SN6OWF [Alcon], Tecnis Z9000 [AMO], or Sofport L161AO [Bausch & Lomb]). Ophthalmologic examination including best spectacle-corrected visual acuity, pupil size, ocular dominance investigation, contrast sensitivity under mesopic and photopic conditions, and wavefront analysis was performed 2 months postoperatively. RESULTS: Aspheric IOLs showed better contrast sensitivity compared to spherical IOLs at spatial frequencies of 6, 12, and 18 cycles per degree (cpd) under photopic conditions and at all spatial frequencies under mesopic conditions. There was no significant difference among the three aspheric IOLs at all spatial frequencies under either photopic or mesopic conditions. Mean total spherical aberration was statistically lower in dominant eyes with aspheric IOLs (0.05 +/- 0.06, 0.11 +/- 0.1, and 0.19 +/- 0.08 pm for the Tecnis Z9000, Acrysof IQ SN6OWF, and Sofport L161AO, respectively) compared with eyes with spherical IOLs (0.62 +/- 0.24 and 0.46 +/- 0.19 microm for the Acrysof SN6OAT and Sensar AR40e, respectively) for a 5-mm pupil diameter. CONCLUSIONS: The aspheric IOLs had less wavefront aberrations and performed better under both photopic and mesopic contrast sensitivity compared to the spherical IOLs. These findings confirm it is possible to improve the optical performance of IOLs by modifying the surfaces.     

Spherical aberration and contrast sensitivity after cataract surgery with the Tecnis Z9000 intraocular lens

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified prolate anterior surface (Tecnis Z9000, AMO) results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. SETTING: Hospital NISA Virgen del Consuelo, Valencia, Spain. METHODS: In an intraindividual randomized prospective study of 30 patients with bilateral cataract, the Tecnis Z9000 IOL was compared with 2 IOLs with spherical surfaces, the AR40e (AMO) and the Stabibag (Ioltech). Ocular aberrations for a 4.0 mm pupil and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. RESULTS: Eyes with the Tecnis Z9000 IOL had significantly less spherical aberration and a greater Strehl ratio after surgery. Significant reduction in coma aberration was also found in some cases. Refraction, visual acuity, and contrast sensitivity were not significantly different between the 3 IOL groups. CONCLUSION: A significant reduction in spherical aberration after Tecnis Z9000 IOL implantation was achieved, but visual acuity and contrast sensitivity were not affected by the aspheric silicone IOL compared to spherical acrylic IOLs.     

Low contrast visual acuity in pseudophakic patients implanted with an anterior surface modified prolate intraocular lens

PURPOSE: To determine whether implantation of a new intraocular lens (IOL) with a modified prolate anterior surface, designed to reduce the positive spherical aberration of the pseudophakic eyes, results in improved contrast sensitivity assessed in terms of low contrast visual acuity (VA). METHODS: We carried out an intraindividual study of 12 patients with bilateral cataracts, randomized to receive a prolate anterior surface IOL (Tecnis Z9000, Pharmacia) in one eye and a biconvex spherical surface IOL (CeeOn 911 A, Pharmacia) in the other. High and low contrast VA was assessed under photopic conditions, before and after pupil dilation. RESULTS: After mydriasis, the Technis Z9000 provided significantly better low contrast VA at contrast levels < or = 25%. No significant difference was found under normal pupil conditions. CONCLUSION: Our results confirm the hypothesis that the spherical aberration of the eye after cataract surgery can be reduced by an anterior prolate surface IOL.     

Monochromatic aberrations in eyes with different intraocular lens optic designs

PURPOSE: To study the wavefront aberration profile of eyes with three different types of intraocular lenses (IOLs)--the Tecnis Z9000 (modified prolate surface design) (Pfizer, New York, NY), the Acrysof MA60BM (unequal biconvex optic) (Alcon, Ft Worth, Tex), and the Sensar Optiedge AR40e (equibiconvex optic) (AMO, Santa Ana, Calif)--in eyes following cataract surgery. METHODS: This study was conducted in two parts. The first part was a randomized open study of 32 eyes of 16 patients who underwent bilateral phacoemulsification with a foldable IOL in the capsular bag. A Tecnis Z9000 IOL was implanted in one eye and an Acrysof MA60BM IOL in the fellow eye. The ALLEGRETTO WAVE Analyzer (Wavelight Laser Technologies AG, Erlangen, Germany) was used to measure ocular aberrations 2 weeks after surgery. A paired t test was used to compare each Zernike term from Z3(-3) to Z6(6) between fellow eyes (pupil diameter = 6 mm). In the second part of the study, the wavefront aberrations of 16 eyes that underwent an identical surgical procedure as in the first part of the study but had a Sensar Optiedge AR40e IOL implanted were studied and compared with eyes with the Tecnis Z9000 and Acrysof MA60BM IOLs. RESULTS: The mean spherical aberration (Z4(0)) was statistically significantly lower in eyes with a Tecnis Z9000 IOL (Z4(0) = 0.07 +/- 0.12 microm) compared with eyes with an Acrysof MA60BM IOL (Z4(0) = 0.29 +/- 0.20 microm, P < .001) and with eyes with a Sensar Optiedge AR40e IOL (Z4(0) = 0.20 +/- 0.09 microm, P = .002). No statistically significant differences were noted in any of the Zernike terms between eyes with Acrysof MA60BM and Sensar Optiedge AR40e IOLs, or in the root-mean-square (RMS) of total higher order aberrations among the three IOL groups. CONCLUSIONS: The implantation of a Tecnis Z9000 IOL produces a significant reduction in spherical aberration of the eye. No significant differences were noted in the wavefront profile between eyes with Acrysof MA60BM and Sensar Optiedge AR40e IOLs. No significant differences were found in the RMS of total higher order aberrations among the three IOL groups.     

Impact of a modified optic design on visual function: clinical comparative study

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified anterior surface designed to compensate for the positive spherical aberration of the cornea in eyes of cataract patients results in improved pseudophakic quality of vision. SETTING: Department of Ophthalmology, Bundesknappschaft's Hospital, Sulzbach, Germany. METHODS: In an intraindividual randomized study of 45 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9000, Pharmacia) was compared with a biconvex lens with spherical surfaces (SI-40, Allergan). All patients had bilateral cataract surgery; in 1 eye the Z9000 IOL was implanted and in the other, the SI-40 IOL. After 1 and 3 months, the following investigations were performed: assessment of the anterior and posterior segments including IOL decentration and tilt, pupil size, high- and low-contrast visual acuities, photopic and mesopic contrast sensitivities, and wavefront aberration of the cornea and eye. RESULTS: Thirty-seven patients were examined at all follow-up visits. Although the eyes with the Z9000 IOL had significantly better best corrected visual acuity after 3 months, the improved quality of vision was more apparent when assessing low-contrast visual acuity and contrast sensitivity. Wavefront measurements revealed no significant spherical aberration in eyes with a Z9000 IOL but significantly positive spherical aberration in eyes with an SI-40 IOL. CONCLUSIONS: The clinical results confirm the theoretical preclinical calculations that the spherical aberration of the eye after cataract surgery can be eliminated by modifying the anterior surface of the IOL. The Tecnis Z9000 lens compensates for the positive spherical aberration in older eyes. This leads to a significant improvement, particularly in contrast sensitivity and mesopic visual quality.     

Visual performance of aspherical and spherical intraocular lenses: intraindividual comparison of visual acuity, contrast sensitivity, and higher-order aberrations

PURPOSE: To intraindividually compare visual performance in terms of photopic high-contrast visual acuity (HCVA), mesopic HCVA, mesopic low-contrast visual acuity (LCVA), and contrast sensitivity (CS) in patients after implantation of either an aspherical or a spherical intraocular lens (IOL). SETTING: Department of Ophthalmology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany. METHODS: Forty eyes of 20 patients were randomized to implantation of an aspherical IOL (Tecnis Z9000, AMO) in 1 eye and a spherical IOL (Sensar AR40e, AMO) in the other eye. Three to 4 months postoperatively, photopic HCVA (270 cd/m(2)) was measured with the observer-independent Frankfurt-Freiburg Contrast and Acuity Test System (FF-CATS) and high-mesopic HCVA and LCVA (8 cd/m(2)) were measured with Early Treatment Diabetic Retinopathy Study charts. CS was assessed with the FF-CATS under photopic (167 cd/m(2)), high-mesopic (1.67 cd/m(2)), and low-mesopic (0.167 cd/m(2)) luminance conditions with and without glare. For each individual eye, higher-order wavefront aberrations were reconstructed for a physiological mesopic pupil diameter. Intraindividual differences (Delta(i)) in visual acuity, contrast sensitivity, and higher-order aberrations (HOAs) were calculated, and the influence of age and Delta(i) HOA on Delta(i) contrast sensitivity (logCS) under high-mesopic conditions was investigated using multiple regression analysis. RESULTS: There were no statistically significant differences between the Tecnis IOL and the Sensar IOL in visual acuity measurements or contrast sensitivity measurements. For physiological mesopic pupil diameter, primary spherical aberration (Z(4)(0)) was significantly lower in the Tecnis group (P<.001). For all parameters studied except Z(4)(0), the Delta(i) values were distributed around zero. Multiple regression analysis showed only a partial influence of Delta(i) Z(4)(0) on Delta(i) logCS (adjusted R(2) = 0.49) but did not show any influence of age, coma-like aberration, or residual HOA. CONCLUSIONS: Although Z(4)(0) was significantly lower in the eyes with the aspherical IOL, no statistically significant differences were found between aspherical and spherical IOLs in LCVA, HCVA, and contrast sensitivity. Statistical analysis of intraindividual contrast sensitivity differences showed that in most patients, this Z(4)(0) difference was too low to have an effect on contrast sensitivity.     

Personalized correction of spherical aberration in cataract surgery

PURPOSE: To compare contrast sensitivity after phacoemulsification with implantation of the Tecnis intraocular lens (IOL) between patients with a selected preoperative corneal spherical aberration and patients without a selected amount of aberration. SETTING: Private practice, St. Catharines, Ontario, Canada. METHODS: Thirty-three cataract patients were divided into 2 groups. The first group (n = 13) included consecutive patients with a spherical aberration of at least +0.33 microm measured with the Oculus Easygraph. Consecutive patients meeting the inclusion criteria (n = 20) were included in the second group. All patients had phacoemulsification with implantation of the Tecnis IOL. After 3 to 5 weeks, contrast sensitivity was measured by sinusoidal grating charts for distance under photopic (85 cd/m2) and mesopic (3 cd/m2) conditions with optical correction in place. Five standard spatial frequencies were tested. RESULTS: All surgical procedures and postoperative courses were uneventful. The IOLs were in the bag without decentration or tilt. The mean preoperative spherical aberration was +0.370 microm +/- 0.024 (SD) in the first group and +0.291 +/- 0.081 microm in the second group (P = .0010). Patients in the first group had better contrast sensitivity than those in the second group. Statistically significant differences were detected at spatial frequencies of 6.0 cycles per degree (cpd) and 12 cpd under photopic conditions (P = .0267 and P = .0215, respectively) and mesopic conditions (P = .0356 and P = .0217, respectively). CONCLUSIONS: The Tecnis IOL has a negative spherical aberration of -0.27 microm. Targeting for a postoperative mean residual spherical aberration of approximately +0.10 microm by selecting patients according to their preoperative spherical aberration resulted in better contrast sensitivity.     

Contrast sensitivity after LASIK flap creation with a femtosecond laser and a mechanical microkeratome

PURPOSE: To compare the effects on contrast sensitivity of the IntraLase femtosecond laser for flap creation (IntraLASIK) and standard LASIK for myopia. METHODS: Two hundred eyes of 100 consecutive patients underwent LASIK treatment using the VISX S2 laser system. The femtosecond laser (15 kHz IntraLase) was used for flap creation in 100 eyes (50 patients) and a mechanical microkeratome (Carriazo-Barraquer) was used in 100 eyes (50 patients). Best spectacle-corrected contrast sensitivity was measured before and 6 months postoperatively in the IntraLASIK and mechanical LASIK groups. The IntraLASIK and mechanical LASIK-induced changes in contrast sensitivity were compared under photopic (85 cd/m2) and mesopic (5, 2.5, and 0.1 cd/m2) conditions. RESULTS: Contrast sensitivity for eyes after IntraLASIK did not differ from preoperative values at the photopic level (85 cd/m2). However, under mesopic conditions, a statistically significant reduction (P < .01) in contrast sensitivity was found at high spatial frequencies (12 and 18 cpd), although no significant contrast sensitivity differences were observed at low and middle spatial frequencies (P > .01 for 1.5, 3, and 6 cpd). No statistically significant differences were found between IntraLASIK and mechanical LASIK for 1.5, 3, and 6 cpd at any luminance level (P > .01). IntraLASIK showed better contrast sensitivity than mechanical LASIK under mesopic conditions at 12 cpd and photopic and mesopic conditions at 18 cpd (P < .01). CONCLUSIONS: IntraLASIK surgery demonstrated better contrast sensitivity at high spatial frequencies under photopic and mesopic conditions than mechanical LASIK.     

Visual and optical performance of the Akreos Adapt Advanced Optics and Tecnis Z9000 intraocular lenses: Swedish multicenter study

PURPOSE: To compare the subjective visual and objective optical performance of 2 aspherical intraocular lenses (IOLs), the Akreos Adapt Advanced Optics (AO) (Bausch & Lomb, Inc.) and the Tecnis Z9000 (Advanced Medical Optics, Inc.). SETTING: Four university hospitals in Sweden. METHODS: This study comprised 80 patients, 20 each from 4 university hospital centers in Sweden. All patients had bilateral clear corneal phacoemulsification with implantation of an Akreos Adapt AO IOL in 1 eye and Tecnis Z9000 IOL in the other eye according to a randomization protocol. Preoperatively, 90% contrast Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity was measured and the mesopic pupil sizes were determined. Ten to 12 weeks postoperatively, 12.5% and 90% contrast ETDRS visual acuities and photopic and mesopic Functional Acuity Contrast Test chart contrast sensitivities were determined. Wavefront analysis was performed with the Zywave II aberrometer (Bausch & Lomb, Inc.), and a questionnaire on the subjective quality of vision was completed by each patient. RESULTS: The Akreos AO IOL and Tecnis Z9000 IOL produced similar high- and low-contrast visual acuities as well as photopic and mesopic contrast sensitivities. The Tecnis Z9000 IOL resulted in lower spherical aberrations of the eye (mean 0.05 +/- 0.13 microm versus 0.35 +/- 0.13 microm root mean square, 6.0 mm pupil) (P<.001); however, the Akreos AO IOL provided a larger depth of field (mean 1.22 diopter [D] +/- 0.48 [SD] versus 0.86 +/- 0.50 D, 6.0 mm pupil) (P<.001). Patient satisfaction was generally high, although 68.8% of the patients reported some type of visual disturbance postoperatively. Twenty-eight percent of patients reported better subjective visual quality in the Akreos AO eye and 14%, in the Tecnis Z9000 eye (P<.0001). Accordingly, 33% perceived more visual disturbances in the Tecnis Z9000 eye and 11%, in the Akreos AO eye (P<.0001). CONCLUSIONS: Maximum reduction of spherical aberration did not maximize subjective visual quality. The higher perceived quality of vision with the Akreos AO IOL could be because of differences in depth of field, IOL material, or IOL design.     

Spherical aberration and contrast sensitivity in eyes implanted with aspheric and spherical intraocular lenses: a comparative study

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified anterior aspheric surface results in reduced spherical aberration and improved contrast sensitivity after cataract surgery. DESIGN: Prospective, comparative, interventional case series. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified anterior surface (Tecnis Z9001; Advanced Medical Optics, Santa Ana, California, USA; group 1) was compared with biconvex lens with spherical surfaces (ClariFlex; Advanced Medical Optics; group 2). Ocular aberrations for a 5.0-mm pupil and 6.0-mm pupil were measured with Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed up for three months. RESULTS: No statistically significant difference in postoperative uncorrected and best-corrected distance vision acuity after a follow-up of three months existed between the groups. Postoperative contrast sensitivity testing revealed significant differences between the groups under photopic and mesopic conditions. These differences reached statistical significance under photopic conditions at three spatial frequencies and under mesopic conditions at all spatial frequencies. When analyzing higher-order aberrations, the difference between the groups was statistically significant at the 5.00-mm and 6.00-mm pupil diameters, with the group 1 inducing less higher-order aberration and also less spherical aberration compared with group 2. CONCLUSIONS: Results show the Tecnis Z9001 IOL with a modified anterior aspheric surface induced significantly less higher-order aberration and spherical aberration compared with the ClariFlex IOL. Contrast sensitivity revealed better values under photopic and mesopic conditions with the Tecnis Z9001 IOL.     

Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study

PURPOSE: To determine whether implantation of an intraocular lens (IOL) with a modified posterior aspherical surface (AcrySof IQ, Alcon Surgical Laboratories) results in reduced ocular aberrations (spherical aberration) and improved contrast sensitivity after cataract surgery. SETTING: Brasilia Ophthalmologic Hospital, Brasilia, and Sao Geraldo Eye Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil. METHODS: In an intraindividual randomized prospective study of 25 patients with bilateral cataract, an IOL with a modified posterior surface (AcrySof IQ) was compared with a biconvex IOL with spherical surfaces (AcrySof Natural, Alcon). Ocular aberrations with a 5.0 mm and 6.0 mm pupil were measured with a Hartmann-Shack aberrometer. Quality of vision was measured by visual acuity and contrast sensitivity under mesopic and photopic conditions. All patients were followed for 3 months. RESULTS: There were no statistically significant differences between eyes in postoperative uncorrected and best corrected distance visual acuities after a follow-up of 1 month and 3 months. Postoperatively, there was a statistically significant between-group difference in contrast sensitivity under photopic conditions without glare at 18 cycles per degree (cpd) (P = .04) and under mesopic conditions without glare at all spatial frequencies (3 cpd, 6 cpd, 12 cpd, and 18 cpd; P = .03, P = .009, P = .003, and P = .003, respectively) and with glare at 3 cpd and 6 cpd (P = .001 and P = .02, respectively). The difference in higher-order aberration (HOA) values between groups was statistically significant with a 5.0 mm and 6.0 mm pupil, with the AcrySof IQ IOL inducing less HOA than the AcrySof Natural IOL. Eyes with an AcrySof IQ IOL also had statistically significant less spherical aberration than eyes with an AcrySof Natural IOL with both pupil diameters (P<.001). CONCLUSIONS: The AcrySof IQ IOL with a modified posterior surface induced significantly less HOA and spherical aberration than the AcrySof Natural IOL. Contrast sensitivity was better under mesopic conditions with the AcrySof IQ IOL.     

非球面晶状体与传统球面晶状体植入术后对比敏感度的研究

目的:比较白内障术后早期非球面晶状体与传统球面晶状体植入术后功能视力.方法:白内障患者共50例,随机分成两组,一组患者植入以Acrysof IQ(Alcon)为代表的非球面晶状体,共23例 23眼;一组植入以AR40e(AMO)为代表的传统球面晶状体,共27例27眼.于术后1mo用CSV-1000E对比敏感度测试仪(由VECTOR VISION 公司提供)进行对比敏感度测定.结果:以Acrysof IQ (Alcon)为代表的非球面晶状体在6.12.18cpd时较以AR40e(AMO)为代表的传统球面晶状体能显著的提高患者对比敏感度.结论:以Acrysof IQ(Alcon)为代表的非球面晶状体可提高患者的功能视力     

Akreos AO人工晶状体与Tecnis Z9000人工晶状体植入眼后患者视功能对比研究

目的对比植入Akreos AO人工晶状体(intraocular lens,IOL)与Tecnis Z9000 IOL后的波前像差及视功能等指标。方法 82例(100眼)行超声乳化白内障吸出联合IOL植入术的患者,50眼植入Akreos AO IOL(Akreos AO组),50眼植入Tecnis Z9000IOL(Tecnis Z9000组),于术后3个月观察裸眼视力及最佳矫正视力、对比敏感度、波前像差并进行主观问卷调查。结果术后3个月Akreos AO组及Tecnis Z9000组的裸眼视力及最佳矫正视力差异均无统计学意义(均为P>0.05)。Tecnis Z9000组在瞳孔直径为4.0mm、5.0mm、6.0mm下的总体高阶像差及球面像差Z(4,0)均明显低于Akreos AO组(均为P<0.001)。两组在瞳孔直径为4.0mm、5.0mm、6.0mm下的总体三阶像差均方根值差异均无统计学意义(均为P>0.05)。术后3个月,Akreos AO组与Tecnis Z9000组在明视、暗视、明视眩光、暗视眩光下各个空间频率的对比敏感度差异均无统计学意义(均为P>0.05)。术后Akreos AO组患者满意度为95.9%,高于Tecnis Z9000组的81.3%,两组差异有统计学意义(χ2=5.189,P=0.023),术后眩光、光晕及暗处功能视力的不满意率两组差异没有统计学意义。结论虽然Akreos AO IOL与Tecnis Z9000IOL相比保留了患眼的部分球面像差,但植入Akreos AO IOL的患眼仍能够获得满意的术后客观、主观视功能及很高的患者满意度。     

非球面人工晶状体植入术后视觉质量对比分析

目的:评价3种非球面人工晶状体(AcrySof SN60WF、TecnisZ9001和KS-3Ai)植入术后的视觉质量。方法:采用前瞻性随机对照研究方法,收集我院老年性白内障手术患者88例126眼,平均年龄67.3±8.7岁,将入选患者按植入不同的人工晶状体(Intraocular lens,IOL)随机分为4组:AcrySofSN60WF(IQ)组(23例33眼)、TecnisZ9001组(23例33眼)、KS-3Ai组(20例29眼),SN60AT球面人工晶状体组为对照组(22例31眼)。术后随访3mo,观察指标:裸眼视力(uncorrected visual acuity,UCVA)及最佳矫正视力(best corrected visual acuity,BCVA),眼压,等效球镜度数,角膜Q值,瞳孔直径,6mm全眼球总高阶像差及四阶球差均方根值(root mean square,RMS),夜光、昼光及夜眩光3种视觉条件下的对比敏感度(contrast sensitivity,CS)。结果:术后各组的UCVA、BCVA、等效球镜度数和瞳孔直径均无统计学差异。总高阶像差和四阶球差RMS:非球面组低于球面组,差异具有统计学意义(P<0.05);非球面组间比较无统计学差异。术后角膜Q值与球差成正相关(r=0.183,P<0.05)。术后对比敏感度:与球面IOL相比,IQ,Tecnis可提高术后3种视觉条件下的CS,KS-3Ai可提高术后夜光、夜眩光两种视觉条件下的CS;非球面IOL组间比较,IQ组在昼光、夜眩光视觉条件下的CS好于Tecnis组和KS-3Ai组,TECNIS组和KS-3Ai组之间在3种视觉条件下均无统计学差异。结论:3种非球面IOL均可有效地减少术眼的总高阶像差和四阶球差。3种非球面IOL均可以提高术眼术后的CS,IQ组在昼光、夜眩光视觉条件下的CS与Tecnis组和KS-3Ai组相比较差异具有统计学意义,Tecnis组和KS-3Ai组之间在3种视觉条件下的CS均无统计学差异。     

Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens: prospective randomized masked clinical trial

PURPOSE: To evaluate contrast sensitivity and glare disability after implantation of an AcrySof IQ Natural SN60WF aspherical intraocular lens (IOL) (Alcon Laboratories). SETTING: Iladevi Cataract & IOL Research Centre, Ahmedabad, India. METHODS: One hundred twenty consecutive patients who had phacoemulsification in a prospective triple-masked trial were randomized to receive an AcrySof SA60AT IOL (40 eyes), AcrySof Natural SN60AT IOL (40 eyes), or AcrySof IQ SN60WF IOL (40 eyes). At 3 months, contrast sensitivity was measured using the CSV-1000E contrast sensitivity chart test face (Vector Vision) at 3, 6, 12, and 18 cycles per degrees (cpd) under photopic conditions (85 cd/m(2)) and mesopic conditions (2.7 cd/m(2)) with 4.0 mm and 6.0 mm fixed central apertures, with and without glare. The Kruskal-Wallis test was used and a pair-wise comparison performed. The main outcome measure was the difference in contrast sensitivity between IOLs at each spatial frequency. RESULTS: The best corrected visual acuity was similar between the 3 IOL groups (P = .6). The AcrySof IQ group had significantly higher contrast sensitivity at 18 cpd under photopic conditions (P = .008); at 3, 6, 12, and 18 cpd during mesopic testing with a 4.0 mm aperture without glare (P = .018, P = .011, P = .007, and P = .0001, respectively) and with glare (P = .003, P = .006, P = .005, and P = .004, respectively); and at all spatial frequencies during mesopic testing with a 6.0 mm aperture without glare (P = .018, P = .006, P = .009, and P = .0001, respectively) and with glare (P = .019, P = .002, P = .01, and P = .017, respectively). CONCLUSION: Eyes with the AcrySof IQ SN60WF IOL had significantly higher contrast sensitivity than eyes with an AcrySof SA60AT or AcrySof Natural SN60AT IOL at all spatial frequencies during mesopic testing (with and without glare) with 4.0 and 6.0 mm artificial pupil.