白内障术后植入不同人工晶状体视觉质量的对比分析

目的 对比分析白内障手术植入蓝光滤过晶状体(SA60AT)与非球面晶状体(TecnisZg001)术后视觉质量的变化.方法 选择我院2007年5月至2008年2月年龄相关性白内障患者72例.随机分成两组,均行超声乳化吸除联合人工晶状体植入术.对照组(36例)植入蓝光滤过晶状体SA60AT,实验组(36例)植入非球面晶状体TecnisZ9001.于术后1个月和3个月分别进行视力、对比敏感度和波前像差的检查.结果 视力:术后1个月和3个月,两组术后术眼最佳矫正视力差异无统计学意义(P＞0.05).对比敏感度:术后1个月,在无眩光和眩光环境下,对比敏感度6c/d、12c/d、18c/d,对照组均小于实验组,差异有显著性(P＜0.05),术后3个月在无眩光和眩光环境下,对比敏感度6c/d、12c/d、18c/d,对照组均小于实验组,差异有显著性(P＜0.05).波前像差:术后1个月、3个月,两组在瞳孔直径≥5 mm时的三阶彗差、四阶球差、高阶像差的均方根(RMS值)比较,实验组均低于对照组,两组有统计学意义(P＜0.05).结论 非球面晶状体与蓝光滤过晶状体在同时提高患者视力的同时,可以更好的改善术眼对比敏感度和高级像差,提高术眼视觉质量.     

不同人体晶状体设计对人工晶状体眼波前像差的影响

目的 评价超声乳化白内障吸除联合人工晶状体植入术后人工晶状体眼的波前像差,讨论不同设计的人工晶状体对术后人工晶状体眼波前像差的影响.方法 选择年龄相关性白内障患者62例(69眼),年龄41～84(平均63.4±4.0)岁.其中男24例(28眼),女38例(41眼),右眼38例,左眼31例.随机平均分为3组,使年龄性别相匹配.其中A组植入三片式人工晶状体(ACRYsofMA60BM),B组植入一片式人工晶状体(ACRYsofSA60AT),C组植入蓝光滤过型一片式人工晶状体(ACRYsofSN60AT).同一术者,同一超声乳化仪(AlconINFINITI VISION SYSTEM)和手术显微镜(Carl Zeiss Stativ S88),术中均采用角膜曲率最高经线上宽3.2mm长1.75mm的角巩膜缘隧道切口.术后1mo使用客观型波前像差仪(Nidek OPD-scan ARK-10000)进行波前像差检测,得出总体高阶像差的均方根(RMSh).结果 A组三片式(ACRYsofMA60BM)的RMSh平均达到0.702±0.090μm,B组一片式(ACRYsof SA60AT)的RMSh平均达到0.529±0.067μm,C组蓝光滤过型一片式(ACRYsofSN60AT)的RMSh平均达到0.566±0.066μm.三组比较采用单向方差分析,5.0mm瞳孔大小时A组的总体像差值最高(P<0.01),其余两组没有显著性差异(P=0.126).组间差异有统计学意义.结论 人工晶状体襻的设计对超声乳化白内障吸除联合人工晶状体植入术后人工晶状体眼的像差有明显影响,但光学区染色对单色像差的影响无统计学差异.这一结果对进一步完善白内障手术以及人工晶状体材料和设计的改善提供了有意义的信息.     

不同人工晶状体设计对人工晶状体眼波前像差的影响

目的:评价超声乳化白内障吸除联合人工晶状体植入术后人工晶状体眼的波前像差,讨论不同设计的人工晶状体对术后人工晶状体眼波前像差的影响。方法:选择年龄相关性白内障患者62例(69眼),年龄41～84(平均63.4±4.0)岁。其中男24例(28眼),女38例(41眼),右眼38例,左眼31例。随机平均分为3组,使年龄性别相匹配。其中A组植入三片式人工晶状体(ACRYsofMA60BM),B组植入一片式人工晶状体(ACRYsofSA60AT),C组植入蓝光滤过型一片式人工晶状体(ACRYsofSN60AT)。同一术者,同一超声乳化仪(Alcon INFINITI VISION SYSTEM)和手术显微镜(CarZeissStativS88),术中均采用角膜曲率最高经线上宽3.2mm长1.75mm的角巩膜缘隧道切口。术后1mo使用客观型波前像差仪(NidekOPD-scanARK-10000)进行波前像差检测,得出总体高阶像差的均方根(RMSh)。结果:A组三片式(ACRYsofMA60BM)的RMSh平均达到0.702±0.090μm,B组一片式(ACRYsofSA60AT)的RM-Sh平均达到0.529±0.067μm,C组蓝光滤过型一片式(ACRYsofSN60AT)的RMSh平均达到0.566±0.066μm。三组比较采用单向方差分析,5.0mm瞳孔大小时A组的总体像差值最高(P<0.01),其余两组没有显著性差异(P=0.126)。组间差异有统计学意义。结论:人工晶状体襻的设计对超声乳化白内障吸除联合人工晶状体植入术后人工晶状体眼的像差有明显影响,但光学区染色对单色像差的影响无统计学差异。这一结果对进一步完善白内障手术以及人工晶状体材料和设计的改善提供了有意义的信息。     

非球面人工晶状体眼的视觉质量

目的 比较年龄相关性白内障患者植入两种不同光学面设计的人工晶状体（intraocular lens,IOL）,即非球面和球面IOL眼的最佳矫正视力（best corrected visual acuity,BCVA）、对比敏感度及波前像差,分析人工晶状体光学面设计对人工晶状体眼视觉质量的影响。方法 连续选取2005年1月-2006年1月年龄相关性白内障患者43例（60眼）作为观察对象,随机分为两组,行超声乳化白内障摘除联合人工晶状体植入术,分别植入非球面人工晶状体（试验组,21例,30眼）和球面型人工晶状体（对照组,22例,30眼）。术后第2个月回访患者,行医学验光、对比敏感度和波前像差检查。对所得的数据行配对t检验。结果 试验组的BCVA为5.00±0.09,对照组的BCVA为5.00±0.05,两组差异无统计学意义﹙t=0.254,P=0.801﹚。试验组在夜视、夜视加眩光条件下的对比敏感度明显高于对照组,两组差异有统计学意义﹙P＜0.05）。在瞳孔直径5.0 mm状态下,试验组的球差、第四阶像差、第五阶像差、第六阶像差及总体高阶像差均方根值明显低于对照组﹙P＜0.05）。结论 非球面人工晶状体眼视觉质量明显优于球面人工晶状体眼。     

双眼超声乳化白内障吸除术后植入不同人工晶状体对比敏感度及像差改变的对比研究

目的探讨双眼超声乳化白内障吸除术后植入不同人工晶状体（IOL）后对比敏感度及像差的改变。方法选择我院2005年4至8月年龄相关性白内障患者63例,在知情同意的前提下,双眼行超声乳化白内障摘除术后,一只眼植入SA60AT型IOL,另一只眼植入TecnisZ9001型IOL。术后1和3个月分别进行电脑及综合验光仪验光及最佳矫正视力、眩光和无眩光条件下的对比敏感度、角膜像差、4和6mm瞳孔直径时眼的总体像差检测。结果术后1和3个月,所有患者双眼最佳矫正视力的差异均无统计学意义（P〉0．05）;两组角膜的球面像差、彗差及总像差均方根的差异均无统计学意义（P〉0．05）。术后1和3个月植入29001型IOL眼的对比敏感度在空间频率3、6、12、18c／d时无眩光、有眩光条件下均大于植入SA60AT型IOL的眼（P〈0．05）。术后1和3个月,瞳孔直径4和6mm时比较Zemike多项式C12、RMS4、RMSh,植入Z9001型IOL的眼均小于植入SA60AT型IOL的眼（P〈0．05）。结论TecnisZ9001较SA60AT型IOL可以改善眼的高阶像差特别是球面像差,提高功能视力。     

晶状体乳化吸出非球面人工晶状体植入术后视觉质量的临床研究

目的 评价老年性白内障晶状体乳化吸出联合非球面人工晶状体植入术术后的视觉质量,并与普通人工晶状体植入术后进行对比.方法 50例（50眼）老年性白内障行晶状体超声乳化吸出术,以随机双盲的方式分别植入TecnisZ9001非球面人工晶状体（实验组）和SN60AT普通人工晶状体（对照组）.随访时间2个月,观察术后最佳矫正视力、对比敏感视力、眼内像差及手术并发症.结果 术后2个月最佳矫正视力、对比敏感视力、高价像差（主要是球差、彗差）两组间差异有统计学意义.结论 临床观察证实了老年性白内障摘出联合非球面人工晶状体植入术术后能够抵消老年人角膜的正球差,从而提高术后视觉质量,尤其是对比敏感度和低对比视力.     

白内障摘除蓝光滤过型人工晶状体植入术后的临床观察

目的 比较研究白内障超声乳化植入蓝光滤过型人工晶状体和普通一片式人工晶状体的临床效果.方法 选取行白内障超声乳化摘除联合人工晶状体植入患者60例,60只眼,术后裸眼视力大于等于0.8.根据植入人工晶状体的类型不同,分为试验组和对照组,试验组植入YA-60BB人工晶状体组,30只眼;对照组植入AR40e人工晶状体组,30只眼.术后一个月检查患者的对比敏感度、畏光蓝视和色觉等主观视觉症状.结果 (1)YA-60BB人工晶状体组对比敏感度和AR40e人工晶状体组相比,术后一个月昼眩光状态1.5cpd空间频率下,和夜眩光状态1.5、3cpd空间频率下,两组对比敏感度相比差异有统计学意义(P<0.05),蓝光滤过组明显高于非蓝光滤过组.其余状态下,两组相比差异无统计学意义(P0.05).(2)术后一个月两组间畏光症状相比,差异无统计学意义(P0.05).两种晶体间色觉相比也无明显差异.蓝视症状相比,两组间差异有统计学意义(P<0.05),蓝光滤过组的术后蓝视症状明显少于非蓝光滤过组.结论 植入YA-60BB人工晶状体可提高眩光状态下低空间频率下的对比敏感度,也可以减轻患者术后的蓝视症状,而对色觉无负面的影响.     

白内障摘除蓝光滤过型人工晶状体植入术后的临床观察

目的 比较研究白内障超声乳化植入蓝光滤过型人工晶状体和普通一片式人工晶状体的临床效果.方法 选取行白内障超声乳化摘除联合人工晶状体植入患者60例,60只眼,术后裸眼视力大于等于0.8.根据植入人工晶状体的类型不同,分为试验组和对照组,试验组植入YA-60BB人工晶状体组,30只眼;对照组植入AR40e人工晶状体组,30只眼.术后一个月检查患者的对比敏感度、畏光蓝视和色觉等主观视觉症状.结果 (1)YA-60BB人工晶状体组对比敏感度和AR40e人工晶状体组相比,术后一个月昼眩光状态1.5cpd空间频率下,和夜眩光状态1.5、3cpd空间频率下,两组对比敏感度相比差异有统计学意义(P<0.05),蓝光滤过组明显高于非蓝光滤过组.其余状态下,两组相比差异无统计学意义(P0.05).(2)术后一个月两组间畏光症状相比,差异无统计学意义(P0.05).两种晶体间色觉相比也无明显差异.蓝视症状相比,两组间差异有统计学意义(P<0.05),蓝光滤过组的术后蓝视症状明显少于非蓝光滤过组.结论 植入YA-60BB人工晶状体可提高眩光状态下低空间频率下的对比敏感度,也可以减轻患者术后的蓝视症状,而对色觉无负面的影响.     

白内障摘除蓝光滤过型人工晶状体植入术后的临床观察

目的 比较研究白内障超声乳化植入蓝光滤过型人工晶状体和普通一片式人工晶状体的临床效果.方法 选取行白内障超声乳化摘除联合人工晶状体植入患者60例,60只眼,术后裸眼视力大于等于0.8.根据植入人工晶状体的类型不同,分为试验组和对照组,试验组植入YA-60BB人工晶状体组,30只眼;对照组植入AR40e人工晶状体组,30只眼.术后一个月检查患者的对比敏感度、畏光蓝视和色觉等主观视觉症状.结果 (1)YA-60BB人工晶状体组对比敏感度和AR40e人工晶状体组相比,术后一个月昼眩光状态1.5cpd空间频率下,和夜眩光状态1.5、3cpd空间频率下,两组对比敏感度相比差异有统计学意义(P<0.05),蓝光滤过组明显高于非蓝光滤过组.其余状态下,两组相比差异无统计学意义(P0.05).(2)术后一个月两组间畏光症状相比,差异无统计学意义(P0.05).两种晶体间色觉相比也无明显差异.蓝视症状相比,两组间差异有统计学意义(P<0.05),蓝光滤过组的术后蓝视症状明显少于非蓝光滤过组.结论 植入YA-60BB人工晶状体可提高眩光状态下低空间频率下的对比敏感度,也可以减轻患者术后的蓝视症状,而对色觉无负面的影响.     

白内障摘除蓝光滤过型人工晶状体植入术后的临床观察

目的 比较研究白内障超声乳化植入蓝光滤过型人工晶状体和普通一片式人工晶状体的临床效果.方法 选取行白内障超声乳化摘除联合人工晶状体植入患者60例,60只眼,术后裸眼视力大于等于0.8.根据植入人工晶状体的类型不同,分为试验组和对照组,试验组植入YA-60BB人工晶状体组,30只眼;对照组植入AR40e人工晶状体组,30只眼.术后一个月检查患者的对比敏感度、畏光蓝视和色觉等主观视觉症状.结果 (1)YA-60BB人工晶状体组对比敏感度和AR40e人工晶状体组相比,术后一个月昼眩光状态1.5cpd空间频率下,和夜眩光状态1.5、3cpd空间频率下,两组对比敏感度相比差异有统计学意义(P<0.05),蓝光滤过组明显高于非蓝光滤过组.其余状态下,两组相比差异无统计学意义(P0.05).(2)术后一个月两组间畏光症状相比,差异无统计学意义(P0.05).两种晶体间色觉相比也无明显差异.蓝视症状相比,两组间差异有统计学意义(P<0.05),蓝光滤过组的术后蓝视症状明显少于非蓝光滤过组.结论 植入YA-60BB人工晶状体可提高眩光状态下低空间频率下的对比敏感度,也可以减轻患者术后的蓝视症状,而对色觉无负面的影响.     

Contrast sensitivity and color vision with a yellow intraocular len

OBJECTIVE: To evaluate contrast sensitivity and color vision of yellow ultraviolet (UV) intraocular len (IOL) in cataract patients. DESIGN: Randomized clinical trial. METHODS: Extracapsular cataract extraction was performed in 60 senile cataract patients. The patients were randomly assigned to receive 30 yellow UV IOLs and 30 ordinary UV IOLs. Visual acuity, contrast sensitivity, and color vision were examined up to 6 months postoperatively. RESULTS: The yellow UV IOLs showed statistically significantly higher spatial contrast sensitivity than ordinary UV IOLs in the low and middle frequencies. There was no significant difference between yellow and ordinary UV IOL in color vision. Incidences of photophobia and cyanopsia were less in patients who received the yellow UV IOLs. CONCLUSIONS: Yellow UV IOLs are preferable to ordinary UV IOLs in preserving spatial contrast sensitivity and cause less photophobia and cyanopsia in the early postoperative period.     

Theoretical comparison of aberration-correcting customized and aspheric intraocular lenses

PURPOSE: To assess the performance and optical limitations of standard, aspheric, and wavefront-customized intraocular lenses (IOLs) using clinically verified pseudophakic eye models. METHODS: White light pseudophakic eye models were constructed from physical measurements performed on 46 individual cataract patients and subsequently verified using the clinically measured contrast sensitivity function (CSF) and wavefront aberration of pseudophakic patients implanted with two different types of IOLs. These models are then used to design IOLs that correct the astigmatism and higher order aberrations of each individual eye model's cornea and to investigate how this correction would affect visual benefit, subjective tolerance to lens misalignment (tilt, decentration, and rotation), and depth of field. RESULTS: Physiological eye models and clinical outcomes show similar levels of higher order aberration and contrast improvement. Customized correction of ocular wavefront aberrations with an IOL results in contrast improvements on the order of 200% over the control and the Tecnis IOLs. The customized lenses can be, on average, decentered by as much as 0.8 mm, tilted > 10 degrees , and rotated as much as 15 degrees before their polychromatic modulation transfer function at 8 cycles/degree is less than that of the Tecnis or spherical control lens. Correction of wavefront aberration results in a narrower through focus curve but better out of focus performance for +/- 0.50 diopters. CONCLUSIONS: The use of realistic eye models that include higher order aberrations and chromatic aberrations are important when determining the impact of new IOL designs. Customized IOLs show the potential to improve visual performance.     

Comparison of contrast sensitivity and color discrimination after clear and yellow intraocular lens implantation

PURPOSE: To compare contrast sensitivity and color vision in patients in whom blue-light filtering and non-yellow-tinted intraocular lenses (IOLs) were implanted. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty eyes of 20 patients were enrolled in a blue-light filtering fellow-eye control study; patients were implanted with a yellow-tinted IOL (AcrySof Natural, Alcon) in 1 eye and a non-yellow-tinted IOL (AcrySof SA60AT, Alcon) in the fellow eye after cataract surgery. Three months postoperatively, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and the color discrimination with the Farnsworth-Munsell 100 Hue test. RESULTS: Eyes implanted with blue-light filtering IOLs showed similar contrast sensitivity to that in fellow eyes implanted with non-yellow-tinted IOLs (P>.1). Both types of IOLs showed normal contrast sensitivity values (normalized log-contrast sensitivity about 1.0). There were no statistically significant differences in chromatic discrimination between the 2 types of IOLs (P = .56). CONCLUSION: The use of blue-light filtering IOLs is more advisable because they are capable of protecting the retina against ultraviolet light without disturbance of contrast sensitivity and chromatic vision, which produces subjective impairment in visual function.     

Visual function with blue light filter IOLs

BACKGROUND: Recently, intraocular lenses (IOLs) with a blue light filter have been introduced to protect the retina from age-related macular degeneration (AMD) after cataract extraction. A reduction of longitudinal chromatic aberration by filtering blue light may enhance patient's visual function. In this study we compared subjective and objective parameters of visual function following implantation of blue light filter (yellow) IOLs and IOLs of the same design without filter. PATIENTS AND METHODS: 21 patients (21 eyes) underwent implantation of an IOL with a blue light filter (AF-1 UY, Hoya, Japan), 22 patients (22 eyes) received an IOL without blue light filter (AF-1 UV, Hoya, Japan). Patients were examined three months postoperatively for uncorrected and best corrected spectacle visual acuity, mesopic and photopic contrast sensitivity, colour vision and subjective quality of vision by a standard questionnaire. RESULTS: Eyes with blue light filter IOLs did not show any significant difference in any parameter analysed when compared to eyes without the blue light filter IOL. Subjective quality of vision was considered to be high by all patients and no significant difference was observed between the two IOL groups. CONCLUSION: The visual function of patients with blue filter IOLs is not significantly different to those without blue light filter IOLs. Since blue light filter IOLs did not show any functional disadvantage, but potentially protect the macula from AMD, blue light filter IOLs may be considered as a reasonable alternative to traditional IOLs, especially in eyes with a high risk for the development of macular degeneration.     

非球面单焦点及多焦点人工晶体眼高阶像差及对比敏感度比较

目的探讨非球面、单焦点及多焦点人工晶体眼的对比敏感度及高阶像差的差别。方法病人进行随机分组,其中一组病人植入非球面人工晶体Z9001,一组植入单焦点人工晶体SA60AT,一组植入多焦点人工晶体SA40N,共124只眼进入本研究。术后由Allegretto Wave Analyzer(Allegretto,Germany)像差仪测量高阶像差,由CSV-1000E(Vector Vision,USA)测量对比敏感度。结果术后的最佳矫正视力,瞳孔直径,撕囊口直径的大小及角膜高阶像差比较,组间差异不具有统计学意义。术后的高阶像差测量,其中球面像差、4阶高阶像差及总体像差比较中SA40N组大于SA60AT组,SA60AT组大于Z9001组。对比敏感度比较,在所有的空间频率3、6、12、18cpd,Z9001组大于SA60AT组,SA60AT组大于SA40N组。结论多焦点人工晶体眼较单焦点人工晶体相比,可以引起眼的高阶像差增加,对比敏感度降低。非球面人工晶体可以减少球面像差、增加对比敏感度。     

Blue-light filtering intraocular lens in patients with diabetes: contrast sensitivity and chromatic discrimination

PURPOSE: To evaluate potential changes in contrast sensitivity and color discrimination in diabetic patients who had cataract surgery and implantation of the blue-light filtering AcrySof Natural (SN60AT) intraocular lens (IOL) compared with an ultraviolet-only filtering (AcrySof SA60AT) IOL. SETTING: Refractive Surgery Unit, Hospital NISA Valencia al Mar, Valencia, Spain. METHODS: Forty-four eyes of 22 diabetic patients were enrolled in a blue-light filtering fellow-eye control study. Patients received yellow-tinted IOLs (AcrySof Natural) in 1 eye and non-yellow-tinted IOLs (AcrySof SA60AT) in the fellow eye. Three months after surgery, monocular contrast sensitivity function was measured with the CSV 1000-E contrast sensitivity chart at distance and color discrimination was tested with the Farnsworth-Munsell 100-hue test. RESULTS: Eyes implanted with the blue-light filtering IOLs showed better contrast sensitivity values than fellow eyes implanted with non-yellow-tinted IOLs (P<.05). The blue-light filtering IOL did not modify chromatic discrimination compared with the non-yellow-tinted IOL (P = .62). In the blue-yellow axis discrimination study, the eyes implanted with the AcrySof Natural IOL had statistically significant better color vision (P = .008). CONCLUSIONS: In diabetic patients, the AcrySof Natural IOL provides better contrast sensitivity than the AcrySof SA60AT. The blue-light filter of the AcrySof Natural IOL did not cause chromatic discrimination defects based on total error scores and improved color vision in the blue-yellow chromatic axis in diabetic patients.     

Predicting the optical performance of eyes implanted with IOLs to correct spherical aberration

PURPOSE: To use powerful modeling techniques for predicting the optical performance of eyes implanted with different types of intraocular lenses (IOLs). This approach will allow performance of "virtual cataract surgery," with different IOL designs that can be used and physical parameters that may occur during actual surgery-in particular, in IOLs that correct spherical aberration. METHODS: A computer model was developed to predict the optical performance of individual eyes after IOL implantation. The approach was validated in a group of patients with eyes implanted with different IOLs. In these patients, corneal wavefront aberrations were calculated from elevations provided by videokeratography. Ocular aberrations were measured with a high-dynamic range Hartmann-Shack wavefront sensor. Misalignments (IOL tilt and decentration) were estimated with a new instrument, based on recording Purkinje images. This model of particular corneal aberrations and IOL parameters (intrinsic optical design details plus geometric location data) was used to estimate the total ocular aberrations after surgery and to compared them with actual aberrations measured directly with the wavefront sensor. RESULTS: The aberrations of implanted eyes predicted by the individualized optical models were well correlated with the actual aberration measured in each subject. This result indicates that the approach is adequate in evaluating the actual optical performance of different types of lenses. The model allows a large number of "virtual" surgeries to be performed, to test the performance of current or future IOL designs. CONCLUSIONS: A "virtual surgery" approach was designed to predict the optical performance in pseudophakic eyes. In each subject, it was possible to obtain the eye's optical performance with a particular IOL and biometric data after surgery. Specifically, this modeling can be used to evaluate the tolerances to misalignments and depth of focus of IOLs correcting spherical aberration in actual eyes. This approach is quite powerful and is especially applicable to the study of current and future aberration-correction IOL designs.     

Effect of cataract surgery incision location and intraocular lens type on ocular aberrations

PURPOSE: To determine whether Hartmann-Shack wavefront sensing detects differences in optical performance in vivo between poly(methyl methacrylate) (PMMA) and foldable acrylic intraocular lenses (IOLs) and between clear corneal and scleral tunnel incisions and whether optical differences are manifested as differences in visual performance. SETTING: Department of Optometry, University of Bradford, West Yorkshire, United Kingdom. METHODS: This study comprised 74 subjects; 17 were phakic with no ocular pathology, 20 had implantation of a Pharmacia 722C PMMA IOL through a scleral tunnel, 21 had implantation of an Alcon AcrySof IOL through a scleral tunnel, and 16 had implantation of an AcrySof IOL through a corneal incision. Visual acuity and contrast sensitivity testing, ocular optical quality measurement using Hartmann-Shack wavefront sensing, and corneal surface measurement with a videokeratoscope were performed in all cases. RESULTS: There were significant differences between groups in the total root-mean-square (RMS) wavefront aberration over a 6.0 mm pupil (F=3.91; degrees of freedom=3,70; P<.05) mediated at the 4th-order RMS, specifically spherical and tetrafoil aberrations. The PMMA-scleral group had the least aberrations and the AcrySof-corneal group the most. For a 3.5 mm diameter pupil, the total higher-order RMS wavefront aberration was not significantly different between the groups (P>.05). There were no differences between groups in corneal shape, visual acuity, or contrast sensitivity. CONCLUSIONS: Implantation of the spherical PMMA IOL led to a slight reduction in total wavefront aberration compared to phakic eyes. AcrySof IOLs induced more aberrations, especially spherical aberration. Corneal-based incisions for IOL implantation compounded this increase. Studies of the optical performance of IOLs in vivo should use wavefront sensing as the main outcome measure rather than visual measures, which are readily confounded by multiple factors.     

Wavefront technology in cataract surgery

PURPOSE OF REVIEW: As advances in technology allow cataract surgeons to address higher order optical aberrations, the measurement of functional vision becomes increasingly critical. Contrast sensitivity testing is assuming a prominent place in our evaluation of surgical modalities because it reflects functional vision and correlates with visual performance. The Tecnis Z9000 intraocular lens (IOL) (Pfizer, New York) is the first foldable IOL designed to correct higher order optical aberrations and represents a first step toward the integration of wavefront technology and cataract surgery. RECENT FINDINGS: Contrast sensitivity declines with age, even in the absence of ocular pathology. Wavefront science demonstrates that the youthful crystalline lens compensates for aberrations in the cornea. The aging lens loses its balance with the cornea, as both the magnitude and the sign of its spherical aberration change. Older pseudophakic patients have generally the same contrast sensitivity as their age-matched counterparts without cataract. The Tecnis Z9000 IOL (Pfizer, New York) has been designed with a modified prolate anterior surface to compensate for the spherical aberration of the cornea, thus eliminating total ocular spherical aberration. Clinical data demonstrate that this modified prolate IOL provides superior functional vision, similar to that of younger people, and hence improves visual performance when compared with conventional spherical IOLs. It appears likely that the decline in functional vision with age involves changes in the spherical aberration of the crystalline lens. SUMMARY: The integration of wave-front technology and lens-based surgery represents a step toward improving functional vision and quality of life for cataract patients.