Optical Bench Evaluation of the Latest Refractive Enhanced Depth of Focus Intraocular Lens.

Purpose: Any new intraocular lens (IOL) on the market claims to outperform competitors. We aimed to estimate the modulation transfer function (MTF) for different defocus of a novel refractive enhanced depth of focus (EDoF) IOL and the simulated visual acuity over this range of vision. Further, we analyzed the wavefront pattern produced by this IOL to reveal the function of the IOL's optics. Methods: For the novel TECNIS® PureSee® (ZEN00V) IOL, through frequency and through focus MTF were recorded on the optical bench (ISO-2 Cornea 0.28 µm, 546 nm). MTFa and the simulated visual acuity were calculated for different defocus. Apertures of 3 mm and 4.5 mm were applied. Higher order aberrations of the IOLs' optics were recorded and analyzed. Results: PureSee® IOL demonstrated a considerable depth of focus of about 1.7 D at the spectacle plane and a continuous simulated visual acuity over this range of defocus. For the 4.5 mm aperture, near focus depth was reduced, yet far distance MTF was even better. Higher order aberrations revealed increased primary and secondary spherical aberrations. Conclusion: Optical bench results suggest that the new ZEN00V matches the clinical criteria of an EDoF IOL by an increased range of vision and is far distance dominant for an enlarged pupil. This behaviour seems to be due to subtle power changes in the central optics that produce a complex modification of wavefront.

Enhanced Depth of Focus Intraocular Lenses: Through Focus Evaluation of Wavefront-Shaping versus Diffractive Optics.

Introduction: A new class of nondiffractive, wavefront-shaping Enhanced-Depth-of-Focus (EDoF) IOLs has been introduced very recently to cope with photic phenomena known from diffractive EDoF IOLs. We investigated the through focus modulation transfer function (MTF) of two wavefront-shaping EDoF IOLs compared to an established diffractive EDoF IOL on the optical bench. Such comparison on the optical bench had not been performed before and is of high clinical importance for the cataract surgeon. Material and Methods: Tecnis Symfony (diffractive) and the wavefront-shaping Acrysof IQ Vivity and LuxSmart Crystal IOLs (22 D each) were assessed by the OptiSpheric IOL PRO 2 imaging test bench with an ISO-2 cornea and a wavelength of 546 nm. Apertures of 3 mm and 4.5 mm were applied. Results: For all three IOLs, two peaks showed up in the through focus MTF curves representing the primary and secondary focus. For Symfony, these peaks were most distinct. Power difference between far and intermediate focus was 1.25 D (Symfony), 1.75 D (Vivity), and 1.5 D (LuxSmart) with an aperture of 3 mm. With an aperture of 4.5 mm, only for LuxSmart, power difference diminished slightly to about 1 D, and only the MTF in the intermediate focus decreased for all lenses. Conclusion: For all three IOLs, we could confirm a considerable depth of focus that was most extended for Vivity. Both new wavefront-shaping IOLs had lower values of peak MTF but a markedly more continuous through focus behavior compared to the diffractive EDoF IOL.

Depth of focus of four novel extended range of vision intraocular lenses.

PURPOSE: To assess the depth of focus of four latest non-diffractive extended range of vision IOLs on the optical bench. Such comparison had not been done before. METHODS: We assessed and compared the through focus modulation transfer function (MTF) of the following novel IOLs with a nominal power of 22 D: Acrysof Vivity, LuxSmart Crystal, RayOne EMV and Tecnis Eyhance. An ISO-2 model eye was applied with apertures of 3 and 4.5 mm with monochromatic light of 546 nm. Measurements were done on OptiSpheric IOL PRO 2 optical bench. RESULTS: For the aperture of 3 mm, Eyhance and RayOne EMV showed the most pronounced peak in MTF with only little enlarged depth of power. Vivity and LuxSmart showed two peaks of about 1.7 D respectively 1.3 D depth of focus, yet reduced MTF and with maxima differently located. For 4.5 mm, MTF values for Eyhance and particularly for RayOne EMV dropped. For Vivity and LuxSmart, only the peak for the secondary focus decreased. CONCLUSION: Vivity and LuxSmart showed a larger depth of focus for our measuring conditions than Eyhance and RayOne EMV. Correspondingly, the peak MTF was best for Eyhance and RayOne ERV with small aperture. With the larger aperture, RayOne EMV considerably lost performance.

Effect of decentration and tilt on four novel extended range of vision intraocular lenses regarding far distance.

PURPOSE: To analyze the effect of decentration and tilt on four novel non diffractive extended range of vision intraocular lenses (IOLs). METHODS: Acrysof Vivity, LuxSmart Crystal, RayOne EMV and Tecnis Eyhance were compared on the optical bench (power of 22 D each). Modulation transfer functions were obtained and Strehl ratio was calculated in an ISO-2 model. Apertures of 3 mm and 4.5 mm were applied. For qualitative assessment, United States Airforce (USAF) chart images were evaluated. Additional to centered IOLs, tilt of 5 degrees and decentration of 1 mm were applied. RESULTS: RayOne EMV was very robust against misalignment but had considerable deterioration of modulation transfer function (MTF) for large aperture with USAF images seriously blurred. Tilt and decentration decreased the performance of Eyhance significantly but had minor impact on the performance of Vivity and LuxSmart. For 4.5 mm aperture, MTF and Strehl ratio decreased markedly for all IOLs compared to 3 mm aperture size. The best MTF and Strehl ratio was obtained for Eyhance IOL well centered for both sizes of aperture. CONCLUSION: Tilt and decentration had a major impact on the performance of Eyhance only, which performed best of all IOLs tested when well centered. With large aperture, performance of all IOLs significantly decreased. Manufacturer's different approaches for these novel IOLs to increase depth of focus by increasing spherical aberration lead to a different performance in respect to contrast function and sensitivity to misalignment. Our results apply to the distance vision. Near vision performance will be evaluated in a separate investigation.

Evaluating Optical Quality of a New Hydrophilic Enhanced Monofocal Intraocular Lens and Comparison to the Monofocal Counterpart: An Optical Bench Analysis.

INTRODUCTION: The aim of the study was to analyze the optical properties of a new hydrophilic enhanced monofocal intraocular lens (IOL) using optical bench analysis and compare it with its monofocal counterpart. METHODS: This laboratory study investigates the enhanced monofocal intraocular lens (L-333) and the monofocal counterpart (L-313) IOL by Teleon Surgical, Spankeren, Netherlands on the optical bench, using OptiSpheric IOL PRO2 (Trioptics, Germany) in order to assess the optical quality according to ISO 11979 with ISO-2 Cornea. IOLs (power 22.0 D) were evaluated regarding through frequency modulation transfer function (MTF), Strehl ratio (SR), and through focus MTF at 50 lp/mm using a 3.0-mm and a 4.5-mm aperture. Tilt and decentration were applied. In addition, wavefront measurements were obtained using WaveMaster® IOL 2 device (Trioptics, Germany) and analyzed. RESULTS: Centered: The MTF (mean) at 50 lp/mm (L-333/L-313) with 3.0 mm aperture was 0.606/0.724 and with 4.5 mm aperture 0.330/0.409. The SR (mean) with 3.0 mm aperture was 0.586/0.809 and with 4.5 mm aperture 0.330/0.348. Decentered by 1 mm: The MTF (mean) at 50 lp/mm (L-333/L-313) with 3.0 mm aperture was 0.485/0.705 and with 4.5 mm aperture 0.255/0.374. The SR (mean) with 3.0 mm aperture was 0.457/0.739 and with 4.5 mm aperture 0.185/0.268. Tilted by 5 degrees: The MTF (mean) at 50 lp/mm (L-333/L-313) with 3.0 mm aperture was 0.577/0.657 and with 4.5 mm aperture 0.345/0.336. The SR (mean) with 3.0 mm aperture was 0.583/0.702 and with 4.5 mm aperture 0.269/0.237. In through focus MTF and aperture of 3.0 mm, the L-333 showed a peak of 0.41 with some enlarged depth of power of about 2 D. For the aperture of 4.5 mm, the MTF values of L-313 and L-333 were slightly reduced; L-333 showed an MTF peak of 0.23 and some reduced depth of power of about 1.5 D. Wavefront measurements showed no major aberrations for the L-313, while a combination of moderate increase in Z 4-0 and Z 6-0 with opposite sign was revealed for the L-333. CONCLUSION: The enhanced monofocal Lentis Quantum (L-333) produces some enlarged depth of focus by combining spherical aberration of different order and opposite sign. The Lentis Quantum performs very well in comparison to the aspherical monofocal counterpart owing to its optical design. Results with large apertures were sufficient too, suggesting that  the lens is a good option in eyes with a wide pupil and thus in refractive surgeries of young patients.

Enhanced Depth-of-focus Intraocular Lenses: Latest Wavefront-shaped Optics versus Diffractive Optics.

SIGNIFICANCE: The modulation transfer functions (MTFs) of two novel enhanced depth-of-focus (EDoF) intraocular lenses (IOLs) were compared with an established diffractive EDoF IOL. Such assessment, which was not described before in the literature, is of high clinical impact in lens surgery. PURPOSE: A new kind of nondiffractive, wavefront-shaped EDoF IOLs has been introduced very recently to cope with halos and glare known from diffractive optics. We aimed to assess the performance of two of these novel EDoF IOLs compared with an established diffractive EDoF IOL. METHODS: TECNIS Symfony, AcrySof IQ Vivity, and LuxSmart Crystal IOLs (22 D each) were assessed by the OptiSpheric IOL PRO 2 imaging test bench with an ISO-2 cornea and a wavelength of 546 nm. Measurements were carried out by TRIOPTICS GmbH. Through-frequency MTF, Strehl ratio, and U.S. Air Force targets were evaluated. A decentration of 1 mm and a tilt of 5° as well as different apertures of 3 and 4.5 mm were applied additionally. RESULTS: TECNIS Symfony performed superiorly to Vivity and LuxSmart for our settings. The diffractive optics of Symfony showed a considerable decrease in MTF and Strehl ratio when decentered. Overall, decentration had more impact on MTF and Strehl ratio than tilt. Larger aperture led to a decreased MTF and Strehl ratio for all IOLs tested. U.S. Air Force targets had better contrast for Symfony and for small aperture. CONCLUSION: The novel wavefront-shaped EDoF IOLs failed to outperform the established diffractive achromatic optics of Symfony EDoF IOL with respect to MTF and qualitative contrast function. These results apply only to the distance viewing condition. Near vision performance will be evaluated in a future study.

Impact of Decentration and Tilt on Spherical, Aberration Correcting, and Specific Aspherical Intraocular Lenses: An Optical Bench Analysis.

INTRODUCTION: The human eye is not optically symmetrical, and very few intraocular lens (IOLs) are perfectly centered in the eye. That is why contrast sensitivity can degrade in some conditions, especially in low light. In an optical bench analysis, we compare spherical (A), aberration correcting (B), and specific aspherical lenses (C) in terms of impact of decentration and tilt on the modulation transfer function as well as the simulated overall quality with USAF test targets. MATERIAL AND METHODS: The OptiSpheric IOL PRO2 was used to measure the optical performance of IOLs (A, B, C). In order to assess the optical quality of the IOLs, the optical quality parameters for the aperture size of 3.0 mm and 4.5 mm at the IOL plane were assessed. Through Frequency Modulation Transfer Function (MTF) and Strehl Ratio (SR) values, as well as the "US Airforce 1951 resolution test chart images" as qualitative simulation, were analyzed. All measurements (ISO) were repeated and done for centered, decentered (1 mm), and tilted (5°) IOLs. RESULTS: Centered: The MTF (mean) at 50 lp/mm (IOL A, B, C) with 3.0-mm aperture was 0.794/0.716/0.797 (ISO-1 cornea) and 0.673/0.752/0.723 (ISO-2 cornea) and with 4.5-mm aperture 0.728/0.365/0.751 (ISO 1) and 0.276/0.767/0.505 (ISO 2). The SR (mean) with 3.0-mm aperture was 0.763/0.829/0.898 and with 4.5-mm aperture 0.228/0.386/0.432. Decentered by 1 mm: The MTF (mean) at 50 lp/mm with 3.0-mm aperture was 0.779/0.459/0.726 (ISO 1) and 0.695/0.381/0.662 (ISO 2). The MTF (mean) at 50 lp/mm with 4.5-mm aperture was 0.732/0.348/0.653 (ISO 1) and 0.355/0.069/0.346 (ISO 2). The SR (mean) with 3.0-mm aperture was 0.829/0.543/0.397 and with 4.5-mm aperture was 0.259/0.145/0.192. Tilted by 5°: The MTF (mean) at 50 lp/mm with 3.0-mm aperture was 0.731/0.705/0.751 (ISO 1) and 0.623/0.727/0.732 (ISO 2). The MTF (mean) at 50 lp/mm with 4.5-mm aperture was 0.579/0.406/0.701 (ISO 1) and 0.277/0.512/0.429 (ISO 2). The SR (mean) with 3.0-mm aperture was 0.539/0.478/0.514 and with 4.5-mm aperture was 0.262/0.136/0.201. CONCLUSION: Aberration correcting IOLs perform best when perfectly centered. The optical performance of aberration correcting IOLs can be markedly downgraded by misalignment. The examined ZO optic performed well in decentration and tilt. The ZO concept seems to be a good alternative to aspheric lenses, as it achieves to combine benefits of spherical and aspheric intraocular lenses. There is no perfect IOL, but fitting and choosing the right one for the individual case seems to be crucial to take advantage of benefits and minimize disadvantages. This is why knowledge of optical properties is also mandatory for the surgeon.

Analysis of higher order aberrations in recently developed wavefront-shaped IOLs.

PURPOSE: A new class of enhanced range of vision intraocular lenses (IOLs) has been introduced recently to cope with compromises of diffractive optics in patients aiming for spectacle independence. Few information is available about their optical function. We aimed to analyze higher order aberrations of four of these new wavefront-shaped IOLs under standardized conditions. METHODS: Two recently developed enhanced monofocal and two recently developed enhanced depth of focus IOLs (power 22 D) were analyzed by a Shack-Hartmann sensor in an in-situ model eye according to ISO 11,979 in NaCl with 546 nm. We determined the Zernike polynomials up to the 10th order. RESULTS: Only spherical aberration (SA) of different orders was considerably modified. Whereas RaySof EMV showed a moderate increase in Z 4-0, Eyhance and Vivity produced a considerable increase of negative Z 4-0. A combination of Z 4-0 and Z 6-0 with an opposite sign was found in LuxSmart. CONCLUSION: SAs of different orders are the only relevant Zernike polynomials in this new class of wavefront-shaped IOLs. RaySof EMV proved to be a monofocal IOL with increased positive SA. The central change in radial power and the resulting increase in negative SA in Eyhance IOL might produce some depth of field. The magnitude of SA modification of Vivity and LuxSmart is expected to extend the depth of focus considerably. Surgeons can select among these novel IOLs depending on corneal asphericity and the patient's wish for spectacle independence.

Optical Bench Analysis of 2 Depth of Focus Intraocular Lenses.

BACKGROUND: The aim of the study was to analyze the objective optical properties of 2 enhanced depth of focus (EDoF) intraocular lenses (IOLs) using optical bench analysis. METHODS: This experimental study investigates 2 new EDoF IOLs, the Alcon AcrySof IQ Vivity and the Bausch & Lomb LuxSmart Crystal, on the optical bench, using OptiSpheric IOL PRO2 (Trioptics, Germany) in order to assess the optical quality according to ISO 11979 with ISO-2 Cornea. IOLs (power 22.0 D) were evaluated regarding modulation transfer function (MTF) at 50 lp/mm and Strehl ratio (SR) using a 3.0-mm and a 4.5-mm aperture. In addition, wavefront measurements were obtained using WaveMaster® IOL 2 device (Trioptics, Germany), and USAF targets were analyzed. RESULTS: Centered: the MTF (mean) at 50 lp/mm (AcrySof IQ Vivity/LuxSmart Crystal) with 3.0 mm aperture was 0.250/0.257 and with 4.5 mm aperture 0.202/0.243. The SR (mean) with 3.0 mm aperture was 0.261/0.355 and with 4.5 mm aperture 0.176/0.206. Decentered by 1 mm: the MTF (mean) at 50 lp/mm (AcrySof IQ Vivity/LuxSmart Crystal) with 3.0 mm aperture was 0.266/0.247 and with 4.5 mm aperture 0.126/0.215. The SR (mean) with 3.0 mm aperture was 0.272/0.234 and with 4.5 mm aperture 0.133/0.183. Tilted by 5 degree: the MTF (mean) at 50 lp/mm (AcrySof IQ Vivity/LuxSmart Crystal) with 3.0 mm aperture was 0.221/0.360 and with 4.5 mm aperture 0.214/0.229. The SR (mean) with 3.0 mm aperture was 0.232/0.428 and with 4.5 mm aperture 0.225/0.229. The simulated visual function using USAF test targets showed corresponding qualitative results. Wavefront measurements proved a complex optical design. Higher order aberrations in the central part of the optics were modulated up to the 10th order to enhance the range of functional vision to near distance, leaving the peripheral parts of the optics aberration free or as aberration correcting. CONCLUSION: The diversity of EDOF IOLs, their optics, and their respective impact on the vision quality must be understood in order to select the appropriate IOL in each individual case. This analysis of new, innovative IOL optics based on increased negative spherical aberration may help the ophthalmic surgeon to select the IOL which meets the individual requirements of the patient for best postoperative outcomes. It seems that there is no perfect IOL that is equally suitable for all patients, but the right choice is an individual, customized approach dealing with patients' expectations.

A Novel Concept of Correcting Presbyopia: First Clinical Results with a Phakic Diffractive Intraocular Lens.

PURPOSE: To evaluate the effect of a novel technique to correct presbyopia. A phakic IOL (presbyopic IPCL; implantable phakic contact lens) with a diffractive optic is implanted and its impact on visual acuity, refraction, patient satisfaction in patients striving for spectacle-independence is evaluated. DESIGN: Retrospective noncomparative open-label clinical trial. METHODS: Sixteen eyes of 8 patients (average age 47 years) had a presbyopic IPCL implanted in the posterior chamber. The visual acuity on different distances, refractive status, corneal topography, endothelial cell density, anterior chamber depth, white-to-white, mesopic pupil size and intraocular pressure (IOP) were measured before implantation of this novel phakic IOL with diffractive optic and four weeks after surgery. RESULTS: At follow-up four weeks after surgery, 9 of the 16 eyes were emmetropic and uncorrected distance visual acuity was at least 0.8. Near vision was excellent in all patients without the need to wear reading glasses. There was neither a significant change in IOP nor a significant surgical impact on endothelial cells. Patient satisfaction was high. There was no major complaint of halos or glare. CONCLUSION: The presbyopic IPCL can provide the presbyopic patient with good visual acuity and spectacle-independence for far and near distance. We found this novel technique to have a good safety profile during the surgical procedure and our short follow-up period. Further long-term follow-up is mandatory.

Effect of age on the pupillomotor field.

To differentiate physiologic variation from visual field loss with pupillomotor perimetry, the effect of age on the normal pupillomotor field must be known. Given the absence of reported data, the authors aimed to analyze the effect of age on the pupillomotor field as measured with light stimuli of different properties. Subjects consisted of 23 healthy volunteers aged 20 to 28 years ("younger subjects") and 20 healthy volunteers aged 50 to 67 years ("older subjects"). Within a field of 20 degrees, a sequence of 25 focal light stimuli was performed repeatedly on a monitor. The pupil light reflex (PLR) was recorded to stimuli of different diameter and luminance under mesopic conditions. The mean amplitude of the PLR was calculated for each stimulus location and condition. Increasing stimulus luminance or size caused a larger PLR amplitude and a steeper decline of the PLR amplitude from the center to the periphery of the pupillomotor field. The older subjects had reduced mean PLR amplitude with a less pronounced decrease of PLR amplitude toward the field periphery. For the peripheral locations, the largest PLR amplitude was found in the temporal superior quadrants. There was considerable intra-individual test-retest variation in PLR amplitudes in younger and older subjects. The PLR is markedly reduced in older compared with younger subjects. Older subjects have a relatively less pronounced central peak of sensitivity. There are intra-individual test-retest variations in PLR amplitude and asymmetries in sensitivity within the normal pupillomotor field at any age. These findings must be considered in interpreting the results of pupillomotor perimetry.