Pupil dependence assessment with multifocal intraocular lenses through visual acuity and contrast sensitivity defocus curves. 2021

Joaquín Fernández, and Manuel Rodríguez-Vallejo, and Javier Martínez, and Noemi Burguera, and David P Piñero
Department of Ophthalmology (Qvision), Vithas Virgen del Mar Hospital, Almería, Spain.

OBJECTIVE To identify the most sensitive visual performance metric for evaluating the pupil-dependency of a multifocal intraocular lens (MIOL) and to determine the pupil measurement method most correlated with such metric. METHODS Twenty-seven right eyes implanted with a MIOL were included in the analysis. Three pupil size measurements were obtained preoperatively and at 1 month after surgery with the Keratograph 5M system: photopic (PP), mesopic (MP), and the average from both (AP). Pupil was also measured with a rule (RP) under the same light conditions of postoperative visual performance measurements that included, corrected visual acuities (VA) at three distances (far, 67 cm and 40 cm), visual acuity (VADC) and contrast sensitivity defocus curves for optotype sizes of 0.3 logMAR (CSDC3) and 0.7 logMAR (CSDC7). Differences in visual performance were also analyzed for eyes with RP > 3 mm (Group A) and RP ⩽ 3 mm (Group B). RESULTS PP diameter decreased after surgery by 16% (p = 0.001), whereas MP (p = 0.013) and AP (p = 0.008) decreased by 10%. The best agreement with RP was obtained for AP. Group B showed a trend to better performance than Group A for all the included metrics (p > 0.05). From the three types of defocus curves, CSDC3 obtained generally highest statistical power for testing differences between groups. The strongest statistically significant correlations between pupil size and CSDC3 were obtained for RP and AP. CONCLUSIONS The CSDC3 was the most sensitive metric to detect MIOL pupil-dependency. PR and AP were more correlated with CSDC3 than PP and MP.

UI MeSH Term Description Entries
D007910 Lenses, Intraocular Artificial implanted lenses. Implantable Contact Lens,Lens, Intraocular,Contact Lens, Implantable,Intraocular Lens,Intraocular Lenses,Lens, Implantable Contact
D011446 Prospective Studies Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group. Prospective Study,Studies, Prospective,Study, Prospective
D011474 Prosthesis Design The plan and delineation of prostheses in general or a specific prosthesis. Design, Prosthesis,Designs, Prosthesis,Prosthesis Designs
D011680 Pupil The aperture in the iris through which light passes. Pupils
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000075542 Multifocal Intraocular Lenses Artificially implanted lenses that direct light toward distant and near focal points allowing clear vision for a range of distances. Accommodating IOLs,Accommodating Intraocular Lens,Accommodating Intraocular Lenses,Multifocal IOLs,Multifocal Intraocular Lens,Accommodating IOL,IOL, Accommodating,IOL, Multifocal,IOLs, Accommodating,Intraocular Lens, Accommodating,Intraocular Lens, Multifocal,Intraocular Lenses, Accommodating,Multifocal IOL
D014792 Visual Acuity Clarity or sharpness of OCULAR VISION or the ability of the eye to see fine details. Visual acuity depends on the functions of RETINA, neuronal transmission, and the interpretative ability of the brain. Normal visual acuity is expressed as 20/20 indicating that one can see at 20 feet what should normally be seen at that distance. Visual acuity can also be influenced by brightness, color, and contrast. Acuities, Visual,Acuity, Visual,Visual Acuities
D015350 Contrast Sensitivity The ability to detect sharp boundaries (stimuli) and to detect slight changes in luminance at regions without distinct contours. Psychophysical measurements of this visual function are used to evaluate VISUAL ACUITY and to detect eye disease. Visual Contrast Sensitivity,Sensitivity, Contrast,Sensitivity, Visual Contrast
D018918 Phacoemulsification A procedure for removal of the crystalline lens in cataract surgery in which an anterior capsulectomy is performed by means of a needle inserted through a small incision at the temporal limbus, allowing the lens contents to fall through the dilated pupil into the anterior chamber where they are broken up by the use of ultrasound and aspirated out of the eye through the incision. (Cline, et al., Dictionary of Visual Science, 4th ed & In Focus 1993;1(1):1) Phacoemulsifications
D019654 Lens Implantation, Intraocular Insertion of an artificial lens to replace the natural CRYSTALLINE LENS after CATARACT EXTRACTION or to supplement the natural lens which is left in place. Implantation, Intraocular Lens,Implantations, Intraocular Lens,Intraocular Lens Implantation,Intraocular Lens Implantations,Lens Implantations, Intraocular

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