Can We Improve The Performance Of Extended Depth Of Focus Iols ?

To determine if near vision can be improved in emmetropic pseudophakic eyes implanted with extended depth of focus intraocular lens & hybrid monofocal without compromising distance vision after inducing myopic astigmatism & a negative SA.

Narayana Nethralaya

40 patients (80 eyes) having undergone phacoemulsification with AcrySof Vivity IOL and Tecnis Eyhance IOL underwent subjective refraction. In experiment 1, after measurement of wavefront aberration, visual acuity (VA) assessment for near, intermediate and distance with baseline SA on Visual adaptive optics simulator (Voptica Inc) was done. Only SA was modulated in steps of -0.01 μm &VA was tested at different targets in the same order and defocus curves were plotted. In experiment 2, patients were induced with myopic astigmatism in steps of 0.25 D in the axis accepted by patient and vision was recorded at all distances. The optimal induced cylinder to obtain an improvement in near visual acuity was identified & defocus curves were plotted.

On inducing negative spherical aberration, near & intermediate vision improved in both the groups, with the Vivity IOL group performing better than Eyhance which was statistically significant (p<0.05). 80% eyes showed an improvement in near vision after inducing negative spherical aberration of which 57% eyes improved with SA of -0.05 μm. Inducing negative defocus and negative spherical aberration improved near vision in both groups significantly (p<0.05).   With induced cylinder and sphere, the distance vision showed a statistically significant change (p<0.01) in both Vivity and Eyhance group. The change in the intermediate and near vision in the 2 groups was also found to be significant (p<0.0001).

Inducing negative spherical aberration and a myopic astigmatism may improve the near and intermediate visual acuity in patients implanted with extended depth of focus IOLs