Prospective Intraindividual Comparison Of An Enhanced Monofocal And An Aspheric Monofocal Intraocular Lens

Enhanced monofocal intraocular lenses (IOLs) modify spherical aberrations to increase intermediate visual acuity after cataract surgery. The aim of this clinical study was to intraindividually compare monocular visual performance of an enhanced monofocal IOL with an aspheric monofocal IOL on the same platform.

This single-center, prospective clinical trial was conducted at the Department of Ophthalmology, Medical University of Vienna.

A total of 55 patients and 110 eyes eligible for bilateral cataract surgery were recruited. The aspheric monofocal ZCB00 IOL was implanted in the dominant eye and the enhanced monofocal ICB00 IOL in the non-dominant eye (both Johnson & Johnson Vision, Santa Ana, CA, USA). Two to six months after surgery, study participants received a detailed follow-up examination including monocular best-corrected distance (BCDVA), 80cm and 66cm intermediate (DCIVA) and 40cm near (DCNVA) visual acuity. Furthermore, distance-corrected contrast acuity (CA) at 4m and 66cm as well as monocular defocus curves from +0.5D to -1.5D were assessed. Additional IOL evaluation included higher order aberrations (HOAs) as well as decentration and tilt parameters.

At follow-up, the ZCB00 performed better at BCDVA (ZCB00: -0.05±0.06logMAR; ICB00: -0.03±0.07logMAR; p= .014), the ICB00 was better at 80cm DCIVA (ZCB00: 0.30±0.12logMAR; ICB00: 0.24±0.13logMAR; p= .006) and 66cm DCIVA (ZCB00: 0.39±0.12logMAR; ICB00: 0.33±0.14logMAR; p= .003). Defocus acuity was better with the ZCB00 at +0.5D (p= .034), the ICB00 performed better from -0.5D to -1.5D (p< .05). Monocular DCNVA, CA and defocus levels of +0.25D to -0.25D as well as IOL tilt and decentration were comparable (p> .05). Internal HOAs (ZCB00: 0.12±0.07μm; ICB00: 0.16±0.07μm; p= .001) and spherical aberrations (ZCB00: -0.01±0.02μm; ICB00: -0.05±0.04μm; p< .001) were increased with the ICB00 at 3mm pupil aperture and comparable at 5mm (p> .05).

Although statistically significant differences of intermediate visual acuity were observed with the enhanced monofocal ICB00 IOL, the clinical results were below 1 line (5 letters) on ETDRS reading charts at all distances tested. Monocular distance visual acuity was observed with better results in the ZCB00 group. Monocular near visual acuity as well as monocular contrast acuity were identical in both groups. Decentration, tilt as well as higher order aberration values were generally low.