Visual performance of patients implanted with progressive ... · Visual performance of patients...
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Visual performance of patients implanted with progressive PAD
Bi-Flex M analyzed by the Qvision iPad Multifocal Lens Analyzer.
Fernández J, MD, PhD
Rodríguez-Vallejo M, OD, PhD
Tauste A, OD, PhD
Martínez J, OD
Piñero DP, OD, PhD
Authors:
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Diopters (D) Distance
-4.00 25 cm
-3.50 28 cm
-3.00 33 cm
-2.50 40 cm
-2.00 50 cm
-1.50 67 cm
-1.00 1 m
-0.50 2 m
0.00 Infinite
+0.50 Infinite
+1.00 Infinite
-0.50D
-1.00
0.00D
-2.00D
-1.50D
INTRODUCTION to DEFOCUS CURVES
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Some disadvantages of the conventional method:
✓Each clinician has different decision criteria.
✓The patient can memorize the letters or optotypes.
✓The clinician may take a long time for completing
the defocus curve.
✓The clinician spends a long time recording all the
visual acuities for each defocus lens.
INTRODUCTION to DEFOCUS CURVES
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CDAVCDSC
INTRODUCTION to DEFOCUS CURVES
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METHODS
41 eyes without any complication
9 eyes with complications
6 eyes with anterior capsule tear
3 eyes with corneal erosion
25 implanted subjects
Complications or Adverse Events not related with the IOL
5 men and 20 women
Mean age 69.7 ± 7.4 [56 to 83]
Corneal astigmatism ≤ 0.75 D
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METHODS
1 month follow-up
Monocular standardized reports
Binocular defocus curves with MLA
3 month follow-up
Monocular defocus curves with MLA
Factors for optimizing the performance
Eyes with complicationswere excluded from the analysis
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RESULTS Binocular defocus curve comparison
Confounding variable, subjects were significantly older 74 ± 6 vs 68 ± 5 in the complications group (p = 0.03)
1 month
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ACCURACY or PREDICTABILITY
Kane JX et al. J Cataract Refract Surg. 2016;42(10):1490-1500.
Comparison 7 equations
OLCI OLCR
Cooke DL, Cooke TL. J Cataract Refract Surg. 2016;42(8):1157-1164.
Mean Lax 23.81 mm; from 20.87 to 29.44 mm; N=1079
No lens thickness Lens thickness
PhacoOptics
Mean 0.40 D
± 0.5 D: 75.1%
Comparison 9 equations
1 month
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ACCURACY or PREDICTABILITY
Comparison 9 equations
Adjusted to intended refraction
mean ± sd-0.15 ± 0.33
median (iqr)0 (0.23)
* Manifested spherical equivalent – Target spherical refraction
SRK-T 1 month
Refractive cylinder after surgery
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EFFICACY (monocular far distance) 1 month
mean ± sd0.10 ± 0.16
median (iqr)0.1 (0.13)
mean ± sd0.00 ± 0.08
median (iqr)0.00 (0.03)
UDVA
CDVA
Far distance
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EFFICACY (monocular intermediate distance) 1 month
mean ± sd0.20 ± 0.14
median (iqr)0.2 (0.2)
mean ± sd0.22 ± 0.16
median (iqr)0.2 (0.2)
UIVA
CIVA
67 cm of distance
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EFFICACY (monocular near distance) 1 month
mean ± sd0.09 ± 0.10
median (iqr)0.1 (0.1)
mean ± sd0.08 ± 0.10
median (iqr)0.1 (0.1)
UNVA
CNVA
40 cm of distance
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EFFICACY (lines of difference Uncorrected vs Corrected) 1 month
Distance Intermediate Near
Good tolerance to the residual refractive error at 67 cm and 40 cm
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Multifocal lens analyzer defocus curves
n=18 n=20
Binocular 1 month follow-up Monocular 3 month follow-up
Binocular summation improves close to 1 line of visual acuity at all distances
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Monocular defocus curves correlations 3 month
• Visual Acuity Defocus Curve
Area under the curve above 0.3 logMAR
Distance Intermediate Near Total
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Monocular defocus curves correlations 3 month
No significant differences were found but older subjects presented poorer defocus curves
• Total area: r= -0.51, p=0.03
• Far area: r= -0.49, p=0.04
• Intermediate area: r= -0.11 p=0.64
• Near area: r= -0.61 p=0.006
Area under the curve was correlated with age
at far and near
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IOL decentration versus pupil center 3 month
15 % Nasal decentatrion 0.3 mm
40% Close to pupil center < 0.3 mm
45% Temporal decentration 0.3 mm
RE
RE
RE
15% Superior decentration 0.3 mm
45% Close to pupil center < 0.3 mm
40% Inferior decentration 0.3 mm
HORIZONTAL VERTICAL
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IOL decentration versus pupil center 3 month
RE
RE
RE
HORIZONTAL VERTICAL
CenteredNasal Temporal
Inte
rmed
iate
AU
C
Inte
rmed
iate
AU
C
CenteredInferior Superior
Harrer A, et al. J Cataract Refract Surg. 2017; 43: 1015–9.
Kappa angle is at temporal location from pupil
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Conclusions
Predictability: mean spherical equivalent residual error of -0.15 ± 0.33 D and 88% of eyes in ± 0.50 D
Monocular Efficacy: logMAR Far Intermediate Near
Uncorrected 0.1 0.2 0.09
Corrected 0.0 0.2 0.08
The intermediate and near vision remain almost similar with and withoutbest correction
Binocular defocus curves were around one line of visual acuity better thanmonocular defocus curves.
Younger patients achieved better results in terms of visual acuity defocus curves.