Retinal image quality with multifocal,EDoF,and accommodative intraocular lenses as studied by pyramidal aberrometry

Background:To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function(PSF)Strehl ratio using a pyramidal wavefront sensor(PWS)-based aberrometer.Methods:This study included 194 eyes implanted with:(a)19 AcrySof SA60AT(control group);(b)19 Miniwell;(c)24 LENTIS Mplus LS-313 MF30;(d)33 LENTIS Mplus LS-313 MF15;(e)17 AkkoLens Lumina;(f)31 AT LISA Tri 839MP;(g)20 Precizon Presbyopic;(h)20 AcrySof IQ PanOptix;(i)11 Tecnis Eyhance.Main outcome measures were PSF Strehl ratio,PSF Strehl ratio excluding second-order aberrations(PSFw2),total root mean square(RMS),low-order aberration(LOA)and high-order aberration(HOA)RMS measured by PWS aberrometer.Results:AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0-and 4.0-mm pupil size(0.52±0.14 and 0.31±0.10;P<0.05),followed by SA60AT(0.41±0.11 and 0.28±0.07)and PanOptix(0.4±0.07 and 0.26±0.04).AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.004).Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm(P<0.0001)and 4.0 mm(P=0.002).Total RMS,LOA RMS,HOA RMS,PSF Strehl ratio and PSFw2 varied significantly between the studied groups(P<0.001).Conclusions:Far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens.AT LISA Tri,SA60AT and PanOptix showed the highest values of far distance retinal image quality,while the lowest PSFw2 Strehl ratios were displayed by Miniwell,Mplus MF30 and Precizon Presbyopic.

Corneal collagen cross‑linking epithelium‑on vs.epithelium‑off:a systematic review and meta‑analysis

Background:The purpose of the study was to determine the advantages and disadvantages of epi-on corneal crosslinking(CXL)techniques compared with standard epi-off CXL.Methods:We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results:A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion:Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.

Corneal collagen cross-linking epithelium-on vs. epithelium-off: a systematic review and meta-analysis

Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking(CXL)techniques compared with standard epi-off CXL.Methods We searched MEDLINE and EMBASE for randomized controlled trials(RCTs)and non-randomized studies of interventions(NRSIs)and we evaluated the selected papers according to the Cochrane risk of bias tool.We considered,as primary outcomes,average Kmax flattening,changes in uncorrected and corrected distance visual acuity(UDVA and CDVA);as secondary outcomes,we considered changes in pachymetry values and endothelial cell density(ECD).We also investigated adverse events related to the treatments and treatment failure.Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference(MD)with 95%confidence interval(CI)as the effect size.Results A total of 15 studies were included and among these 15 trials,9 were RCTs and 6 were NRSIs,but only 4 studies showed no high risk of bias and were included in this meta-analysis.Our analysis revealed significant postoperative differences in CDVA(MD=0.07;95%CI 0.04 to 0.10;P<0.001),and no significative differences in UDVA,Kmax,central corneal thickness(CCT)and ECD(P>0.05).Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing(P=0.035)and persistent stromal haze(P=0.026).Conclusion Epi-on CXL is as effective as epi-off CXL.Except for a higher significant improvement in CDVA with current epi-on protocols,our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual,topographic,pachymetric,and endothelial parameters.Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.

Retinal image quality with multifocal, EDoF, and accommodative intraocular lenses as studied by pyramidal aberrometry

BackgroundTo study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer.MethodsThis study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group);(b) 19 Miniwell;(c) 24 LENTIS Mplus LS-313 MF30;(d) 33 LENTIS Mplus LS-313 MF15;(e) 17 AkkoLens Lumina;(f) 31 AT LISA Tri 839MP;(g) 20 Precizon Presbyopic;(h) 20 AcrySof IQ PanOptix;(i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer.ResultsAT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10;P < 0.05), followed by SA60AT (0.41 ± 0.11 and 0.28 ± 0.07) and PanOptix (0.4 ± 0.07 and 0.26 ± 0.04). AT LISA Tri was found to provide a significantly better retinal image quality than PanOptix at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.004). Mplus MF15 was found to be significantly better than Mplus MF30 at both 3.0 mm (P < 0.0001) and 4.0 mm (P = 0.002). Total RMS, LOA RMS, HOA RMS, PSF Strehl ratio and PSFw2 varied significantly between the studied groups (P < 0.001).ConclusionsFar distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens. AT LISA Tri, SA60AT and PanOptix showed the highest values of far distance retinal image quality, while the lowest PSFw2 Strehl ratios were displayed by Miniwell, Mplus MF30 and Precizon Presbyopic.

Reply to the letter to the editor

We appreciate the interest of Miguel Faria Ribeiro in our paper[1],as well as the comments made to it.The interest of the topic is sound,as nowadays an enormous amount of new so-called“premium lenses”are appearing in the market,with different optical profiles which obviously lead to different light distributions and different quality of retinal image.This is why our interest in this topic is longstanding and we have published extensive summaries about the outcomes and complications of multifocal lenses over the last years[2,3].