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José I Belda,1,2 Javier Placeres,1,2 Juan C Elvira,3 Xavier Puig,4 Caridad Pérez-Vives,5 Ming Zou,6 Jing Yu,6 Shaohui Sun,6 Derek O’Boyle7 1Department of Ophthalmology, Hospital Universitario de Torrevieja, Alicante, Spain; 2Visionker Eye Clinic, Alicante, Spain; 3Department of Ophthalmology, Hospital Universitario del Vinalopó, Alicante, Spain; 4Alcon Healthcare SA, Barcelona, Spain; 5Alcon Management SA, Cointrin, Switzerland; 6IQVIA Real World Solutions, Basel, Switzerland; 7Alcon Laboratories Ireland Ltd, Cork, IrelandCorrespondence: Derek O’Boyle, Alcon Laboratories Ireland Ltd., Cork, Ireland, Tel +353879080235, Email derek.oboyle@alcon.comPurpose: To estimate the incidence of neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy up to five years after cataract surgery with different single-piece acrylic monofocal IOLs in a Spanish cohort.Patients and Methods: Data were extracted from electronic medical records. Eligible participants were aged ≥ 65, had cataract surgery with one of five different acrylic monofocal IOLs (Alcon AcrySof, AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag and Zeiss Asphina), and more than six months baseline data. Participants were followed up to five years from surgery and up to six months from Nd:YAG. The incidence of Nd:YAG was compared between the IOLs and multivariate analyses were conducted to identify predictors of Nd:YAG incidence at five-years after cataract surgery.Results: The initial cohort included 9545 patients with 14,519 eyes (53% female, average age 75 years). Of those, 3955 eyes were available for analysis five years after cataract surgery. Throughout the five years post-surgery, Nd:YAG incidence was consistently lower with Alcon Acrysof IOLs than the other IOLs. At five years the Nd:YAG incidence rate for Alcon Acrysof was 8.8%. In comparison, the incidence was 47.4% for AJL LLASY60 (OR = 9.54, 95% CI [6.57, 13.84]), 44.3% for Zeiss Asphina (OR = 8.35, 95% CI [5.85, 11.94]) and 44.0% for IOL Tech Stabibag (OR = 8.02, 95% CI [4.60, 13.84]).Conclusion: Alcon AcrySof IOLs have a consistently lower risk of Nd:YAG incidence over a long follow-up period after cataract surgery, highlighting the importance of IOL choice for patients’ long-term outcomes.Keywords: Nd:YAG, long-term outcome, monofocal IOLs, real-world evidence

José I Belda,1 Javier Placeres,1 Juan Carlos Elvira,2 Xavier Puig,3 Caridad Pérez-Vives,4 Ming Zou,5 Shaohui Sun,5 Jing Yu,5 Derek O’Boyle6 1Hospital Universitario de Torrevieja, Torrevieja, Alicante, Spain; 2Hospital Universitario del Vinalopó, Elche, Alicante, Spain; 3Alcon Healthcare, S.A, Barcelona, Spain; 4Alcon Management SA, Cointrin, Switzerland; 5IQVIA Real World Solutions, Basel, Switzerland; 6Alcon Laboratories Ireland Ltd., Cork, IrelandCorrespondence: Derek O’Boyle, Alcon Laboratories Ireland Ltd., Cork, Ireland, Email derek.oboyle@Alcon.comPurpose: To estimate the economic impact of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser capsulotomy and its related complications for five different intraocular lenses (IOLs) from the payer and hospital perspectives in Spain.Materials and Methods: The three-year incidence rates of Nd:YAG laser capsulotomy after cataract surgery with five different single-piece acrylic monofocal IOLs (AcrySof IOLs, AJL LLASY60, IOL Tech Stabibag, Medicontur Bi-flex, Zeiss Asphina) for 8293 patients were derived from odds ratios of multivariate analysis adjusted for age, gender, and diabetic retinopathy. A cost-consequence model for a hypothetical cohort of 2000 eyes was then developed to quantify the potential impact of Nd:YAG capsulotomy in terms of costs and time for each of the included IOLs, from the payer and hospital perspectives.Results: The adjusted three-year Nd:YAG laser capsulotomy incidence was 5.0% (95% CI 3.9 to 6.1) for AcrySof and ranged from 26.0% to 44.0% for the other four IOLs. The average costs of Nd:YAG treatment and related complications were € 261.90 for payers and € 19.99 for hospitals. The average time needed for Nd:YAG treatment and related complications was 32.82 minutes. Model estimates based on 2000 hypothetical cataract surgeries showed that AcrySof IOLs could lead to cost savings between € 110,259.90 and € 205,591.50 for payers. For hospitals, time, and cost savings with AcrySof ranged from 230.29 hours and € 8415.79 compared to Zeiss Asphina to 429.40 hours and € 15,692.15 compared to AJL LLASY60 IOLs.Conclusion: Post cataract surgery, AcrySof IOLs were associated with a significantly lower incidence of Nd:YAG treatment and its subsequent complications compared to other IOLs. Our analysis shows that IOL choice is an important factor that can reduce the burden for patients, payers, and hospitals.Keywords: cost, resources, Nd:YAG capsulotomy, cataract, PCO, IOL

Objectives: To investigate the associations between different single-piece monofocal intraocular lenses (IOLs) and neodymium-doped yttrium aluminum garnet laser (Nd:YAG) capsulotomy incidence 3 years after cataract surgery in a Spanish cohort., Methods: This is a longitudinal retrospective cohort study. Data were extracted from the electronic medical records of two large regional hospitals in Spain. Patients aged ≥65 years receiving cataract surgery with placement of five different IOLs and with ≥6 months of baseline data were included. We report the Nd:YAG capsulotomy incidence 3 years post cataract surgery, and the survival plot over the 3 years of follow-up time. The associated adjusted (age, gender, and diabetic retinopathy) multivariate analysis with odds ratios (ORs) and 95% CIs is also presented., Results: The cohort (53% female, mean age 75 ± 5.9 years) included 14,519 eyes (Alcon AcrySof = 2968, AJL LLASY60 = 1776, Medicontur Bi-flex = 5176, Zeiss Asphina = 4478, and IOL Tech Stabibag = 121). Of these, 8293 were retained until 3-year follow-up. At 3 years after cataract surgery, the Nd:YAG capsulotomy incidence was 5% for Alcon AcrySof, while it ranged from 21.2% to 31.1% for the other IOLs (p < 0.0001 for each comparison). The odds for Nd:YAG capsulotomy were significantly higher (p < 0.0001) for other IOLs compared with those of Alcon AcrySof (ORs = 8.85, 5.86, 5.74, 5.21 for AJL LLASY60, Medicontur Bi-flex, IOL Tech Stabibag, and Zeiss Asphina, respectively)., Conclusions: The lower Nd:YAG capsulotomy rates for Alcon AcrySof IOLs compared to the other IOLs support the importance of lens choice in reducing patient burden and treatment costs., (© 2021. The Author(s).)

There is strong evidence that the IOL material is the factor having the greatest impact on posterior capsule opacification (PCO), anterior capsule opacification (ACO) development, and glistening formation after cataract surgery, even though there are other IOL features-such as haptic material and design and edge and optic design-that also have some influence. We reviewed the published literature describing the adverse events that are mainly related to the intraocular lens (IOL) material, such as PCO, ACO, and the subsequent capsule contraction, as well as glistening formation. The adverse events presented in this overview are the most common ones in clinical practice, and therefore, they are generally included in the clinical protocols for IOL evaluation.

We have reviewed a set of recently published studies that compared the anterior chamber depth (ACD) and/or white-to-white (WTW) distance obtained by means of different measuring devices. Since some of those studies reached contradictory conclusions regarding device interchangeability, this review was carried out in attempting to clarify which clinical devices can or cannot be considered as interchangeable in clinical practice to measure ACD and/or WTW distance, among these devices: A-scan, ultrasound biomicroscopy, Orbscan and Orbscan II (Bausch&Lomb Surgical Inc., San Dimas, California, USA), Pentacam and Pentacam HR (Oculus, Wetzlar, Germany), Galilei (Ziemer, Switzerland), Visante optical coherence tomography (Visante OCT, Carl Zeiss Meditec Inc., Dublin, California, USA), IOLMaster (Carl Zeiss Meditec, Jena, Germany), and Lenstar LS 900/Biograph (Haag-Streit AG, Koeniz, Switzerland/Alcon Laboratories Inc., Ft Worth, Texas, USA).

Purpose: To evaluate refractive and visual outcomes and complications associated with phakic intraocular lens (pIOL) implantation to correct high myopia., Settings: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Retrospective observational case series., Methods: Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), refraction, vault, and adverse effects were evaluated after 5 years with Visian ICMV4 pIOL., Results: Mean spherical equivalent (SE) dropped from -18.32 ± 2.37 diopters (D) preoperatively to -0.88 ± 0.52D 5 years postoperatively; 61% of eyes were within ±0.75 D of the target. The mean Snellen decimal CDVA and UDVA were 0.73 ± 0.23 and 0.55 ± 0.26, respectively. More than 50% of eyes achieved 20/25 or better CDVA postoperatively. Four eyes had lost 2 or 1 lines of CDVA, 10 eyes had not lost any lines from preoperatively, and 46 eyes had gained 1 or more lines of CDVA 5 years postoperatively. The safety index was 1.26 ± 0.32. Forty eyes had UDVA of 20/40 or better postoperatively. The efficacy index was 0.99 ± 0.42. At 5-year follow-up, the mean central vault was 475.28 ± 216.38 μm. No eyes showed central contact between the pIOL and crystalline lens. Nevertheless, 10 eyes showed peripheral contact with a central vault between 150 and 260 μm. Two eyes developed anterior subcapsular cataract, although only 1 eye required cataract surgery., Conclusions: Predictability, safety and effective outcomes of posterior pIOL of (- were good, as well as postoperative complications over the long term. A central vault of 260 μm was enough to prevent the peripheral contact between the pIOL and crystalline lens in eyes with high myopia., Financial Disclosure: The authors have no proprietary interest in any of the materials mentioned in this article., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the visual impact of adding different spherical aberration values to an Implantable Collamer Lens phakic intraocular lens (pIOL) to increase the depth of focus using an adaptive optics visual simulator., Setting: University of Valencia, Valencia, Spain., Design: Experimental study., Methods: Wavefront aberrations in -3.00 D and -6.00 diopter (D) pIOLs were measured in vitro. Afterward, different simulated pIOL experimental prototypes were created along with variances in the spherical aberration. An adaptive optics visual simulator was used to simulate vision after the implantation of the different pIOL prototypes from their wavefront aberrations. The corrected distance visual acuity (CDVA) and depth of focus were measured in 3.0 and 4.5 mm pupils., Results: In a 3.0 mm pupil, the CDVA achieved with -3.00 and -6.00 D pIOLs and all pIOL prototypes evaluated was above 20/20 except for a -6.00 D pIOL + spherical aberration 4 at 50% CDVA contrast, which decreased to 20/25. However, in a 4.5 mm pupil, the CDVA obtained with the pIOL prototypes decreased significantly and was more pronounced when the spherical aberration induced was negative. The depth of focus increment was larger with the highest spherical aberration added and with a small pupil. Nevertheless, it was independent of the sign of the added spherical aberration., Conclusions: The outcomes show that residual negative spherical aberration after pIOL implantation will disrupt the CDVA. However, some residual positive spherical aberration after pIOL implantation increased the depth of focus with excellent CDVA, providing a possible pIOL design for young presbyopic patients., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the effect of different disposable soft contact lenses on several corneal parameters-thickness, anterior and posterior curvature, and volume-by means of a Scheimpflug imaging-based device (Pentacam HR). Diurnal variations of these parameters were taken into account., Methods: Twenty-one young, healthy subjects wore 4 different types of daily disposable soft contact lenses on 4 different days: Dailies AquaComfort Plus, SofLens, Dailies Total1, and Acuvue TruEye. The lenses had different material and water content. Pachymetry and curvature maps and corneal volume values were obtained using the Pentacam HR twice a day: one before putting the lens on and one after an 8-hour period of contact lens wear. Measurements were also taken without any contact lenses being worn., Results: Regarding corneal thickness, the lens with the most similar behavior to the naked eye scenario was the Dailies Total1, causing a thickening of 0.2 ± 0.1% in the central zone and 0.6 ± 0.2% in the periphery. All 4 lenses caused a slight but not significant flattening in the anterior corneal curvature, whereas the posterior corneal curvature only experienced a significant but small steepening with the SofLens. The use of these lenses increased corneal volume slightly., Conclusions: Variations in corneal parameters seem to depend on the type of contact lens used (material, oxygen transmissibility, water content). However, the magnitude of the changes introduced by the use of soft contact lenses over the 8-hour period was small and probably not large enough to influence either visual acuity or comfort.

Purpose: To compare the optical quality in vitro of 2 designs of the Visian Implantable Collamer Lens phakic intraocular lens (pIOL) for different powers and optical apertures., Setting: University of Valencia, Valencia, Spain., Design: Experimental study., Methods: The Nimo TR1504 deflectometry device was used to measure the V4c pIOL, which has a smaller optic diameter, and the V5 pIOL, which has a larger optic diameter. The pIOLs were measured for -3.00 diopters (D), -6.00 D, -9.50 D, and -10.50 D at different optical apertures from 3.00 to 6.00 mm depending on the IOL power and model. The root mean square of higher-order aberrations (RMS HOAs) was analyzed. The Strehl ratio, point-spread functions (PSFs), and simulated images were calculated from wavefront aberrations., Results: There were no statistically significant differences in any Zernike RMS or RMS HOAs between the 2 pIOL models with the same power and optical aperture (P > .05). Both pIOLs had negative spherical aberration that increased with the pIOL power. Strehl ratio values showed no statistically significant differences between the pIOLs with the same power and pupil aperture. Minimal differences were seen in the PSFs and simulated images between the pIOLs., Conclusions: Both pIOLs showed good and comparable in vitro optical quality similar that of a perfect lens in that they should not affect visual performance after implantation. Patients with larger pupil diameters could benefit from the pIOL with the larger optic diameter because it showed better in vitro optical quality than the previous design with a smaller optic diameter., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim was to study the interchangeability of various devices that measure anterior chamber depth (ACD) and white-to-white (WTW) distance., Methods: Eighty right eyes of eighty patients aged 20 to 40 years were included. Their spherical equivalent ranged from -4.25 to +1.00 dioptres. Each eye's ACD and the WTW distance were measured using the following devices: a Castroviejo surgical calliper, CA-200F Corneal Analyser, Orbscan II, Pentacam HR and IOLMaster 500., Results: The Pentacam HR measured significantly greater ACD (p < 0.01) than the other two devices, whereas IOLMaster 500 and Orbscan II yielded comparable (p > 0.01) distances. Nonetheless, in every device comparison, the mean difference was within clinically acceptable limits. The device comparison showed that for WTW distance measurements IOLMaster 500 yields the greatest value (p < 0.01), whereas CA-200F Corneal Analyser yields the smallest one (p < 0.01)., Conclusion: Pentacam HR, Orbscan II and IOLMaster 500 can be used interchangeably to measure ACD, whereas Orbscan II, IOLMaster 500, Castroviejo surgical calliper and CA-200F Corneal Analyser cannot be considered interchangeable, when it comes to measuring WTW distance., (© 2015 The Authors. Clinical and Experimental Optometry © 2015 Optometry Australia.)

Purpose: To evaluate the prevalence of cataract after Implantable Collamer Lens phakic intraocular lens (pIOL) implantation with different models at different ages and for different refractive powers., Setting: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Retrospective nonrandomized clinical study., Methods: The pIOL (models V4, V4b, or V4c) was implanted in all cases., Results: The study included 3420 eyes (1898 patients). The mean patient age at surgery was 31.2 years ± 6.4 (SD) (range 18 to 50 years) and the mean spherical refractive error, -7.27 ± 5.24 diopters (D) (range -26.5 to 12.5 D). Twenty-one eyes (0.61%) of 15 patients had pIOL explantation (all model V4) because cataract developed. The mean age of the patients who had explantation was 39.43 ± 4.57 years; 7 were younger than 40 years, and 8 were 40 years or older. The mean spherical equivalent was -10.1 ± 5.41 D; 3 eyes had a pIOL power less than -10.50 D, 4 eyes between -10.50 D and -13.50 D, and 14 higher than -13.50 D. The mean time between pIOL implantation and cataract surgery was 4.2 ± 1.8 years. No eye with implantation of the latest models (V4b and V4c) developed cataract. The mean vault distance in eyes that developed cataracts was 103 ± 69 μm., Conclusions: The incidence of cataract was low after pIOL implantation at the 6-year follow-up. The rate of cataract was higher in older patients and in those with high refractive errors., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To assess the effect of different disposable soft contact lenses upon corneal thickness, and upon anterior and posterior corneal curvatures using a dual-Scheimpflug imaging based device., Methods: Twenty-eight young, healthy subjects wore four different types of daily disposable soft contact lenses on four different days: Dailies Total1, Proclear 1 Day, Clariti 1-Day and 1-Day Acuvue Moist. The lenses had different material and water content. Pachymetry maps and keratometry values were obtained using the Galilei G4 twice a day: one before putting the lens on and one after an eight-hour period of contact-lens wear. Measurements were also recorded without any contact lenses being worn during a day., Results: Clariti 1-Day lens caused the greatest thickening in the central (8.9±2.8 μm; p<0.01) and in the peripheral cornea (10.1±4.6 μm; p<0.01), whereas Dailies Total1 was the lens that had the most similar behaviour to the non-contact lens scenario. All the lenses caused a slight flattening in the anterior corneal curvature, except Clariti 1-Day, which induced a very slight steepening. The four lenses caused a steepening of different magnitude in the posterior corneal curvature., Conclusions: The magnitude of the changes introduced by the use of soft contact lenses over the eight-hour wearing period was rather small. Thus it is probable it will not influence the vision nor the comfort of the subject. Also, variations on corneal parameters seem to depend on the type of contact lens used., (Copyright © 2014 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the predictability, stability, safety, and efficacy of Visian V4b Implantable Collamer Lens phakic intraocular lens (pIOL) implantation to treat varying degrees of myopia., Setting: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Prospective nonrandomized clinical study., Methods: The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, pIOL vault, and adverse effects were evaluated 12 months postoperatively., Results: The study enrolled 121 eyes (68 patients). The mean spherical equivalent decreased from -8.61 diopters (D) ± 3.41 (SD) (range -18.75 to -2.25 D) preoperatively to -0.18 ± 0.29 D (range -1.25 to 0.50 D) 12 months postoperatively; 97 eyes (80.2%) were within ±0.25 D of the target refraction and 114 eyes (94.2%) were within ±0.50 D (r(2) = 0.99). The mean Snellen decimal UDVA and CDVA were 0.91 ± 0.17 and 0.97 ± 0.09, respectively. Postoperatively, the UDVA was 20/20 or better in 80 eyes (66.1%) and 20/40 or better in 115 eyes (95.0%). The mean efficacy index was 0.96 ± 0.14. The CDVA was 20/20 or better in 103 eyes (85.1%) and 20/40 or better in all eyes. No eye lost lines of CDVA, and 22 eyes (18.2%) gained 1 or more lines of CDVA. The mean safety index was 1.04 ± 0.10. There were no intraoperative complications., Conclusions: The predictability, safety, and effectiveness of the pIOL were good throughout the 12-month follow-up and comparable to outcomes reported for previous pIOL models., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To measure and compare the optical quality of spherical and aspheric toric intraocular lenses (IOLs)., Methods: Wavefront aberrations of AcrySof Toric and IQ Toric IOLs (Alcon Laboratories) for different powers were measured at 3- and 5-mm pupils by Nimo TR0805 instrument. The Zernike coefficients of trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were evaluated. The point spread functions (PSFs) of each IOL evaluated were calculated from the wavefront aberrations. The PSF images also were calculated from the IOL wavefront aberrations, adding the cornea's aberrations to simulate the optical quality after their implantation., Results: Spherical toric IOLs showed positive and aspheric toric IOLs negative spherical aberrations. Statistically significant differences were found in spherical aberration root mean square (RMS) values between spherical and aspheric IOLs for both pupil sizes (p<0.05). Aspheric toric IOLs showed higher spherical aberration RMS values. We found differences in PSF images between both IOL designs at 5-mm pupil. The PSFs corresponding to the aspheric toric IOLs showed more spread out than the PSFs corresponding to the spherical toric IOLs. However, when corneal aberrations were added, aspheric toric IOLs showed better optical quality than spherical toric IOLs., Conclusions: At 3-mm pupil, the optical quality between the IOL designs was similar, but at 5-mm pupil the optical quality was higher for spherical IOLs than aspheric IOLs. However, when theoretical corneal aberrations were added, aspheric toric IOLs showed better optical quality than spherical toric IOLs, due to the compensation between aspheric toric IOL negative spherical aberration and corneal positive spherical aberration.

Purpose: To assess the predictability, stability, safety, and efficacy of a collagen copolymer toric phakic intraocular lens (pIOL) to correct moderate and high astigmatism., Setting: Fernández-Vega Ophthalmological Institute, Oviedo, Spain., Design: Case series., Methods: After implantation of the TV4b toric Implantable Collamer Lens pIOL, the uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, toric pIOL vault, and adverse effects were evaluated over 12 months., Results: The study enrolled 35 eyes of 20 patients with a mean sphere of -5.46 diopters (D) ± 4.17 (SD) and mean cylinder of -3.14 ± 1.19 D. At 12 months, the mean sphere was -0.04 ± 0.16 D, with 97% of eyes being within ±0.50 D of the target (r(2) = 0.99), and the mean cylinder was -0.29 ± 0.42 D. For the astigmatism components, 80% of eyes were within ±0.25 D of both J0 (r(2) = 0.99) and J45 (r(2) = 0.99). The mean decimal UDVA was 0.89 ± 0.16 and the mean decimal CDVA, 0.95 ± 0.12. No eye lost lines of CDVA, and 43% of eyes gained 1 or more lines. The safety index was 1.08 at 12 months. More than 50% of eyes had a Snellen UDVA of 20/20. The efficacy index was 0.97 at 3 months and 1.01 at 12 months., Conclusion: The visual and refractive outcomes were good and highly stable throughout the follow-up, indicating that this toric pIOL model is predictable, safe, and effective in correcting low and high levels of astigmatism., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To analyze the optical quality of aspheric toric intraocular lenses (IOLs) at different degrees of decentering., Methods: Wavefront aberrations of Acrysof IQ Toric IOLs (SN6AT3, SN6AT4, and SN6AT5; Alcon Laboratories Inc, Fort Worth, TX, USA) for different powers (15.00, 20.00 and 23.50 diopters [D]) and for different degrees of decentering (diagonal, horizontal, and vertical decentering of 0.3 and 0.6mm) were measured in vitro at 3- and 5-mm pupils. The Zernike coefficients of trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were evaluated. The point spread functions (PSFs) and modulation transfer function (MTF) of each IOL evaluated were calculated from the wavefront aberrations., Results: Coma aberration increased significantly with IOL decentration. Statistically significant differences were found between centered and all decentered positions in coma aberration (p < 0.05). Although, we only found visible differences between centered and decentered positions in PSF images and MTF curves for horizontal and vertical 0.6 mm of decentering at 3- and 5-mm pupil., Conclusions: Despite the coma increment, these values were clinically negligible and have no effect on visual performance, except for vertical and horizontal 0.6 mm of decentering, which could have a negative effect on visual quality.

Purpose: To evaluate the visual quality achieved in patients undergoing standard or modified implantable Collamer lens (ICL) to correct residual myopic error after laser-assisted in situ keratomileusis (LASIK) surgery., Methods: The adaptive optics visual simulator was used to simulate LASIK surgery of moderate and high myopia with a myopic regression corrected by a standard and modified ICL. Visual acuity (VA) and contrast sensitivity (CS) were measured in 14 subjects at 3- and 4.5-mm pupil. Point spread function and simulated retinal images were calculated., Results: Comparing LASIK plus standard ICL and LASIK plus modified ICL simulations, for moderate myopia, VA improvement was less than 1 line in all VA contrasts and both pupils evaluated. No statistically significant differences were found in CS between the simulations at any spatial frequency evaluated and for 3-mm pupil (p>0.05), but differences were significant at 4.5-mm pupil (p<0.05). For high myopia, the VA improvement was less than 1 line at 3-mm pupil, although it increased 2 or more lines at 4.5-mm pupil. Statistically significant differences were found in CS between the simulations for all spatial frequencies and both pupils evaluated (p<0.05), except for low and medium spatial frequencies at 3-mm pupil (p>0.05)., Conclusions: These outcomes suggest that an ICL is a good option to correct the myopic residual error after myopic LASIK. When the ICL's spherical aberration is modified, the post-LASIK eyes of high myopia are the most benefited, as these eyes are more aberrated than after moderate myopic LASIK.

Purpose: To compare optical and visual quality of implantable collamer lens (ICL) implantation and femtosecond laser in situ keratomileusis (F-LASIK) for myopia., Methods: The CRX1 adaptive optics visual simulator (Imagine Eyes, Orsay, France) was used to simulate the wavefront aberration pattern after the two surgical procedures for -3-diopter (D) and -6-D myopia. Visual acuity at different contrasts and contrast sensitivities at 10, 20, and 25 cycles/degree (cpd) were measured for 3-mm and 5-mm pupils. The modulation transfer function (MTF) and point spread function (PSF) were calculated for 5-mm pupils., Results: F-LASIK MTF was worse than ICL MTF, which was close to diffraction-limited MTF. ICL cases showed less spread out of PSF than F-LASIK cases. ICL cases showed better visual acuity values than F-LASIK cases for all pupils, contrasts, and myopic treatments (p<0.05). No statistically significant differences were found in contrast sensitivities between ICL and F-LASIK cases with -3-D myopia for both pupils for all evaluated spatial frequencies (p>0.05). For -6-D myopia, however, statistically significant differences in contrast sensitivities were found for both pupils for all evaluated spatial frequencies (p<0.05). Contrast sensitivities were better after ICL implantation than after F-LASIK., Conclusions: ICL implantation and F-LASIK provide good optical and visual quality, although the former provides better outcomes of MTF, PSF, visual acuity, and contrast sensitivity, especially for cases with large refractive errors and pupil sizes. These outcomes are related to the F-LASIK producing larger high-order aberrations.

Aims: To assess and compare the optical quality of the myopic and hyperopic implantable collamer lens (ICL) from its wavefront aberrations for different powers and pupil diameters., Settings and Design: Prospective study., Material and Methods: The wavefront aberrations of two myopic (-3 and -6 diopters (D)) and two hyperopic V4b ICLs (+3 and +6D) were measured in vitro. To assess and compare the optical quality of different powers of ICLs, we analyzed the root mean square (RMS) of total higher order aberrations (HOAs), trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration at 3- and 4.5-mm pupil. In addition, the point spread functions (PSFs) of each ICL evaluated were calculated from the wavefront aberrations at 3- and 4.5-mm pupil., Statistical Analysis: A Student's t-test for unpaired data was used for comparison between myopic and hyperopic ICLs., Results: Myopic ICLs showed negative spherical aberration, in contrast hyperopic ICLs showed positive spherical aberration, which increases when the ICL power increases, due to the innate optical properties of the lens. All ICLs evaluated had negligible amounts of other aberrations. We did not find statistical significant differences in any Zernike coefficient RMS values analyzed between myopic and hyperopic ICLs at 3- and 4.5-mm pupil (P > 0.05)., Conclusions: Myopic and hyperopic ICLs provide good and comparable optical quality for low to moderate refractive error. The ICLs evaluated showed values of wavefront aberrations clinically negligible to affect the visual quality after implantation.

Purpose: To measure angle kappa distance with Orbscan II and Galilei G4, and to evaluate possible variations in this value for different accommodation degrees., Methods: Angle kappa was measured using the Orbscan II and the Galilei G4 in the right eye of 80 patients aged from 20 to 40 years. This value was measured three times per eye and per device, and the average was retained. Angle kappa was measured for far vision using the Orbscan II and the Galilei G4 in a random order for each subject. The Galilei G4 was used to measure angle kappa as a function of accommodation, where the first measure started at +1 D and the vergence was changed until reaching -4 D, in 1 D steps. In both measures, the kappa distance was expressed in millimetres., Results: At distance, the values of angle kappa were 0.43 ± 0.13 mm and 0.27 ± 0.15 mm measured with the Orbscan II and Galilei G4 systems respectively. Statistical significant differences were found (P < 0.01). With regard to the angle kappa values obtained as a function of accommodation, the values were 0.25 ± 0.15 mm, 0.26 ± 0.15 mm, 0.30 ± 0.20 mm, 0.27 ± 0.15 and 0.26 ± 0.15 mm, for +1 D, -1 D, -2 D, -3 D and -4 D respectively. No statistical significant differences were found among 0 D and the other vergences evaluated (P > 0.01)., Conclusions: For far vision, Orbscan II measured significantly higher angle kappa values than Galilei G4, the mean difference being 0.16 ± 0.08 mm. For different accommodation levels, the kappa distance did not change significantly.

Purpose: To compare the visual quality of implantable collamer lens (ICL) with and without central hole (Hole ICL and conventional ICL) at different degrees of decentering., Methods: An adaptive optics visual simulator (crx1, Imagine Eyes, Orsay, France) was used to simulate the -3, -6 and -12 dioptres (D) conventional and Hole ICLs in three conditions: centred and decentred 0.3 and 0.6 mm. Visual acuity (VA) at high-contrast, medium-contrast and low-contrast and contrast sensitivity (CS) were measured in 15 observers for 3 and 4.5 mm pupils., Results: No statistically significant differences in VA and CS were found between conventional and Hole ICLs for any ICL powers and pupil sizes evaluated (p>0.05). Regarding the effect of the ICL decentration on visual performance, we did not find statistically significant differences in VA and CS between centred, 0.3 and 0.6 mm decentred (p>0.05). Moreover, the ICL decentration affected the same manner on the conventional and Hole ICLs., Conclusions: The outcomes showed that conventional and Hole ICLs provided good and comparable visual performance for all powers and pupil sizes evaluated. Besides, ICL decentering affects the same manner both ICL models evaluated. The ICL decentering did not have any effect on the visual performance.

Purpose: To compare visual and optical quality of the Crystalens HD intraocular lens (IOL) with that of a monofocal IOL., Methods: The wavefront aberration patterns of the monocular Akreos Adapt AO IOL and the single-optic accommodating Crystalens HD IOL were measured in a model eye. The Crystalens IOL was measured in its nonaccommodative state and then, after flexing the haptic to produce 1.4 mm of movement, in its accommodative state. Using an adaptive optics system, subjects' aberrations were removed and replaced with those of pseudophakes viewing with either lens. Monocular distance visual acuity (DVA) at high (100%), medium (50%), and low (10%) contrast and contrast sensitivity (CS) were measured for both IOL optics. Near VA (NVA) and CS were measured for the Crystalens HD IOL in its accommodative state. Depth of focus around the distance and near focus was also evaluated for the Crystalens HD IOL. Modulation transfer function (MTF), point spread function (PSF), and Strehl ratio were also calculated. All measures were taken for 3- and 5-mm pupils., Results: The MTF, PSF, and Strehl ratio showed comparable values between IOLs (p > 0.05). There were no significant differences in DVA and CS between IOLs for all contrasts and pupils (p > 0.05). When spherically focused, mean DVA and NVA with the Crystalens HD IOL were ≥20/20 at 100 and 50% contrasts for both pupils. Monocular DVA, NVA, and CS were slightly better with 3- than 5-mm pupils, but without statistically significant differences. The Crystalens HD IOL showed about 0.75 and 0.50 D of depth of focus in its accommodative state and nonaccommodative state, respectively., Conclusions: The optical and visual quality with the nonaccommodatied Crystalens HD IOL was comparable to that of a monofocal IOL. If this lens can move 1.4 mm in the eye, it will provide high-quality optics for near vision as well.

Purpose: To compare the optical quality of implantable Collamer lens (ICL) with and without central hole (Hole ICL and conventional ICL) at different degrees of decentering., Design: Experimental laboratory investigation., Methods: Wavefront aberrations of the -3, -6, and -12 diopter (D) V4b and -3, -6, and -12 D V4c ICLs were measured in 3 conditions-centered and decentered 0.3 and 0.6 mm-at 3-mm and 4.5-mm pupils. The root mean square of total higher order aberrations, trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were evaluated. In addition, point spread function and simulated retinal images of ICLs were calculated from the wavefront aberrations for each ICL and all conditions of decentering at 4.5-mm pupil., Results: No statistically significant differences in any Zernike coefficient terms evaluated were found between conventional and Hole ICLs for any ICL powers and pupils evaluated (P > .05). We could not appreciate differences in the point spread function images and in simulated retinal images. Regarding the effect of the ICL decentration, coma aberration increased significantly with ICL decentration (P < .05), although these differences were not visible in the point spread function images and simulated retinal images. The ICL decentration was affected in the same manner on the conventional and Hole ICLs., Conclusions: The outcomes showed good and comparable optical quality of the conventional and Hole ICLs for all ICL powers evaluated. Despite that coma aberration increased with ICL decentering, these values were clinically negligible and did not have a significant effect on the simulated visual performance., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To study the effect of simulated amblyopic and normal higher-order aberrations on visual performance of normal eyes., Methods: To assess visual function, an adaptive optics visual simulator was used to compensate volunteers' ocular aberrations and simulate the wavefront aberration patterns found in healthy and amblyopic eyes in 7 healthy individuals. Visual acuity for high (100%), medium (50%), and low (10%) contrast and contrast sensitivity at 10, 20, and 25 cycles per degree (cpd) were measured after simulation of both pattern aberrations. The modulation transfer function and the point spread function were computed based on the aberration data. All measures were taken for 3 and 5.5 mm pupil sizes., Results: No statistically significant differences in visual acuity and contrast sensitivity were found between both groups for any analyzed contrast level, spatial frequency, and pupil size values. Mean logMAR visual acuity for a 3 mm pupil was -0.11 ± 0.04 for 100% contrast levels, -0.06 ± 0.06 for 50%, and 0.17 ± 0.07 for 10%. For a 5.5 mm pupil, the values were -0.06 ± 0.04 (100%), 0.00 ± 0.05 (50%), and 0.21 ± 0.06 (10%). Mean contrast sensitivity for a 3 mm pupil was 1.9 ± 0.2 for 10 cpd, 1.2 ± 0.15 for 20 cpd, and 0.9 ± 0.1 for 25 cpd. For a 5.5 mm pupil, contrast sensitivity was 1.4 ± 0.2 (10 cpd), 0.9 ± 0.2 (20 cpd), and 0.6 ± 0.2 (25 cpd). MTFs and PSFs were comparable in the two groups for both pupils., Conclusions: The higher-order aberrations seen in idiopathic amblyopic eyes alone do not appear to contribute to the decreased visual function., (Copyright © 2013 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Purpose: To evaluate the optical quality of the Visian Implantable Collamer Lens (ICL) for different powers and pupil diameters., Methods: Wavefront aberrations of the -3, -6, -9, -12 and -15 diopters (D) V4b ICLs were measured at 3- and 4.5-mm pupils. The root mean square (RMS) of total higher order aberrations (HOAs), trefoil, coma, tetrafoil, secondary astigmatism, and spherical aberration were evaluated. In addition, modulation transfer function (MTF) of the five ICL powers was measured for a 3-mm pupil. The point spread functions (PSFs) of each ICL evaluated was calculated from the wavefront aberrations at 4.5-mm pupil., Results: The ICLs evaluated had negative spherical aberration and negligible amounts of other aberrations. The negative spherical aberration increases when the ICL power increases being related with its innate optical properties. At 3-mm pupil, no statistically significant differences between ICLs were found for all the Zernike coefficient RMS values analyzed (p > 0.05). At 4.5-mm pupil, significant RMS values for the spherical aberration and total HOAs were found between medium-low and high powers (p < 0.05). Similar MTFs were obtained for all ICLs, although they slightly worsened when increased the ICL power., Conclusions: ICLs evaluated provide good optical quality in terms of wavefront aberrations, MTF, and PSF. Although spherical aberration increases with ICL power, these values are clinically negligible to affect the visual quality after its implantation.

Purpose: To compare the optical and visual quality of a simulated Toric Implantable Collamer Lens (TICL) and a bioptics technique to treat high myopic astigmatism., Methods: An adaptive optics visual simulator was used to simulate the vision after TICL implantation and a bioptics procedure from the wavefront aberration pattern for moderate and high-myopic astigmatism. Visual acuity (VA) at different contrasts and contrast sensitivity (CS) at 10, 20 and 25 cycles degree(-1) were measured for 3 and 5-mm pupils. Modulation Transfer Function (MTF) and Point Spread Function (PSF) were calculated for a 5-mm pupil., Results: At a 3-mm pupil we only found statistically significant differences in VA between the two simulated surgeries at low-contrast for moderate- and high-myopic astigmatism (p < 0.05). Statistically significant differences were found in CS at 3-mm pupil between both procedures at the highest spatial frequency for moderate-myopic astigmatism and at all frequencies for high-myopic astigmatism (p < 0.05). At a 5-mm pupil we found statistically significant differences in VA and CS between both simulated surgeries at all contrasts and frequencies evaluated for both groups (p < 0.05). In all cases VA and CS were better with the TICL than with the bioptics technique. MTFs for the bioptics technique were worse than those computed for the TICL. The TICL showed less spread out of the PSF than the bioptics procedure., Conclusions: Simulated TICL and bioptics procedures provided good optical and visual quality, although TICL implantation provided slightly better outcomes than the bioptics procedure, especially when the pupil diameter was increased., (Ophthalmic & Physiological Optics © 2013 The College of Optometrists.)

Purpose: To evaluate distance and near contrast sensitivity (CS) under photopic and mesopic conditions before and after refractive lens exchange (RLE) and implantation of the aspheric AcrySofReSTOR (SN6AD3 model) intraocular lens (IOL)., Methods: Seventy-four eyes of 37 patients after RLE underwent bilateral implantation with the aspheric AcrySof ReSTOR IOL. The patient sample was divided into myopic and hyperopic groups. Monocular uncorrected visual acuity at distance and near (UCVA and UCNVA, respectively) and monocular best corrected visual acuity at distance and near (BCVA and BCNVA, respectively) were measured before and 6 months postoperatively. Monocular CS function was measured at three different luminance levels (85, 5 and 2.5 cd/m²) before and after RLE. Post-implantation results at 6 months were compared with those found before surgery., Results: Our results revealed that patients in both groups obtained good UCVA and BCVA after RLE at distance and near vision in relation to pre-surgery values. No statistically significant differences were found between the values of CS pre and post-RLE at distance and near, at any lighting condition and spatial frequency (p>0.002)., Conclusions: Refractive lens exchange with aspheric AcrySof ReSTOR IOL in myopic and hyperopic population provided good visual function and yield good distance and near CS under photopic and mesopic conditions.

Purpose: To evaluate visual and optical quality of the implantable collamer lens for different powers and sizes of incision surgery., Design: Prospective study in humans., Methods: An adaptive optics visual simulator was used to measure 3 powers of implantable collamer lenses and simulate the implantable collamer lens wavefront aberration's pattern for small- and large-incision surgery. Visual acuity (VA) and contrast sensitivity were measured in 11 observers for 3- and 5-mm pupils. Modulation transfer function, point spread function, and Strehl ratio were calculated., Results: At 3 mm pupil, no statistically significant differences were found between both incision sizes for any implantable collamer lens power, except for -15 diopter (D) implantable collamer lens at 25 cycles/degree (cpd) (P < .05). At 5 mm pupil, statistically significant differences in Strehl ratio, VA, and contrast sensitivity were found between both incision sizes for all implantable collamer lens powers (P < .05). The outcomes were better with small incision. Implantable collamer lens power also affected the optical and visual quality. At 3 mm pupil, no statistically significant differences were found in VA and contrast sensitivity between implantable collamer lens powers, except between -3 and -15 D at low-contrast VA and at 20 and 25 cpd (P < .05). At 5 mm pupil, no statistically significant differences were found in Strehl ratio, VA, and contrast sensitivity between -3 and -6 D implantable collamer lens, but they did become apparent for -15 D implantable collamer lens for both incision sizes, all contrasts and spatial frequencies (P < .05)., Conclusions: The implantable collamer lens provides good optical and visual quality, although these outcomes decreased with large-incision surgery because of the increase of aberrations., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose: To evaluate the optical quality of Acrysof Restor SN6AD1 refractive-diffractive +3.00 D and Lentis Mplus LS-312 nonrotational symmetric +3.00 D aspheric multifocal intraocular lenses (IOLs) and analyze the effect of tilt and decentration., Setting: University of Valencia, Valencia, and University of Murcia, Murcia, Spain., Design: Experimental study., Methods: An artificial model eye was used to measure wavefront aberrations of both IOL models. The modulation transfer function (MTF) and point-spread function (PSF) were calculated for a 5.0 mm pupil and under 5 situations: centered, 0.2 mm and 0.4 mm decentered, and 2 degrees and 4 degrees tilted., Results: The refractive-diffractive IOL had the highest MTF values at all spatial frequencies. Similarly, the PSF was worse for the refractive-diffractive IOL. The MTFs for the refractive-diffractive IOL decreased when the IOL was decentered or tilted, being more robust for tilting than decentration. The MTFs for the nonrotational symmetric IOL were similar under all testing conditions. Cutoff frequencies for the refractive-diffractive IOL were stable over the range of tilting studied and comparable with the cutoff when the IOL was centered (approximately 50 cycles per degree [cpd]). When the IOL was decentered, the cutoff frequency decreased by approximately 40 cpd. The nonrotational symmetric IOL cutoff frequencies for misalignment and tilt were low (approximately 30 cpd) and similar under all conditions., Conclusions: The refractive-diffractive IOL provided better optical quality than the nonrotational symmetric IOL. Tilt and decentration had a significant impact on optical quality with both IOLs, being more severe with the nonrotational symmetric IOL., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose. To compare optical and visual quality of the implantable Collamer lens (ICL) and laser in situ keratomileusis (LASIK) for myopia. Methods. An adaptive optics visual simulator (CRX1, Imagine Eyes, France) was used to simulate the vision after ICL implantation and LASIK procedure from the wavefront aberration pattern for -3 and -6 D. Monocular visual acuity (VA) at different contrasts and contrast sensitivity (CS) at 10, 20, and 25 cycles/degree (cpd) were measured for 3- and 5-mm pupils. Modulation transfer function (MTF) and point spread function (PSF) were calculated for a 5-mm pupil. Results. The ICL showed a MTF near of diffraction-limited MTF, but the post-LASIK of MTF worsened moving away from both curves. Statistically significant differences were found in VA between both procedures for all conditions (p<0.05). For -3 D ICL and LASIK, we did not find statistically significant differences in CS between the procedures for both pupils and any spatial frequencies (p>0.05). But for -6 D ICL and LASIK, the effect of aberrations became apparent, finding statistically significant differences in CS between both procedures for 2 pupils and all spatial frequencies evaluated (p<0.05). In all cases optical and visual quality was better with the ICL procedure. Conclusions. Both ICL and LASIK procedures provide good optical and visual quality, although the ICL provides better outcomes, especially for large refractive errors and pupil sizes. These outcomes are due to the LASIK procedure inducing higher higher-order aberrations than ICL implantation.

Purpose: To analyze visual quality differences between intraocular lenses (IOLs) and assess the impact of IOL decentration and tilt on visual quality., Setting: University of Valencia, Valencia, Spain., Design: Cohort study., Methods: The crx1 adaptive optics visual simulator was used to simulate the wavefront aberration pattern of 2 commercially available aspheric aberration-correcting IOLs (Acrysof IQ SN60WF and Tecnis ZA9003) and 2 spherical IOLs (Akreos Adapt and Triplato) in 5 situations: centered, decentered 0.2 mm and 0.4 mm, and tilted 2 degrees and 4 degrees. Monocular distance visual acuity at 100%, 50%, and 10% contrast and the depth of focus were measured., Results: Ten eyes of 10 patients were evaluated. When the IOLs were centered, there were no differences in visual acuity between the 4 IOLs at any contrast. The aberration-correcting IOLs were more sensitive to tilt and decentration than the spherical IOLs; Tecnis ZA9003 IOL was the most sensitive to decentration and the Acrysof IQ SN60WF IOL was the most sensitive to tilt. Higher residual spherical aberration slightly improved depth of focus and the tolerance to defocus., Conclusions: The results in this study suggest that the aspheric aberration-correcting and spherical IOLs provided comparable visual quality when centered in eyes in which the corneal higher-order aberrations are those of the average of the human cornea. Tilt and decentration of the IOLs had an impact on visual quality, with aberration-correcting IOLs having a greater effect than the spherical IOLs., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the depth of focus with monofocal intraocular lenses (IOLs) in patients with different corneal profiles using adaptive optics (AO) visual simulation., Methods: An AO visual simulator (crx1, Imagine Eyes) was used to simulate the aberration pattern of three monofocal IOLs (Acrysof IQ SN60WF [Alcon Laboratories Inc]; Akreos Adapt AO [Bausch & Lomb]; and Triplato [AJL Ophthalmic]) of different optic designs. Five groups were considered: patients without any corneal refractive surgery (normal cornea group) and with prior low and high myopic and hyperopic ablations (low myopic ablation, high myopic ablation, low hyperopic ablation, and high hyperopic ablation groups). Defocus curves for all situations were measured, with the target being moved from -5.00 to +2.50 diopters (D) in 0.25-D steps, and visual acuity was measured at all vergences., Results: Ten eyes from 10 patients were evaluated. The higher residual spherical aberration (SA) for all IOLs was obtained for the high myopic ablation group and the most negative residual SA was obtained for the high hyperopic ablation group. The best compromise between distance visual and depth of focus for the normal cornea, low myopic ablation, and high myopic ablation groups was obtained with the aspheric designs, whereas the best results for the low hyperopic and high hyperopic ablation groups were obtained with the spherical IOL., Conclusions: The results of this study suggest that the better compromise between distance visual acuity and depth of focus with the three IOLs and the different corneal profiles relies on a certain amount of positive SA. Above a certain limit of residual SA (positive or negative), visual acuity decreases at all vergences, worsening the depth of focus., (Copyright 2012, SLACK Incorporated.)

Purpose: To evaluate visual quality differences among intraocular lenses (IOLs) in patients with previous hyperopic laser ablations and to assess the impact of decentration and tilt of IOLs on visual quality., Methods: An adaptive optics visual simulator was used to simulate the wavefront aberration pattern of one aberration-correcting IOL (AcrySof IQ SN60WF, Alcon Laboratories Inc) and two spherical IOLs with different amounts of positive spherical aberration (Akreos Adapt [Bausch & Lomb] and Triplato [AJL Ophthalmic]) in five situations-centered, 0.2 mm and 0.4 mm of decentration, and 2° and 4° of tilt-in two groups: simulated low hyperopic laser corneal ablation (low hyperopia group) and high hyperopic laser corneal ablation (high hyperopia group). Monocular distance visual acuity at 100%, 50%, and 10% contrast were measured., Results: Ten eyes were evaluated. When the IOLs were centered, all IOLs obtained comparable results for the low hyperopia group, whereas for the high hyperopia group, the Akreos Adapt and AcrySof IQ SN60WF showed better visual acuity than the Triplato. When the IOLs were misaligned, for the low hyperopia group, the best visual acuity results were obtained with the Akreos Adapt and the most critical situation was at 0.4 mm of decentration. For the high hyperopia group, misalignments decreased visual acuity in a higher amount than for the low hyperopia group., Conclusions: Our results suggest that the IOLs studied offer good visual quality when they are centered for both groups. However, tilt and decentration of monofocal IOLs have an impact on visual function in patients with hyperopic ablations. For these patients, the Akreos Adapt is the most robust to misalignments., (Copyright 2012, SLACK Incorporated.)

Purpose: To evaluate visual quality differences between intraocular lenses (IOLs) in patients with previous myopic laser ablations and assess the impact of IOL decentration and tilt on visual quality., Setting: University of Valencia, Burjassot, Spain., Design: Cohort study., Methods: An adaptive optics visual simulator was used to simulate the wavefront aberration pattern of 1 aberration-correcting IOL (Acrysof IQ SN60WF), 1 aberration-free IOL (Akreos Adapt AO), and 1 spherical IOL (Triplato) under 5 IOL situations: centered, 0.2 mm and 0.4 mm decentered, and 2 degrees and 4 degrees tilted in eyes with simulated low or high myopic laser corneal ablations. Monocular distance visual acuity at 100%, 50%, and 10% contrast were measured., Results: Ten eyes of 10 patients were evaluated. When the IOLs were centered, the aberration-correcting IOL provided the best visual quality results in both groups. When the IOLs were misaligned, there was a decrease of visual quality with all simulated IOLs except the aberration-free IOL in the high myopia group. In the misaligned situations, all simulated IOLs obtained comparable visual quality results in both groups., Conclusions: The results suggest that in patients with previous myopic laser corneal ablation, aberration-correcting IOLs should be implanted. The decrease in visual quality when these IOLs are decentered or tilted demonstrates the importance of accurate implantation of these IOLs., Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)