Elsevier

Ophthalmology

Volume 118, Issue 9, September 2011, Pages 1724-1731
Ophthalmology

Original article
The Influence of Tilt, Decentration, and Pupil Size on the Higher-Order Aberration Profile of Aspheric Intraocular Lenses

Presented in part at: ASCRS Symposium & Congress, April 2010, Boston, Massachusetts.
https://doi.org/10.1016/j.ophtha.2011.02.025Get rights and content

Purpose

To characterize the influence of tilt angle, decentration, and pupil size on the higher-order aberration (HOA) profile of 3 aspheric intraocular lenses (IOLs) using a physical model eye.

Design

A 4-factor (model, pupil, angle, decentration) in vitro experimental design comparing 3 aspheric IOLs using a physical model eye.

Methods

Measurements of HOA were obtained using the Zywave aberrometer (Bausch & Lomb, Rochester, NY) and a purpose-built physical model eye. The following IOLs were assessed with various levels and combinations of pupil diameter, decentration, and tilt angle: the AcrySof IQ SN60WF aspheric (Alcon, Hünenberg, Switzerland), Technis ZA9003 aspheric (Advanced Medical Optics, Santa Ana, CA), and Adapt Advanced Optics (Bausch & Lomb). Fifteen Zernike modes were compared using multivariate analysis of variance, canonical discrimination, and regression analysis. Four identical IOLs of each IOL model were assessed at all possible combinations of 3 pupil sizes, 4 levels of decentration, and 4 tilt angles.

Main Outcome Measures

Individual HOA from z200 to z550.

Results

Pupil size, decentration, model, and tilt angle all had statically significant effects on the HOA profile. Pupil size contributed most to observed total variability (54.9%), followed by decentration (22.7%), then model (16.6%), and finally tilt angle (5.7%). All factors demonstrated significant interaction terms with respect to HOA. Intraocular lenses with increased aspheric properties inherent in the design of the optic were more sensitive to decentration and change in pupil size.

Conclusions

The 3 IOL models demonstrated significant differences in HOAs in response to changes in pupil size, decentration, and tilt angle. All IOL models assessed in this study demonstrated minimal HOA at small pupil diameters. The IOL models with lower, or an absence of, negative spherical aberration were most robust to displacement with increased decentration and tilt angle.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

University of Auckland Model Eye

A physical model eye platform to analyze wavefront aberrations introduced by IOLs was designed and constructed for use with the Zywave (Bausch & Lomb, Rochester, NY) aberrometer as previously described.7 For the purposes of this study, specific modifications were incorporated to set the degree of IOL tilt, IOL decentration, and effective pupil size accurately.

The model consists of a Boston XO 45.0-diopter (D) corneal lens with an adjustable iris incorporating fixed pupil apertures at 5 mm, 3

Results

Preliminary experiments to validate the model showed consistent and reproducible results. Multivariate ANOVA analysis of third-, fourth-, and fifth-order Zernike modes demonstrated highly statistically significant results. All 4 variables had a statically significant effect on the HOA; however, the nature of this effect is complex and is highlighted best by the canonical discrimination analysis (CDA) plot (see Fig 1, available at http://aaojournal.org). Statistical significance for the MANOVA

Discussion

Aspheric IOLs are designed to improve visual performance; however, several recent studies have reported conflicting results when aspheric IOLs are compared with spherical IOLs.13, 14, 15 It has been suggested that decentration, tilt, pupil size, and IOL asphericity all could be factors in explaining these disparate results.13, 16 The physiologic variables that in vivo studies have to contend with make testing this hypothesis extremely challenging; therefore, the relative influence and

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