Subjective and objective refractions in eyes with extended-depth-of-focus intraocular lenses using echelette optics: clinical and experimental study.

Yuka Ota,Keiichiro Minami,Keiichiro Okamoto,Masaya Nakashima,Kazuo Tsubota,Shinichi Oki,Hiroko Bissen‐Miyajima

doi:10.1111/aos.14660

Yuka Ota, Keiichiro Minami + Show 5 more

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https://doi.org/10.1111/aos.14660

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Abstract

PurposeTo evaluate differences in subjective and objective refractions in eyes with extended‐depth‐of‐focus intraocular lenses (EDOF IOLs) using echelette optics, and the effect of the light wavelength used during examinations.MethodsIn the prospective study, subjective and objective refractions of 128 eyes of 64 patients were examined 3 months after implantation of the EDOF IOLs (ZXR00V, Johnson & Johnson Surgival Vision). Objective refractions were measured using an autorefractor with a near‐infrared (NIR) light source. Clinical differences in the spherical, cylindrical and spherical equivalent (SE) refractions between the subjective and objective refractions were evaluated. Then, lens powers of monofocal, EDOF and diffractive bifocal IOLs in the use of a 850‐nm light source were measured experimentally for using a lensmeter, and the differences from the monofocal IOLs were calculated.ResultsThe mean objective refractions were more myopic (p < 0.001) than the subjective refractions; the differences in the spherical, cylindrical and SE refractions were −0.71, −0.26 and −0.84 dioptre, respectively. Experimental investigation resulted that there was the mean difference of 0.83 D with the EDOF from monofocal IOLs at 850 nm, while the difference was −0.20 D with bifocal IOLs.ConclusionsThe diffractive EDOF IOLs using echelette gratings inherently induced constant differences in the subjective and objective refractions, which arose from the chromatic difference in IOL powers for the visible and NIR lights.

Highlights

Measurement of the subjective refractions after implantation of presbyopiacorrection intraocular lenses (IOLs) is critical for determining if the postoperative refractions are within the range anticipated preoperatively
The experimental results indicated that the powers of the EDOF IOLs were underestimated when measured at 850 nm, and the difference from the monofocal IOLs was 0.83 D
These findings indicated that the clinical difference in eyes with the EDOF IOLs would result from the chromatic difference in IOL power for NIR lights

Summary

Introduction

Measurement of the subjective refractions after implantation of presbyopiacorrection intraocular lenses (IOLs) is critical for determining if the postoperative refractions are within the range anticipated preoperatively. Objective refractions measured with an autorefractor are normally used as the initial estimates of the subjective refractions (Kinge et al 1996; Bullimore et al 1998). These refractions coincide well for eyes with monofocal IOLs, significant differences between the refractive values were found with some refractive multifocal IOLs (Mun~oz et al, 2007a, 2007b; Albarran-Diego et al 2011; van der Linden et al 2014). The subjective refractions can be measured in the same manner as with monofocal IOLs

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