Residual Spherical Equivalent Research Articles

Effect of preoperative keratometry on visual outcomes after small-incision lenticule extraction for myopia

PurposeTo investigate the relationship between preoperative keratometry (K) and postoperative refraction and compare the visual outcomes after small-incision lenticule extraction (SMILE) between preoperative flat and steep corneas.MethodsThis study involved 814 consecutive eyes of 409 patients who underwent SMILE. A month later, a linear regression analysis of the relationship between preoperative K and the residual spherical equivalent (SE) along with eyes divided by a single standard deviation between flat and steep corneas (< 41.85 D, > 44.57 D, respectively) was conducted. Eyes were distinguished based on the degree of myopia.ResultsOne month after surgery, no significant correlation existed between mean preoperative K and residual SE (P = 0.459). Linear regression analysis showed a weak negative correlation between flat corneas (r2 = 0.042, P = 0.025) rather than steep corneas (P = 0.908). Eyes with preoperative low myopia (< 3.00 D) (r2 = 0.233, P = 0.001) had a weak correlation compared with moderate and high myopia (P = 0.272, P = 0.257, respectively). Twelve months later, the predictability, safety, and efficacy did not vary between preoperative flat and steep corneas (P > 0.05).ConclusionsOne month after SMILE for myopia, the corneas were flatter in the preoperative flat corneas or all the low myopic corneas, and they were more overcorrected. However, preoperative corneal curvature does not influence visual outcomes at 1 year after SMILE.

Influence of Preoperative Keratometry on Refractive Outcomes for Myopia Correction With Small Incision Lenticule Extraction.

To evaluate the effect of preoperative keratometry on refractive outcomes after small incision lenticule extraction (SMILE) for myopia. This retrospective study comprised 515 consecutive eyes that had SMILE to correct myopia. Pearson correlation and linear regression were used to determine the relationship between residual spherical equivalent and preoperative keratometry. The same analyses were repeated in the quartiles with the lowest and highest preoperative myopia. Preoperatively, the mean spherical equivalent was -5.67 ± 1.87 diopters (D) (range: -1.63 to -9.75 D) and the mean keratometry was 43.10 ± 1.30 D (range: 38.90 to 47.00 D). Three months postoperatively, the mean spherical equivalent was -0.07 ± 0.18 D. After adjustment for age, sex, and preoperative spherical equivalent, greater postoperative undercorrection occurred in eyes with steeper corneas (P = .001). Each diopter of steeper keratometry resulted in 0.52% (0.03 D) more undercorrection. Correlation between the mean preoperative keratometry and residual spherical equivalent was significant in the lower preoperative myopia group (r = -0.24, P = .006), but not significant in the higher myopia group (r = -0.02, P = .809). Preoperative keratometry affects refractive outcomes after SMILE. Steeper corneas have greater undercorrection, especially in eyes with low myopia. Knowledge of the correlation between refractive outcomes of SMILE and keratometry would help in modifying current treatment algorithms. [J Refract Surg. 2020;36(6):374-379.].

A prospective study of patients who underwent laser subepithelial keratomileusis (LASEK)

Objective: To compare the preoperative and post-operative unaided visual acuity and assess the post operative complications in patients undergoing LASEK in 2017 and 2018. Methodology: A prospective study was conducted on 30 eyes that underwent LASEK in 2017 and 2018. Patients were reviewed 6 month post operatively and the residual refractive error and uncorrected visual acuity were assessed. Pre procedure unaided visual acuity and post procedure unaided visual acuity were measured and the improvement of Snellen lines was assessed. Results: There is no statistically significant difference between the target residual error (-0.50 D spherical equivalent) and the post-operatively achieved final residual error (p &lt; 0.01), the predictability was 100% (residual spherical equivalent is below -0.5D). There is statistically significant difference between preoperative BCVA and post-operative UCVA. (p &lt; 0.01). There is statistically significant difference between pre-operative best corrected visual acuity (BCVA) and post-operative BCVA. (p &lt; 0.05)

Factors for good near and distance visual outcomes of multifocal intraocular lens with inferior segmental near add.

This study was conducted to investigate factors related to postoperative good near and distance visual outcomes in the Lentis Mplus LS-313 MF20 (Oculentis Gmbh, Berlin, Germany) intraocular lens (IOL)-implanted eye. A retrospective cross-sectional study analyzed a total of 198 eyes of 198 patients. Patients with 20/20-or-more uncorrected distance visual acuity (UDVA, 5m) and J2-or-more uncorrected near visual acuity (UNVA, 40cm) were distributed into the good visual outcome (GVO) group (n = 96), and the remaining patients were distributed into the moderate visual outcome (MVO) group (n = 102). Differences between the two groups were compared for patient age, preoperative measurements (kappa distance, kappa angle, and pupil size), and postoperative measurements (residual sphere, cylinder, and spherical equivalent) to explore factors related to good visual outcomes after IOL implantation. The average age of the GVO group (56.2years) was significantly lower than that of the MVO group (58.6years), and the average kappa distance of the former was significantly smaller than that of the latter. However, there were no significant differences between the two groups in kappa angle and pupil size. Notably, multivariate binary regression analysis revealed that multiple factors including age, residual cylinder, and spherical equivalent were associated with good visual outcomes. Based on the receiver operating characteristic curve, cutoff values regarded as good visual outcome following cataract surgery were calculated to be - 0.38 CD in residual cylinder and - 0.32 D in residual spherical equivalent. Patients with implanted Lentis Mplus LS-313 MF20 IOL who are young, had small kappa distance, and had low levels of postoperative residual cylinder and spherical equivalent tended to exhibit good vision at both near and distance. These results imply that surgeons should minimize postoperative residual cylinder and spherical equivalent to provide good visual outcomes to patients with implanted Lentis Mplus LS-313 MF20 IOL.

Topography-guided versus wavefront-optimized laser in situ keratomileusis for myopia: Surgical outcomes

To compare the outcomes of topography-guided and wavefront-optimized surgery in patients having laser insitu keratomileusis (LASIK) for myopia. Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, and BALGEUN-EYE21 Operation Center, Gwangju, South Korea. Prospective case study. Patients had topography-guided LASIK in 1 eye and wavefront-optimized LASIK in the contralateral eye using Contoura Vision software and the WaveLight EX500 excimer laser. Refractive and visual outcomes were analyzed 3months postoperatively. The study comprised 43 patients. In both groups, the postoperative uncorrected distance visual acuity (UDVA) was 0.0 logarithm of the minimum angle of resolution or better in 90.7% of eyes and the residual spherical equivalent (SE) refractive error was ±0.75 diopter (D) in 81.4% of eyes. The UDVA, residual SE refractive error, and astigmatism did not differ significantly between the 2 groups. There was significant induction of higher-order aberrations (HOAs) in both groups, although corneal coma and trefoil did not increase and ocular trefoil decreased significantly in the topography-guided group (P=.038). However, in the wavefront-optimized group, corneal coma and trefoil increased significantly (P<.001 and P=.046, respectively) and ocular trefoil did not change significantly. In addition, topography-guided LASIK induced significantly fewer corneal total HOAs (P<.001), coma (P<.001), and trefoil (P=.020) than wavefront-optimized LASIK. Although both topography-guided LASIK and wavefront-optimized LASIK safely and effectively achieved the predicted refractive and visual outcomes, topography-guided LASIK induced fewer HOAs and significantly decreased ocular trefoil, corneal total HOAs, and coma.

Femtosecond Laser-Assisted LASIK With and Without the Adjuvant Use of Mitomycin C to Correct Hyperopia.

To compare the visual and refractive results of femtosecond laser-assisted LASIK (FS-LASIK) with and without the adjuvant use of mitomycin C (MMC) to correct hyperopia. A total of 152 consecutive hyperopic eyes were included in this retrospective, observational cohort study, comparing 76 eyes treated with FS-LASIK + MMC with 76 age- and refraction-matched eyes treated with FS-LASIK without MMC. Visual and refractive results were evaluated 1 day, 1 week, and 1, 3, 6, and 15 months postoperatively. Preoperative mean spherical equivalent was +3.27 diopters (D) versus +3.50 D in the MMC and no MMC groups, respectively (P > .05). Three months postoperatively, uncorrected distance visual acuity was significantly better in the MMC group (0.93 ± 0.2) than in the no MMC group (0.87 ± 0.2) (P = .01). The residual spherical equivalent was significantly lower in the MMC group (+0.18 ± 0.40 D) than in the no MMC group (+0.42 ± 0.50 D) (P = .01). Fifteen months postoperatively, including re-treated eyes, no significant differences were found in uncorrected distance visual acuity, corrected distance visual acuity, and residual refraction. Slightly better outcomes were found in the MMC group in terms of efficacy, safety, and predictability; however, these small differences were not statistically significant. The incidence of re-treatments during the 15-month follow-up was significantly lower in the MMC group than in the no MMC group (6.6% vs 10.5%, respectively) (P = .01). FS-LASIK with or without the intraoperative use of MMC is safe and effective to correct hyperopia. However, slightly better refractive outcomes and a lower incidence of re-treatments were observed when intraoperative MMC was used, at least in a 15-month follow-up. [J Refract Surg. 2018;34(1):23-28.].

Deep Anterior Lamellar Keratoplasty followed by Toric Lens Implantation for the Treatment of Concomitant Anterior Stromal Diseases and Cataract

PurposeTo evaluate the outcomes of deep anterior lamellar keratoplasty (DALK) followed by phacoemulsification and toric intraocular lens (IOL) implantation for the treatment of concomitant stromal disease and cataract.MethodsIn this retrospective non-comparative interventional case series, ten eyes affected by stromal disease and cataract underwent DALK followed by phacoemulsification with toric IOL implantation after a minimum period of 5 months from complete suture removal. In each case, topographic astigmatism, refraction, visual acuity, and endothelial cell density were recorded before DALK and 1, 6, and 12 months after cataract surgery. In addition, IOL rotation was evaluated using anterior segment optical coherence tomography.ResultsBig-bubble DALK was performed in all eyes but one that received manual dissection. Topographic astigmatism averaged 5.6 ± 2.2 diopters (D) after suture removal; refractive astigmatism decreased to 0.55 ± 0.61 D as early as one month after cataract surgery and did not change substantially throughout the follow-up period. In all patients, one month after phacoemulsification uncorrected and best spectacle-corrected visual acuity were, respectively, ≥20/40 and ≥20/25 with a residual spherical equivalent of 0.00 ± 0.84 D. At the latest follow-up visit, in all cases the IOL rotation was ≤5 degrees from the intended position and the endothelial cell loss within 8.5%. No complications were recorded.ConclusionsDALK followed by phacoemulsification with toric IOL implantation optimizes visual and refractive outcomes in patients with concomitant stromal disease and cataract. In comparison with a combined procedure, the sequential approach offers better predictability of the postoperative refraction in the absence of an increased risk of complications.

The Safety and Predictability of Implanting Autologous Lenticule Obtained by SMILE for Hyperopia.

To evaluate the safety, effectiveness, stability, and predictability of implanting autologous lenticules obtained from small incision lenticule extraction for the treatment of hyperopia. Five patients (10 eyes) with one myopic eye and one hyperopic eye were enrolled. The myopic eye was treated with small incision lenticule extraction; a lenticule was extracted and subsequently implanted in the hyperopic eye. Follow-up was at 1 day, 1, 3, 6, and 9 months, and 1 year postoperatively. Patients received a complete ophthalmologic examination at each visit, including uncorrected distance visual acuity, corrected distance visual acuity, anterior segment optical coherence tomography, and corneal topography. There were no complications in any eye during follow-up. Compared with preoperative levels, at the last follow-up visit the eyes with lenticule implantation showed mean spherical equivalent reduced by 5.53 diopters (residual spherical equivalent was +1.13 to -2.63 diopters), mean uncorrected distance visual acuity increased approximately two lines (approximately 20/63 to 20/40 Snellen), and corrected distance visual acuity in 4 (80%) eyes gained one line, 2 (40%) eyes gained two lines, and 1 (20%) eye gained more than two lines. There was no significant difference (P > .05) in spherical equivalent compared with 1 day postoperatively and the last follow-up visit. Corneal topography showed that the lenticule was uniform and located well; anterior segment optical coherence tomography images showed that the lenticule was transparent and the demarcation line was visible. Implanting an autologous lenticule obtained by small incision lenticule extraction for hyperopia might be safe, effective, and stable, but its predictability should be improved in the future.

Re-Evaluation of the Safety of Laser-Assisted Subepithelial Keratectomy

Purpose: Additional analyses of outcomes of laser-assisted subepithelial keratectomy (LASEK) are still necessary to improve the safety of LASEK. Therefore, in our study, outcomes were assessed retrospectively in 561 eyes that underwent LASEK treatment. Methods: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA) and residual spherical equivalent were analyzed at 3 and 6 months postoperatively. We assessed four subgroups based on the degree of preoperative myopia considering mean BSCVA and loss of two or more lines. Results: Mean UCVAs and BSCVAs were obtained at 3 and 6 months postoperatively (1.23/1.35 and 1.23/1.37, respectively). The mean predictability was within ±0.125 diopters. Conversely, the safety indexes were 0.94 and 0.96 respectively, and the efficacy indexes were 0.86 and 0.86 at 3 and 6 months postoperatively, respectively. 8.4% eyes and 5.2% eyes lost two or more lines of BSCVA at 3 and 6 months postoperatively, respectively. The mean BSCVAs of the high or ultra-high groups were significantly lower than those of the low or mild groups both 3 months and 6 months postoperatively. The incidence rates of losing two or more lines of BSCVA in the high or ultra-high myopia groups were significantly greater than in the low or mild groups at 3 months and 6 months postoperatively. Conclusion: LASEK predictably corrected myopia achieving >1.2 in UCVA and BSCVA. However, the safety and efficacy indexes were

Clinical study of femtosecond laser corneal small incision lenticule extraction for correction of myopia and myopic astigmatism

To evaluate the safety, efficacy, predictability, stability and complications of femtosecond laser corneal small incision lenticule extraction (SMILE) procedure for the correction of myopia and myopic astigmatism. In this prospective study, 50 patients (88 eyes) with myopia and myopic astigmatism were chosen to be performed SMILE procedure randomly. These patients were followed up at 1 day, 1 week, 1 month and 3 months postoperatively and were examined for uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), manifest refraction, intraocular pressure (IOP) and corneal topography. The results were analyzed with paired-t test, independent-samples t test and regression analysis. SMILE procedure was performed well in all patients, only 3 cases (3 eyes, 3.4%) suffered from the suction loss, 14 cases (26 eyes, 29.5%) developed opaque bubble layer. All patients gained perfect UCVA (20/20), no eye had decrease of BCVA. The residual spherical equivalent was (-0.11 ± 0.29) D, the astigmatism was (0.01 ± 0.33) D 3 months postoperatively. The incidence of diffuse lamellar keratitis and haze was low, and no other complications were observed. The IOP was decreased slightly after 1 month(t = 6.238, P < 0.05), but no changes after 3 months (t = 0.053, P < 0.05). The SMILE procedure is good at the safety, efficacy, predictability and stability for the correction of myopia and myopic astigmatism.

LASIK operations with the Ziemer FEMTO LDV femtosecond laser flap creation after previous photorefractive keratometry or laser-assisted sub-epithelial keratomileusis

Editor, Enhancement procedures may be needed after previous refractive surgery in the cases of under or over correction and regression. Enhancement procedures can be performed by photorefractive keratometry (PRK) or laser-assisted in situ keratomileusis (LASIK). LASIK is an attractive option for retreatment after previous surface ablations such as PRK or laser-assisted sub-epithelial keratomileusis (LASEK). Main reasons for choosing LASIK are a quick recovery and the absence of haze. Previously, in LASIK, corneal flaps have been recreated using various microkeratomes (Comaish et al. 2002; Pitkänen et al. 2010). In recent years, femtosecond lasers have emerged as alternatives to the traditional microkeratome-based LASIK. Femtosecond laser technology has some advantages, such as less variation in flap thickness and a more uniform flap thickness throughout the whole flap, compared to microkeratome-based flaps. However, reports published on reoperations performed with the femtosecond laser technology after previous refractive surgery are still scarce and limited to Intralase (Tran et al. 2008). This study presents the outcomes of the first 89 consecutive reoperated eyes of 71 patients, previously treated with PRK (87 eyes) or LASEK (two eyes), which now underwent LASIK flap creation with the FEMTO LDV (Ziemer Ophthalmic Systems, Port, Switzerland) femtosecond laser and excimer laser treatment with the Allegretto Wave Concerto 500 Hz excimer laser (Wavelight AG, Erlangen, Germany). The patients were operated in the two Finnish Mehiläinen Hospitals, in Tampere and in Helsinki. In all the eyes operated, a superior hinge was used and the intended flap thickness was 90 μm. The diameter of the suction ring was chosen according to the preoperative keratometric K1 value measured before the primary operation. The study included 64 myopic eyes (residual spherical equivalent of refraction, SE, range −6.63 D to −0.25 D, mean SE −1.45 ± 1.01 D) and 25 hyperopic eyes (range SE +0.00 D to +2.88 D, mean SE +1.31 ± 0.91 D). Flap dimensions and the best-corrected visual acuities were measured and intra- and postoperative complications recorded. Mean flap thickness was 90.5 ± 5.4 μm (range, 74–104; Fig. 1) and mean flap diameter was 9.1 ± 0.2 mm (range, 8.8–9.7). Flap thickness was positively correlated with corneal thickness both in myopic (r = 0.33, P < 0.01) and in hyperopic previously surface-ablated eyes (r = 0.51, P < 0.01). The distribution of flap thickness in 89 previously surface-ablated eyes now reoperated with the FEMTO LDV using the intended flap thickness of 90 μm. Complications occurred in six eyes (5.9%). They all were observed in the previously PRK-treated eyes. Most of the complications were very mild, and none of them prevented further treatment with excimer laser. There were no changes in the Snellen lines of BSCVA in 73 eyes (94.8%), and one line was gained in four eyes (5.2%). The mean flap thickness in the previously surface-ablated eyes was equivalent to the one we obtained in our previous study evaluating 787 primary operations with the FEMTO LDV (Pietilä et al. 2010). In this study, flap thickness was affected by corneal thickness just as in our previous study (Pietilä et al. 2010). Although the reason for this positive correlation is unknown, it is, if anything, a clinically advantageous phenomenon. Corneal changes in the previously PRK- or LASEK-treated eyes are mainly ultrastructural (changes in keratocytes in anterior stroma, absence of Bowman’s membrane, subclinical haze in wound healing process). LASIK revision in these eyes poses potentially more risks, and the previously operated corneal tissue is likely to behave in a different way than in the primary LASIK procedure. It is, however, evident that LASIK revisions with the femtosecond technology can be safely performed in most of these cases. Although in general retreatment of previously operated eyes offers greater risks in refractive surgery, the FEMTO LDV femtosecond laser can be successfully used for corneal flap creation in previously surface-ablated eyes.

Satisfaction Level of Physicians Who Have Undergone Corneal Refractive Surgery

PurposeTo evaluate the levels of satisfaction among physicians who have undergone corneal refractive surgery.MethodsThis study included 212 eyes of 107 consecutive patients who underwent laser in situ keratomileusis or laser sub-epithelial keratomileusis surgery. Patients were divided into two groups: one group of physicians and one group of other healthcare workers (HCWs). The physicians' group was also subdivided into two different groups: surgeons or doctors using microscopes and medical physicians. The main outcome measures were scale scores obtained by using the Visual Function Index-14 questionnaires; uncorrected distance visual acuity (UDVA), residual spherical equivalent (SE), optical zone diameter, and residual corneal thickness were also compared between the groups.ResultsNo significant differences in preoperative parameters, with the exception of the ratio of types of refractive surgery, were noted between the physicians and the HCWs group. Additionally, no differences between the groups were noted in the postoperative UDVA, residual SE, optical zone diameter, residual corneal thickness, and level of satisfaction. When comparing the two subgroups of physicians, the differences in satisfaction rates were not statistically significant, even in terms of the performance of delicate manual work.ConclusionsNo statistically significant differences in the clinical outcomes and satisfaction scores were detected after surgery between the physicians and HCWs groups, nor were any significant differences detected between the surgeons and medical physicians groups. Corneal refractive surgery can conceivably be recommended even for physicians who perform intensive near vision-dependent activities and delicate operations.

Terapia fotodinámica con verteporfina en neovascularización coroidea después de cirugía refractiva

To analyze the results obtained with Photodynamic Therapy (PDT) to treat subfoveal and juxtafoveal Choroidal Neovascularization (CNV) in patients with high myopia corrected by Laser-Assisted in situ Keratomileusis (LASIK) or by implanting a Phakic Intraocular Lens (PIOL). We analyzed the results from 14 highly myopic eyes corrected by LASIK (seven cases) or by PIOL implantation (seven cases), which later developed CNV and were treated by PDT with verteporfin. Mean Best Corrected Visual Acuity (BCVA) after refractive surgery was 0.45 SD 0.17 (range, 0.2 to 0.8), with residual spherical equivalent (RSE) -0.5 SD 1.8 D (range, 1 to 5.5 D). After CNV appearance, BCVA was 0.10 SD 0.19 (range, 0.025 to 0.7). CNV was treated in all cases by PDT (mean, 2.0 SD 0.8 treatments). After CNV closure, the mean BCVA improved up to 0.22 SD 0.18 (range, 0.1 to 0.63) (RSE -1.4 SD 1.4 D, range, 0.5 to -4 D). Differences in RSE after refractive surgery and after PDT, and differences between BCVA after CNV appearance and final were not statistically significant (p=0.82 and p=0.06, respectively, Student's t test paired data). We consider that PDT is effective in achieving closure of CNV in myopic patients after refractive surgery without inducing changes in spherical equivalent.

Influence of preoperative keratometry on refractive results after laser-assisted subepithelial keratectomy to correct myopia

To study the relationship between preoperative keratometry and residual spherical equivalent (SE) after myopic laser-assisted subepithelial keratectomy (LASEK). Vissum Madrid, Madrid, Spain. This retrospective study comprised 1149 consecutive eyes that had LASEK to correct myopia. The relationship between preoperative keratometry and the 3-month postoperative SE was analyzed by linear regression. The same analysis was performed in the first decile (percentile 10) with the flattest keratometry readings, in the decile with the steepest readings, and in the quartiles with the lowest and highest preoperative myopia. Preoperatively, the mean SE was -4.59 diopters (D) +/- 2.80 (SD) (range -0.25 to -13.00 D) and the mean keratometry, 44.20 +/- 1.60 D (range 39.00 to 49.00 D). Three months postoperatively, the mean SE was +0.05 +/- 0.50 D. There was a significant (P = .04), although weak (r2 = 0.003), correlation between the mean preoperative keratometry and residual SE. Linear regression showed a positive significant correlation within each decile. The correlation was weak in the decile with the flattest corneas (115 eyes) (r2 = 0.04, P = .04) and slightly stronger in the decile with the steepest corneas (115 eyes) (r2 = 0.1, P = .001) (ie, the steeper the cornea, the greater the overcorrection). There was a weak correlation in the group with higher preoperative myopia (r2 = 0.05, P = .0003) but no correlation in the lower myopia group (P = .3). Preoperative corneal curvature did not seem to influence the spherical refractive outcomes after myopic LASEK.

Retinal straylight in patients with monofocal and multifocal intraocular lenses

To determine the differences in retinal straylight perceived by patients with monofocal intraocular lenses (IOLs) and patients with multifocal IOLs. Vissum-Instituto de Oftalmológico de Alicante, Alicante, Spain. In this prospective study, contrast sensitivity and retinal straylight were measured prospectively 6 months postoperatively in 67 eyes of 40 patients with a monofocal or multifocal IOL. In the monofocal group, a ThinOptX IOL (ThinOptX, Inc.) was implanted in 12 eyes and an Acri. Smart 48 S IOL (Acri.Tec) in 20 eyes. In the multifocal IOL group, a ReZoom IOL (Advanced Medical Optics) was implanted in 13 eyes and a ReSTOR IOL (Alcon Laboratories) in 22 eyes. All measured values were similar between the monofocal and multifocal groups. Contrast sensitivity correlated significantly with the retinal straylight value (r= 0.258; P= .026) and the mean residual spherical equivalent. There was no statistically significant relationship between IOL type and the retinal straylight value (P= .089). Adjusted mean scores suggest that straylight values in the monofocal group were slightly higher than in the multifocal group. In the monofocal group, retinal straylight values were significantly correlated with pupil size (r= -0.377; P= .033). In the multifocal group, a correlation was found between retinal straylight values and contrast sensitivity (r= 0.397; P= .024). After controlling for age differences, there were no significant differences in retinal straylight between IOLs (P= .069). No significant differences in straylight values were found between multifocal IOLs and monofocal IOLs. Pupil miosis during retinal straylight measurement and neural adaptation after multifocal IOL implantation may overcome differences between IOLs.