Optical quality of the eye after lens replacement with a pseudoaccommodating intraocular lens

Purpose

To examine the optical quality of healthy presbyopic eyes before and after implantation of the pseudoaccommodating AcrySof ReSTOR Natural intraocular lens (IOL) (Alcon Laboratories) by measuring visual acuity and wavefront aberrations.

Setting

University of Valencia, Fernández-Vega Ophthalmological Institute, Valencia, Spain.

Methods

Monocular refraction and photopic distance (6 m) and near (0.33 m) visual acuities were determined before and after clear lens extraction with bilateral AcrySof ReSTOR Natural IOL implantation in 30 hyperopic eyes (+0.50 to +4.00 diopters [D]) of presbyopic patients with low astigmatism (≤1.00 D). Postsurgical binocular visual acuity was measured over a range of effective distances. Wavefront aberrations were measured before and after surgery. Aberrations for 2 pupil diameters (3.0 mm and 5.0 mm) were decomposed using Zernike polynomials; total, defocus, astigmatism spherical, and coma aberration terms were studied separately. Postimplantation results were compared with preoperative values.

Results

Safety and efficacy indices for distance vision were 1.01 and 0.96, respectively. At near, they improved to 1.07 and 1.06, respectively. Vision at intermediate distances was noticeably poorer. Total, defocus, and spherical aberrations changed after IOL implantation with both pupil diameters (P<.01). Total and defocus aberrations were significantly reduced postoperatively. Spherical aberration coefficients changed to negative and less positive values for a 3.0 mm and a 5.0 mm pupil, respectively.

Conclusions

Implantation of the pseudoaccommodating IOL in healthy eyes yielded uncorrected levels of high-contrast, distance, and near acuities comparable to preoperative best corrected values. Higher-order aberration levels appeared to be similar to the preoperative values.