Preoperative Higher-Order Aberrations as Predictors of Visual Acuity Changes Following Presbyopia-Correcting (PCIOL) and Aspheric Monofocal Intraocular Lens Implantation

Mateja Jagić,1 Maja Bohač,1 Alma BiÅ¡ćević,2 Sudi Patel11Department of Cataract and Refractive Surgery, University Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia; 2Department of Cataract and Refractive Surgery, Eye Clinic Svjetlost, Sarajevo, Bosnia and HerzegovinaCorrespondence: Mateja Jagić, Department of Cataract and Refractive Surgery, University Eye Hospital Svjetlost, School of Medicine University of Rijeka, Heinzelova 39, Zagreb, 10000, Croatia, Tel +38592 5002675, Fax +3851 7775600, Email mateja.jagic@svjetlost.hrPurpose: To determine if preoperative ocular higher order aberrations (HOAs) were associated with changes in uncorrected distance (UCDVA), intermediate (UCIVA), near (UCNVA), corrected distance at reduced contrast (CDVA 10% and 25%) logMAR acuities after PCIOL or aspheric IOL implantation.Patients and Methods: Records of patients implanted with AcrySof IQ PanOptix (group I, n = 30), TECNIS Symfony (group II, n = 35), TECNIS bifocal (group III, n = 34), or TECNIS monofocal (group IV, n = 32) were reviewed where UCDVA, reduced contrast CDVA (logMAR chart at 6 m), UCIVA and UCNVA (at 80 cm and 40 cm) assessed under photopic conditions (∼ 85 cd/m2), ocular aberrations (under mesopic conditions, pupil sizes 3mm and 5mm), and refraction had been monitored.Results: Data from one eye/case were included for analysis. The chief findings were: (i) Median UCDVA, UCIVA and UCNVA values improved but CDVA (10% and 25%) remained unchanged in groups I–III. Median UCDVA, CDVA (10% and 25%) improved but UCIVA and UCNVA values remained unchanged in group IV. (ii) Mean spherical aberration (5mm pupil) and total root mean square HOA values (for 3 and 5mm pupil sizes) reduced in all 4 groups (ANOVA, p < 0.001). Mean trefoil and coma values did not change significantly. (iii) There were significant correlations between changes (Δ) in uncorrected acuities, CDVA (10% and 25%) and specific preop HOA values. The limits of agreement in the various models describing these associations were ≤ 0.2 units of logMAR acuity in groups II for ΔUCIVA and ΔCDVA (10% and 25%), III for ΔUCNVA and ΔCDVA (10% and 25%), IV for ΔUCIVA and ΔCDVA (10% and 25%).Conclusion: Preoperative HOA measurements showed statistically significant though modest associations with changes in uncorrected visual acuities. In some instances, the estimated change improved by including information regarding preoperative refractive error. Validation in larger cohorts is required before clinical implementation.Keywords: intraocular lenses, cataract surgery, refractive lens exchange