Comparative Global Literature Review of Visual and Optical Quality of Refractive, Diffractive, and Hybrid IOL Designs James P. McCulley, MD Department of Ophthalmology University of Texas Southwestern Medical Center at Dallas Dr. McCulley is a consultant for Alcon Laboratories, Inc.
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Dr. McCulley is a consultant for Alcon Laboratories, Inc .
Comparative Global Literature Review of Visual and Optical Quality of Refractive, Diffractive, and Hybrid IOL Designs. James P. McCulley, MD Department of Ophthalmology University of Texas Southwestern Medical Center at Dallas. Dr. McCulley is a consultant for Alcon Laboratories, Inc. - PowerPoint PPT Presentation
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Comparative Global Literature Reviewof Visual and Optical Quality of
Refractive, Diffractive, and HybridIOL Designs
James P. McCulley, MDDepartment of Ophthalmology
University of Texas Southwestern Medical Center at Dallas
Dr. McCulley is a consultant for Alcon Laboratories, Inc.
Purpose & Methods
PURPOSE: To investigate whether trends in superiority existfor optical characteristics and patient outcomes when making pairwise comparisons between 2 of the following 3 IOL types: refractive, diffractive, and hybrid of refractive with apodized diffractive.
METHODS: Literature searches for published articles
OvidSP Database (MEDLINE, EMBASE pooled), JRS, and JCRSOvidSP Database (MEDLINE, EMBASE pooled), JRS, and JCRS
Keyword search #1:refractive AND diffractive AND (multifocal
OR bifocal) AND intraocular lens
Keep only the applicablecomparative studies
Keyword search #2:compar* AND (multifocal OR bifocal)NOT monofocal AND intraocular lens
*Wildcard asterisk returns “comparative,” “compared,” “comparison,” etc.All results restricted to English language
Model Studies, n Model Studies, n Model Studies, n
Tecnis®,AMO
11Array®,AMO
12ReSTOR®,
Alcon17*
CeeOnTM,Pfizer
6ReZoom®,
AMO10
A-TwinTM,Acri.Tec
3
A-LISATM,Acri.Tec
2
825x +4,3M
1
Older IOL names or manufacturers updated to most recent.*16 Spherical SN60D3 or SA60D3, 1 Aspheric SN6AD3, 0 Aspheric SN6AD1
Study designs• Bilateral groups: 9 studies• Contralateral: 1 study• By eye: 8 studies• Bench: 5 studies
Lens Characteristics
Tecnis® A-LISATM ReZoom® ReSTOR®
Lens Type
Multi-Piece
Single-Piece
Multi-piece
Single- or Multi-Piece
Lens Material
Polysiloxaneor
acrylic
Foldable acrylate with 25% watercontent,
hydrophobic surface,and UV-absorber
Hydrophobic acrylic optic, poly-methyl
methacrylate (PMMA) haptics
UV-absorbing & blue light
filtering acrylate/
methacrylate copolymer
Diffractive IOLs Refractive IOLs Hybrid IOLs
Results:Optical Bench Test Outcomes
5 Studies; 5 result types; 18 pairwise superiorities Outcomes included defocus transfer function, night driving photograph,
modulation transfer function (near, distance, various pupil sizes),Strehl ratio, USAF target resolution
Top three superiorities (others only 1 superiority)– Hybrid IOLs superior over refractive IOLs, n=6– Diffractive IOLs superior over refractive IOLs, n=5– Hybrid IOLs superior over diffractive IOLs, n=4
Results were not tabulated unless a superiority was observed(ie, equivalences and similarities not counted)
Results:Near Visual Acuity (≤40 cm)
14 of 18 studies found pairwise near VA superiorities Includes UCVA, BCVA, photopic (± glare), mesopic (± glare),
defocus curve data, monocular/binocular, various contrast levels
Top three superiorities:– Diffractive IOLs superior over refractive IOLs, n=26– Hybrid IOLs superior over refractive IOLs, n=8– Hybrid IOLs superior over diffractive IOLs, n=5
Results were not tabulated unless a superiority was observed(ie, equivalences and similarities not counted)
Results:Intermediate Visual Acuity (>40 cm to 3 m)
10 of 18 studies found pairwise intermediate VA superiorities Includes UCVA, BCVA, photopic (± glare), mesopic (± glare),
defocus curve data, monocular/binocular, various contrast levels
Trends in superiority were not consistent:– In refractive vs diffractive IOLs: 7 for refractive, 5 for diffractive– In diffractive vs hybrid IOLs: 5 for diffractive, 1 for hybrid – In refractive vs hybrid IOLs: 5 for refractive, 0 for hybrid
All hybrid studies were for +4.0 D IOLs, not +3.0 D IOLsResults were not tabulated unless a superiority was observed
Visual disturbances: superiorities found by 2 of 7 studies– Diffractive > Refractive, negative dysphotopsia (n=1) and halo (n=1)
Contrast sensitivity: superiorities found by 7 of 9 studies– Various spatial frequencies and lighting conditions– Diffractive>Refractive, n=3– Hybrid>Refractive, n=3– Refractive>Diffractive, n=4– Refractive>Hybrid, n=3
Higher-order aberrations: superiorities found by 3 of 4 studies– Included coma, spherical aberration, various pupil sizes– Hybrid>Refractive, n=12 results– Diffractive>Hybrid, n=8 results
Reading acuity and speed: superiorities found by 3 of 3 studies– Various lighting conditions, distances, correction– Top acuity superiority: Diffractive > Refractive (n =15 results)– Top speed superiority: Diffractive > Refractive (n=9 results)
Summary
Based on the number of results from articles comparing one type of multifocal IOL to another, the following possible trends were observed:
– For published optical quality results,• Hybrid > Refractive• Diffractive > Refractive
– For published visual acuity results,• Near vision