University of Groningen Young eyes for elderly people van Gaalen, Kim IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2009 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Gaalen, K. W. V. (2009). Young eyes for elderly people: a clinical comparison of spherical and aspheric intraocular lenses Groningen: s.n. Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 03-10-2018
Intermezzo Optical performance and patients satisfaction one year after implantation of the aspheric Tecnis ZA9003 intraocular lens and the spherical Sensar AR40e intraocular lens Kim W. van Gaalen1, MSc, Steven A. Koopmans2, MD, PhD, Nomdo M. Jansonius1,2, MD, PhD and Aart C. Kooijman1, PhD 1 La bo ratory of Experimental Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands 2 Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Intermezzo Introduction Many studies compared the optical performance of spherical and aspheric intraocular lenses (IOLs) shortly after surgery. 1-19 For example, Kim et al. 4 compared the aspheric Tecnis ZA9003 IOL (AMO, Santa Ana, USA) with the spherical Acrysof SA60AT IOL (Alcon Labs, North Worth, TX, USA) 3 months postoperatively and found a higher contrast sensitivity under both mesopic and photopic conditions in eyes with the Tecnis ZA9003 IOL. In our study (see section 3.1), however, we did not find any difference in optical performance between eyes with the aspheric Tecnis ZA9003 IOL and the spherical Sensar AR40e IOL (AMO, Santa Ana, USA). It might be hypothesized that, for example, early postoperative corneal swelling due to phacoemulsification 20-22 could temporarily lead to a lower optical performance and, hence, veil the difference in optical performance. We therefore repeated the measurements in the eyes with the Tecnis and Sensar IOLs one year after surgery. Apart from the tests performed shortly after surgery, we added an evaluation of posterior capsular opacification (PCO). Most patients reported a subjective better optical performance of the eye with the aspheric Tecnis ZA9003 IOL, being unaware of which eye had received the Tecnis IOL. For that reason we also added a subjective quality of vision assessment, using a questionnaire. Methods To asses the long-term optical performance and possible changes that occur over time, we compa red the optical performance of the aspheric Tecnis ZA9003 IOL with that of its spherical counterpart, the Sensar AR40e IOL 6 weeks (baseline, see section 3.1) and 1 year postoperatively (this section). The latter comparison was performed in a subset of 21 patients. Optimum refraction and best-corrected visual acuity (BCVA) were determined using an Early Treatment Diabetic Retinopathy Study (ETDRS) chart. The postoperative visu al acuity of both eyes had to be at least 0.8 (20/25). Study population and measurements (wavefront aberration, contrast sensitivity [HACSS at 6 cpd], myopic shift, depth of focus and straylight) were described previously in section 3.1. In addition, a subjective quality of vision assessment was performed using the VFQ-39 questionnaire 23 and retroillumination photographs of the entire IOL surface were taken (see below) to determine the amount of PCO. We used the Dutch version of the National Eye Institute's (NEI) VFQ-39 questionnaire. This questionnaire contains 25 standard items (VFQ-25) and 14 optional items, together assigned to 12 subscales (VFQ-39; see Appendix). 23 The subscale scores 72
Optical Performance of Spherical and Aspheric Intraocular Lenses were retrieved by averaging the item scores (ranging from 0 to 100) within the subscales. For the questionnaire, the results from patients who received the Tecnis IOL in the dominant eye (Group I) were compared to the results from patients who received the Sensar IOL in the dominant eye (Group II). To quantify the amount and location of PCO, digital retroillumination photographs of the entire IOL surface were acquired after pupil dilation (Figure 1) with a digital camera (Nikon D70, Sendia, Japan) attached to a slitlamp (Carl Zeiss Meditec, Oberkochen, Germany) by an experienced photographer. Wavefront aberrations and contrast sensitivity measurements were only performed if there was no PCO in the center (that is, in a central zone with a diameter of 3.0 mm) of the pupil. An experienced ophthalmologist (SK), who was unaware which IOL was implanted in which eye, pointed out which eye of the patient had the most PCO. When no difference in PCO formation between both eyes was observed, it was also noted. Figure 1. Illustration of a typical retroillumination photograph in pseudophakic eyes without (A) and with (B) posterior capsular opacification. Statistical Analysis The main outcome variable of the contrast sensitivity test was the logarithmic value of contrast sensitivity (LogCS). ANOVA General Linear Model (GLM) for repeated measurements and post-hoc analysis (t-test for paired samples) with Bonferroni correction were performed to identify effects on the log contrast sensitivity values of the various levels of defocus over time for each IOL separately. The t-test for paired samples with Bonferroni correction was used to explore the differences in wavefront aberrations. The t-test for paired samples was used to explore differences in visual acuity, depth of focus, myopic shift and 73
Intermezzo straylight between the IOLs. To obtain reliable straylight values, the straylight parameter log(s) had to be less than 2.5 in both eyes 24 and had to have a standard deviation of less than 0.12 25,26. The Wilcoxon signed-rank test was used to explore differences in PCO formation between eyes with the Sensar IOL and eyes with the Tecnis IOL. One-way ANOVA was used to explore differences in subscale scores of the VFQ-39 between patients who received the Tecnis IOL in the dominant eye and patients who received the Sensar IOL in the dominant eye. Results Originally, 24 patients (13 female and 11 male patients) were included in this follow-up study. The mean age of these patients was 71.2 (standard deviation 11.4) years. The average follow-up period was 1.4 years (standard deviation 0.3 years). One patient was excluded from the study due to PCO formation at the center of the pupil, another because he/she could not complete the contrast sensitivity tests successfully and a third because the dilated pupil was smaller than the required 5.0 mm. This left 21 patients. None of the patients included in the study had undergone Nd:YAG laser capsulotomy to treat PCO. In 3 patient s, retroillumination photographs failed and, as a consequence, the amount of PCO could not be determined. No difference in the amount and location of PCO between the Sensar and Tecnis IOLs was observed (P =.083). BCVA measured with the Tecnis IOL (99 ± 5 VAR) and the Sensar IOL (100 ± 5 VAR) did not differ statistically significantly from the baseline measurements (Tecnis IOL: 101 ± 4 VAR, P =.13; Sensar IOL: 102 ± 4 VAR, P =.15). Furthermore, no differences in the straylight parameter over time could be found for either eyes with the Tecnis IOL or eyes with the Sensar IOL. Figure 2 shows the differences in average wavefront aberration coefficients between baseline and one year postoperatively up to the sixth order Zernike polynomial of eyes with the Tecnis and the Sensar IOLs separately. The average wavefront aberrations and the overall RMS value one year postoperatively (average overall RMS = 0.23 µm) were similar to baseline (0.24 µm; P =.42). 74
Optical Performance of Spherical and Aspheric Intraocular Lenses Figure 2. Representation of the differences in Zernike coefficients (mean +/- standard error of the mean; artificial pupil size = 5.0 mm) between 6 weeks and 1 year postoperatively of Zernike polynomials up to the sixth order. Black bars represent measurements performed with the Tecnis ZA9003 IOL; gray bars with the Sensar AR40e IOL. A positive difference denotes an increase in aberrations. Figure 3 shows the mean difference in contrast sensitivity between baseline and one year postoperatively. No statistically significant differences could be found. Furthermore, no difference in depth of focus and myopic shift (for methods see section 3.1) between baseline and one year postoperatively were found. Figure 3. Difference in log contrast sensitivity (mean +/- standard error of the mean; artificial pupil size = 5.0 mm) between 6 weeks and 1 year postoperatively. Black bars represent measurements performed with the Tecnis ZA9003 lens; gray bars with the Sensar AR40e lens. A positive difference denotes an increase in contrast sensitivity (LogCS = log contrast sensitivity). 75
Intermezzo Twelve patients received the Tecnis ZA9003 IOL in the dominant eye and 9 patients the Sensar AR40e IOL. Average VFQ-39 scores are presented in table 1. No statistically significant differences were found in any of the subscales, except for that of ocular pain, that is, ocular pain and discomfort and impact on activities. Patients with the Sensar AR40e IOL in the dominant eye experienced significant more ocular pain (P =.004). Table 1. Scores on health-related quality of life (VFQ-39) measures (mean ± SD). Mean score ± SD Tecnis ZA9003 IOL Sensar AR40e IOL P value General Health 58.1 ± 18.4 71.9 ± 14.8.081 General Vision 80.4 ± 14.7 82.2 ± 9.7.753 Ocular Pain 76.0 ± 16.4 95.8 ± 8.8.004 Near Activities 88.5 ± 12.5 94.0 ± 8.4.273 Distance activities 91.9 ± 9.0 94.1 ± 8.5.577 Social functioning 98.6 ± 3.2 100.0 ± 0.0.217 Mental health 91.7 ± 9.1 95.6 ± 6.3.288 Role difficulties 84.9 ± 18.4 95.1 ± 7.5.133 Dependency 97.4 ± 5.0 100.0 ± 0.0.134 Driving 86.9 ± 15.1 87.5 ± 10.8.947 Color vision 95.8 ± 14.4 100.0 ± 0.0.400 Peripheral vision 95.8 ± 9.7 97.2 ± 8.3.735 76
Optical Performance of Spherical and Aspheric Intraocular Lenses Conclusions No differences in contrast sensitivity, depth of focus and myopic shift were found between measurements performed at baseline and one year after cataract surgery. Furthermore, no difference in PCO formation between eyes with the aspheric Tecnis IOL and the spherical Sensar IOL could be found one year postoperatively. Lin et al. administered the VFQ-25 in patients with either the aspheric AcrySof IQ SN60WF IOL (Alcon Labs, Forth Worth, TX, USA) or the spherical AcrySof SA60AT IOL (Alcon Labs, Forth Worth, TX, USA). 27 No differences in any of the subscales were found. Espindle et al. administered the VFQ-39 preoperatively, 30 to 60 days and 120 to 180 days after bilateral cataract surgery with either the blue filtering Acrysof Natural IOL (Alcon Labs, Forth Worth, TX, USA) or the clear Acrysof IOL (Alcon Labs, Forth Worth, TX, USA). 28 A similar improvement in general vision, near- and distance activities, driving and other aspects were found for both IOLs. No statistically significant difference between the IOL types could be found. We did not find statistically significant differences in any of the sub-scales except for that of ocular pain, e.g. ocular pain and discomfort and impact on activities. No explanation for this finding could be found in the literature; both IOLs are made from the same material and have the same design (for example, they have the same edge shape). Therefore, this difference presumably is a chance finding. In conclusion, measurements performed shortly after cataract surgery seems to predict the long-term outcome reliably. 77
Intermezzo Appendix Mangione CM, Lee PP, Gutierrez PR, Spritzer K, Berry S, Hays RD. Development of the 25-item National Eye Institute Visual Function Questionnaire. Arch Ophthalmol. 2001;119:1050-1058. 78
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