This document describes a study examining refractive outcomes after cataract surgery using different intraocular lens (IOL) designs and materials. 236 patients underwent cataract surgery with implantation of foldable IOLs. Results found that aspheric IOL designs and hydrophobic materials had more predictable refractive outcomes, with over 55% of patients within 0.5 diopters of the targeted refraction. References are also provided on how IOL design can impact visual acuity and contrast sensitivity, as well as comparisons of specific IOL models. The conclusions determine that aspheric IOLs provide better predictability of refractive outcome after cataract surgery.

1. 5/29/2015
1
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Refractive outcome after
Phacoemulsification with
Foldable intraocular lenses.
Dr. Anand Sudhalkar
Baroda

2. 5/29/2015
2
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Aim :
To predict the refractive outcome after
cataract surgery after
Phaco-emulsification and implantation of
various foldable intraocular lenses
having different designs and materials.

3. 5/29/2015
3
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Study Design:
• Prospective, single surgeon clinical trial
• 236 consecutive cataract cases.
• Routine, standardized clear corneal
phacoemulsification
• Implantation of foldable intraocular lenses
(IOL).

4. 5/29/2015
4
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Pre-operative work up
• Slit-Lamp, Applanation, Indirect ophth.
• Keratometry: Autokeratometer (Nidek)
• A-Scan (Storz Omega Compuscan)
• SRK II formula.

5. 5/29/2015
5
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Exclusion: Pre Operative
• Traumatic, Secondary Cataract
• Corneal curvature defects, Surgery
forrefractive procedures, Pterigium &
post ulceration opacities.
• Zonular weakness, exfoliations
• Previous Glaucoma procedures

6. 5/29/2015
6
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
IOL power selection
• A-scan printout
• Designated IOL A-Constant
• Targeted refraction and corresponding
power for the selected IOL

7. 5/29/2015
7
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Surgical procedure
• 3mm clear corneal, single plane, self sealing
incision at 12 o’clock.
• 5 to 5.5mm continuous capsulorrhexis, followed
by multiport cortico cleaving hydrodissection,
nuclear rotation was done prior to starting
phacoemulsification with B&L millenium.
• After deep central sculpting, first vertical crack
was obtained and further procedure completed
by stop and chop technique.

8. 5/29/2015
8
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Surgical procedure
• IOL injected with the injector system
specific to the respective IOls
• The anterior and posterior surfaces
identified and to achieve complete in the
bag placement having a thin rim of
anterior capsule covering the IOl all along
the circumference.

9. 5/29/2015
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Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Late Exclusions
• Complications like posterior or anterior capsular
tears, vitreous loss or zonular dehiscence
• the clear corneal incision requiring suturing and
• when complete in the bag placement was not
possible.
• Post op. capsular phimosis

10. 5/29/2015
10
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
236 foldable IOLs:
Design: Spherical(160) or Aspherical(76)
Material: Hydrophilic(106) or Hydrophobic(130)

11. 5/29/2015
11
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Age distribution
Range 9 to 89 years

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Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Power distribution of IOls
Range 6 to 29 Dioptres

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Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Results
• Retinoscopy after 6 weeks and spherical equivalent
Dioptre to obtain BCVA noted.
• Compared with targeted spherical equivalent from
A-Scan
• The difference between targeted and observed
refraction calculated for each case and
crosstabulated within +/- 0.5D group using SPSS
software.

14. 5/29/2015
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Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
Predictions with all IOls
DIFF
2.25-2.75
1.75-2.25
1.25-1.75
.75-1.25
.25-.75
-.25-.25
-.75--.25
-1.25--.75
-1.75--1.25
-2.25--1.75
-2.75--2.25
-3.25--2.75
60
50
40
30
20
10
0
Std. Dev = .97
Mean = -.09
N = 236.00
16
26
47
53
35
26
16
10
•WITHIN +/- 0.5 D

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Baroda 15
Crosstab Between Aspheric and Spherical Design
12 40 14 66
18.2% 61% 21.2% 100.0%
47 90 33 170
27.6% 53% 19.4% 100.0%
59 130 47 236
25.0% 55% 19.9% 100.0%
Count
% within IOL
Count
% within IOL
Count
% within IOL
ASPHERICAL
SPHERICAL
IOL
Total
-3.0 to -.51 -.5 to .5 >.5
RANGE.5
Total

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Baroda 16
Crosstab Between Hydrophilic and Hydrophobic groups
32 53 21 106
30.2% 50.0% 19.8% 100.0%
27 77 26 130
20.8% 59.2% 20.0% 100.0%
59 130 47 236
25.0% 55.1% 19.9% 100.0%
Count
% within IOL
Count
% within IOL
Count
% within IOL
Hydrophilic
Hydrophobic
IOL
Total
-3.0 to -.51 -.5 to .5 >.5
RANGE.5
Total

17. 5/29/2015
17
Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
IOL * RANGE.5 Crosstabulation
18 54 19 91
19.8% 59% 20.9% 100.0%
29 36 14 79
36.7% 46% 17.7% 100.0%
3 17 7 27
11.1% 63% 25.9% 100.0%
3 8 5 16
18.8% 50% 31.3% 100.0%
6 15 2 23
26.1% 65% 8.7% 100.0%
59 130 47 236
25.0% 55% 19.9% 100.0%
Count
% within IOL
Count
% within IOL
Count
% within IOL
Count
% within IOL
Count
% within IOL
Count
% within IOL
ACRYSOF
AKREOS
AKREOS A0
Acry-SN60WF
TECNIS
IOL
Total
-3.0 to -.51 -.5 to .5 >.5
RANGE.5
Total

18. 5/29/2015Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda 18
Cumulative percentages
IOL +/-0.5 +/-0.75 +/-1.0
AKREOSADAPT 45.6% 49.4% 70.9%
ACRYSOF 59.3% 61.5% 72.5%
ACRYSNWF 50% 62.5% 81.3%
AKREOSAO 63% 66.7% 88.9%
TECNIS 65.2% 73.9% 87%
ALL IOLs 55.1 59.3 75.8

19. 5/29/2015Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda 19
• Reference 1.
Effect of intraocular lens implantation on visual
acuity, contrast sensitivity, and depth of focus.
Nio YK; Jansonius NM; Geraghty E; Norrby S; Kooijman AC
• J Cataract Refract Surg. 2003; 29(11):2073-81 (ISSN: 0886-3350)
• CONCLUSIONS: There was a higher amount of
spherical aberration in the IOL group, related to a
larger depth of focus, without loss of contrast
sensitivity at optimum focus or loss of visual acuity.
This might contribute to better quality of vision in
pseudophakic subjects than in presbyopic phakic
subjects.

20. Reference 2
Spherical aberration influence in visual function
after cataract surgery: prospective randomized
trial
• Martínez Palmer A; Palacín Miranda B; Castilla Céspedes M; Comas Serrano M; Puntí
Memorial Garrigosa, Universidad Autónoma de Barcelona, Barcelona, España. Arch
Soc Esp Oftalmol. 2005; 80(2):71-7 (ISSN: 0365-6691)
• PURPOSE: We compare the contrast sensitivity and visual acuity
obtained with an anterior surface modified prolate intraocular lens
(Tecnis Z9000) with the contrast sensitivity and visual acuity obtained
with a standard acrylic foldable intraocular lens (Acrysof SA60 AT).
• CONCLUSION: Visual acuity and contrast sensitivity after cataract
surgery improved in both groups. But monocular and binocular visual
acuity was statistically significantly better only in Tecnis group. The
contrast sensitivity mean values were greater in Tecnis group but
without statistically significant differences.
5/29/2015Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
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21. Reference 3. Visual acuity and contrast sensitivity comparison between
Tecnis and Acrysof SA60AT intraocular lenses. A multicentre
randomized study. Bellucci R.,Scialdone A. from Verona Italy
• Purpose: To evaluate BCVA and photopic
and mesopic contrast sensitivity in
pseudphakic patients implanted either with
the aspheric IOL or a conventional IOL.
• Conclusion: The aspheric Tecnis Iol yielded
better BCVA and distance contrast
sensitivity than conventional Acrysof
SA60AT.
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Baroda 21

22. Reference 4. Predicting the refractive outcome after cataract surgery: the
comparison of different IOLs and SRK-II v SRK-T
M J Elder British Journal of Ophthalmology 2002;86:620-622
• Aim: To determine any differences between the predictive abilities
of the IOL calculation formulas of SRK-II and SRK-T and to compare
these using two different IOL types.
• If it is assumed that an eye retains similar axial lengths
and keratometry before and after surgery, and if IOL
powersare accurately stated by the manufacturer then the
only explanationfor a more consistent refractive outcome
is that the ACD is more predictable
5/29/2015Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
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23. 5/29/2015Sudhalkar Eye Hospital, Mahajan Lane, Raopura,
Baroda
CONCLUSIONS
• Predictability of refractive outcome
significantly better with aspheric design
and Hydrophobic IOL
• The difference in final refraction within +/-
0.5Dioptre range, statistically significant.
• Predictions in target refraction possible if
the A-constant mentioned on IOL is
reliable.