Visual simulation to customize depth of focus with new aspheric IOLs

Investigative Ophthalmology and Visual Science
Eloy A. Villegas, Harilaos S. Ginis, Lucía Hervella, Consuelo Robles, Pedro M. Prieto, Pablo Artal
Purpose: A new type of aspheric intraocular lenses (IOLs) has been designed to increase depth of focus. To account for individual differences in the patient’s eye optics and neural responses, the specific value of spherical aberration of the lens to be implanted needs to be customized. In this work, we evaluate the performance of a customization procedure using an adaptive optics visual simulator.
Methods: An Adaptive Optics Visual Simulator (VAO, Voptica SL, Murcia, Spain) was used to measure visual acuity (VA) at far, intermediate (67 cm) and near (33 cm) distances in 6 eyes with paralyzed accommodation. A new aspheric IOL family with four models having different values of spherical aberration (ArtIOLs, Voptica SL, Murcia, Spain) were used. Inter-subject averages and 95% confidence intervals (CI), calculated as 1.96*SD, were estimated for all viewing distances.
Results: The mean values of VA at intermediate and near distances improved (from 0.12 to -0.06 at intermediate, from 0.57 to 0.11 LogMAR at near) as asphercity increased while VA at far decreased (from -0.12 to 0.10 LogMAR). However, visual performance for each lens design depended on each subject with an inter-subject variability of VA, expressed as CI, ranging between 0.05 and 0.2 LogMAR.
Conclusions: A new set of four aspheric IOLs have been designed to obtain different ranges of depth of focus. Each design can provide quite different visual performance for different subjects at different distances. Preoperative visual simulation using adaptive optics instruments, such as VAO, would allow selection of the optimum type IOL to customize vision.