| Object:This study evaluated postoperative visual function of presbyopia-correcting intraocular lenses(IOLs)with different design principles using defocus curves,amplitude of accommodation(AOA)and depth of focus(DOF).Furthermore,the differences and correlations between subjective and objective DOF and objective AOA were further discussed.This research would provided a theoretical basis for the personalized selection and postoperative visual evaluation of presbyopia-correcting IOLs.Methods:The study included patients who accepted cataract surgery at the First Affiliated Hospital of Guangzhou Medical University from October 2021 to April 2022,and 42patients(42 eyes)were included.The patients were divided into three groups according to the type of IOL selected by the patients.A total of 13 subjects of segmental refractive(Seg Ref)IOL SBL-3(Lenstec,Barbados)implanted were taken as group A,16 subjects of extended-depth-of-focus(EDOF)IOL Symfony ZXR00(Tennis,USA)implanted were taken as group B,and 13 subjects of diffractive Bifocal IOL ZMB00(Tennis,USA)implanted were taken as group C.All patients were followed up at 3 months and 6 months after surgery.The observation indicators included uncorrected distance visual acuity(UDVA)(5m),uncorrected intermediate visual acuity(UIVA)(66cm),uncorrected near visual acuity(UNVA)(33cm),best corrected distance visual acuity(BCDVA)(5m),and distance-corrected intermediate visual acuity(DCIVA)(66cm),distance-corrected near visual acuity(DCNVA)(33cm);Defocus curve measured with Binoptometer 4P(Oculus,Germany)under the best correction for far vision;The subjective depth of focus(DOF)was measured in the defocus curve by different criteria;Objective DOF and higher-order aberration(HOA)measured by i Trace(Tracey,USA);Objective amplitude of accommodation(AOA)and modulation transfer function cutoff(MTF cutoff)measured by OQASII(Visiometrics,Spain);The differences among groups and within groups were analyzed and compared,and the correlation among subjective and objective DOF and objective AOA was explored.Results:1.Visual Acuity Distance visual acuity: There were no statistically significant differences in UDVA and BCDVA among the three groups at 3 and 6 months after surgery.And there was no significant difference in UDVA and BCDVA between 3 month and 6months postoperatively in all groups. Intermediate distance visual acuity: The UIVA and DCIVA in group B was better than group A and Group C at 3 month and 6 months after surgery,and the differences were statistically significant(both p<0.05). Near distance visual acuity: The UNVA and DCNVA in group C were the best among three groups at 3 months after surgery,and the differences were statistically significant(both p<0.05).The UNVA and DCNVA in group B were the worst among three groups at 6 months after surgery,and the differences were statistically significant(both P<0.05).The UNVA and DCNVA of group A at 6 months after surgery were better than those at 3 months after surgery.2.Defoucs Curve The defocus curve of the group A was smooth at 3 months after surgery,and the best VA was at 0.00 D defocus.At 6 months after surgery,the defocus curve tended to be obvious double peaks with peaks at 0.00 D and-2.50 D respectively.The defocus curve of the group B showed a board plateau(0.00 D ～-2.00D),and the best visual acuity was at 0.00 D,while the worst visual acuity was at-3.0D.The defocus curve of the group C had obvious double peaks with peaks at 0.00 D and-3.00 D respectively.The group B achieved significantly higher visual acuity over the range of-2.00 D to-1.00 D defocus than that of group C at 3 months and 6 months postoperatively.At 3months after surgery,the visual acuity of group A was better than that of group C at-1.50 D and the visual acuity of group C was better than that of group A at-3.00 D,and the differences were statistically significant(both p<0.05).At 6 months postoperatively,the group B achieved significantly better visual acuity than that of group A at-1.50 D and-1.00 D,and the visual acuity of group A was better than that of group B at-3.00 D.3.Objective and Subjective DOF,Objective AOA Between-group analyses: At 3 months and 6 months after surgery,subjective DOF measures on 0.1 log MAR criterion of the group B was statistically significant higher than those of the group A and the group C(both p<0.05).Regarding objective DOF measures for 50%,60%,80%,90% threshold levels and the objective AOA,the the group A was statistically significant higher than those of the other groups.(both p<0.05).And the MTF cutoff of group A was lower than those of group B and C,while the HOA in group A was higher than those of the other two groups,with statistical significance(P<0.01)at 3 months and 6 months after surgery. Within-group analyses: In the group A,the subjective DOF(0.3 log MAR criterion)was statistically significant higher than the objective DOF measures under threshold levels of 80%,90% and the subjective DOF(0.1 log MAR criterion)was lower than the objective DOF measures under threshold levels of 50%,60% at 3months and 6 months postoperatively.At 3 months after surgery,the objective DOF measures under threshold levels of 50% was statistically significant higher than the objective AOA.At 6 months after surgery,the subjective DOF(0.1 log MAR criterion)and the objective DOF measures under threshold levels of 90% were both lower than objective AOA(both p<0.05). In the group B,at 3 months and 6 months postoperatively,the subjective DOF(0.3 log MAR criterion)was statistically significantly higher than the objective DOF measures under all threshold levels except for 50% and objective AOA.And the objective AOA and the subjective DOF(0.1 log MAR criterion)were both higer than the objective DOF measures under threshold levels of 90%.At 6 months after surgery,the subjective DOF(0.1 log MAR criterion)was higher than the objective DOF measures under threshold levels of 80%(both p<0.05). In the group C,at 3 months and 6 months postoperatively,the subjective DOF(0.3 log MAR criterion)was statistically significant higher than the objective DOF measures under threshold levels of 80%,90% and objective AOA.And the subjective DOF(0.1 log MAR criterion)was lower than the objective DOF measures under threshold levels of 50%.At 3 months after surgery,the objective DOF measures under threshold levels of 50% was statistically significant higher than the objective AOA(both p<0.05).4.Correlation analyses Correlation analyses of full data: At 3 months after surgery,the objective AOA was positively correlated with objective DOF measures for 50%,60%,80%,90%threshold levels(r=0.422,p=0.005;r=0.443,p=0.003;r=0.371,p=0.016;r=0.346,p=0.025).And the MTF cutoff was negatively correlated with objective AOA(r=-0.709,p < 0.001).At 6 months postoperatively,the objective AOA was negatively correlated with subjective DOF(0.1 log MAR criterion)(r=-0.397,p=0.009),and the MTF cutoff was negatively correlated with objective AOA(r=-0.747,p < 0.001). Correlation analyses by groups: At 3 months after surgery,the subjective DOF(0.3 log MAR criterion)of the group C was positively correlated with objective DOF measures for 90% threshold levels(r=0.581,p=0.037)and the MTF cutoff was negatively correlated with objective AOA(r=-0.684,p=0.010).At 6 months after surgery,in the group A,the subjective DOF(0.1 log MAR criterion)was positively correlated with objective DOF measures for 50%,60% threshold levels(r=0.723,p=0.005;r=0.604,p=0.029).And the subjective DOF(0.1 log MAR criterion)of group B was also significantly negatively correlated with objective AOA(r=-0.500,p=0.048).Conclusion:1.Different types of presbyopia-correcting IOLs could achieve satisfactory full range of visual acuity.The EDOF IOL could provide better intermediate-distance visual acuity,while the Seg Ref IOL and bifocal IOL could provide better neardistance visual acuity.2.EDOF IOL had higher subjective DOF,and the bifocal IOL had higher objective DOF and objective AOA.3.Although the Seg Ref IOL has higher objective DOF and AOA,the index of visual quality MTF cutoff and subjective DOF are lower.Therefore,high objective DOF and objective AOA do not mean better visual quality and greater clear visual range.4.The subjective DOF cannot be replaced by objective DOF or objective AOA measured by machine temporarily.Therefore,we should comprehensively use subjective and objective indicators to evaluate the postoperative visual function in order to provide a reasonable plan for preoperative surgical design. |
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