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Effect of Monofocal, Wavefront-Shaped, and Diffractive Trifocal IOLs on Scanning-Slit Automated Refraction
TAKE-HOME MESSAGE
- This retrospective analysis of the results of autorefraction versus manifest refraction in a cohort of patients who had undergone cataract extraction and lens implantation with four different intraocular lenses (Acrysof IQ Vivity, Acrysof IQ Panoptix, Tecnis ZCBOO, and Envista Mx60E) showed that autorefraction using the scanning-slit retinoscopy (OPD-Scan III) device rendered statistically significant more myopic results in all groups than did the "push-plus" manifest refraction. A discussion of the optics is included.
- The authors conclude that autorefraction should not replace subjective refraction and, in some cases, should not even be used as a starting point.
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersPURPOSE
To compare scanning-slit retinoscopy automated refraction spherical equivalent (ARSE) to subjective manifest refraction spherical equivalent (MRSE) in normal eyes with four different types of intraocular lenses (IOLs).
DESIGN
Retrospective cross-sectional study METHODS: 279 pseudophakic eyes that underwent lens extraction at a private center with implantation of either a wavefront shaped IOL (Acrysof® Vivity, DFT015), a nonapodized diffractive trifocal IOL (Acrysof® Panoptix), or a monofocal IOL with negative spherical aberration (Tecnis ZCBOO) or aberration-free (Envista Mx60E). Patients who had an automated refraction measurement with retinoscopy refractometer and aberrometer (NIDEK OPD Scan III, Nidek Technologies) and subjective refraction data 1-2 months postoperatively were included in the study. Main outcome measured was the difference between automated refraction and subjective refraction.
RESULTS
Sixty-one eyes implanted with a DFT015 IOL, 78 eyes with a TFNT00 IOL, 40 with a ZCBOO IOL and 100 with a Mx60E IOL were enrolled in this study. Statistically significant myopic results were observed when using ARSE compared to MRSE in the DFT015 (-0.95±0.64, -0.33±0.65, p < .001), TFNT00 (-0.43±0.36, -0.2±0.35, p <.001), ZCBOO (-0.81±0.63, -0.4±0.69, p = .008) and Mx60E (-0.75±0.65, -0.45±0.52; p <0.05) IOL groups. The absolute difference between the 2 methods was statistically significant in the DFT015 IOL group (0.65±0.49; p< 0.05).
CONCLUSION
Automated refraction yields myopic results in pseudophakic eyes with monofocal and presbyopia correcting IOLs and may be used with caution. Manifest refraction "push-plus" technique should be used in all pseudophakic eyes to avoid over-minus prescriptions, especially in patient with residual refractive error following cataract surgery.
Additional Info
Disclosure statements are available on the authors' profiles:
Effect of monofocal, wavefront-shaped and diffractive trifocal intraocular lenses on scanning-slit automated refraction
Am J Ophthalmol 2024 Sep 26;[EPub Ahead of Print], L Gouvea, S AlShaker, KM Rocha, W Chamon, CC Chan, DS RootmanFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The authors retrospectively compared subjective manifest refractions (MRs) with automated refractions (ARs) obtained using scanning-slit retinoscopy (Nidek OPD-Scan III) in a series of patients with pseudophakia implanted with monofocal, trifocal, or extended depth-of-focus (EDOF) intraocular lenses (IOLs). They found that ARs were consistently more myopic than MRs for all groups tested, regardless of IOL type. The results were most myopic for ARs in the EDOF group. These results are unsurprising and are mostly owing to the ambiguous refractive endpoint, which is especially evident among patients implanted with trifocal and EDOF IOLs.
Although subjective MR is mostly driven by the sphere and cylinder that minimize blur on the retina, it is also influenced by each individual's unique pattern of higher-order aberrations and their neural adaptation to these additional refractive errors. This is why any AR based on optical principles alone will never match an MR. Unfortunately, we are stuck with the subjective endpoint as the gold standard for now.
However, I do believe that this is an area of research in which artificial intelligence may play a future role. It is plausible that artificial intelligence, or even a more sophisticated AR nomogram, could anticipate and compensate for neural adaptations that occur in response to individual refractive errors. Only time will tell.