Biometric factors associated with the postoperative visual performance of a multifocal intraocular lens

Abstract

Purpose: To identify the biometric factors associated with postoperative visual performance after uneventful phacoemulsification with multifocal intraocular lens (MIOL) implantation.

Methods: In this retrospective cohort study, 72 eyes of 72 patients implanted with the HumanOptics Diff-aAY MIOL were included. Preoperative examination data including the white-to-white distance (WTW), anterior chamber depth (ACD), axial length and corneal astigmatism were gathered through the electronic medical records. One month postoperatively, the pupil parameters, corneal aberrations, corneal astigmatism, IOL tilts and IOL decentrations were measured using an OPD-Scan III aberrometer. Postoperative visual performance parameters were recorded as the visual acuity, depth of focus, modulation transfer function (MTF) and point spread function (PSF) values, area under log contrast sensitivity function (AULCSF), retinal straylight and visual function questionnaire scores. Univariate and multivariate linear regression analyses were then performed to evaluate the associations between the potential biometric factors and postoperative visual outcomes.

Results: Younger age predicted greater MTF and PSF values, better AULCSF and better retinal straylight (P < 0.05). A lower corneal trefoil predicted better MTF and PSF values (P < 0.05). Smaller IOL decentration predicted better distance-corrected near visual acuity, greater AULCSF and better retinal straylight (P < 0.05). A less negative spherical equivalent (SE) predicted better MTF values (P = 0.017), while a more negative SE predicted better Visual Function Index-14 (VF-14) questionnaire scores and satisfaction scores (P < 0.05). A higher IOL power predicted better best corrected distance visual acuity (P = 0.005). Lower preoperative corneal astigmatism predicted greater MTF values (P = 0.020). Lower postoperative corneal astigmatism, smaller corneal high-order aberrations (HOAs), smaller photopic pupil size, larger WTW and deeper ACD predicted a better AULCSF (P < 0.05).

Conclusions: IOL decentration, IOL power, age, preoperative and postoperative corneal astigmatism, SE, photopic pupil size, corneal trefoil, WTW, ACD and corneal HOAs were significantly associated with postoperative visual performance. These findings might aid in patient selection prior to MIOL implantation.

Keywords: Biometric factors; Multifocal intraocular lens; Multivariate linear regression analyses; Visual performance.

Fig. 1

A flowchart of the study process. WTW = white-to-white distance, ACD = anterior chamber depth, AL = axial length, SE = spherical equivalent, UDVA = uncorrected distance visual acuity, UNVA = uncorrected near visual acuity, CDVA = best corrected distance visual acuity, DCNVA = distance-corrected near visual acuity, MTF = modulation transfer function, PSF = point spread function, FACT = functional acuity contrast test, AULCSF = area under log contrast sensitivity function, VF-14 = Visual Function Index-14.

Fig. 2

Cutoff limits of the main determinants of postoperative visual outcomes. CDVA = best corrected distance visual acuity, DCNVA = distance-corrected near visual acuity, MTF = modulation transfer function, PSF = point spread function, AULCSF = area under log contrast sensitivity function, VF-14 = Visual Function Index-14.