Measurements of Multifocal Intraocular Lenses Using a Fluid-Filled Model Eye Charles Campbell This presentation is the result of work done with the assistance.

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Presentation transcript:

Measurements of Multifocal Intraocular Lenses Using a Fluid-Filled Model Eye Charles Campbell This presentation is the result of work done with the assistance of AMO/VISX Inc.

Wavefront measurement of eye with multifocal IOLs implanted An increasing number of eyes with multifocal intraocular lenses implanted Diffractive bifocals Refractive multifocals Correction of post implantation refractive error with laser refractive treatments Wavefront measurements of these eyes and use of the wavefront information for treatment planning What will a wavefront refractor find?

The diffractive bifocal - the optical situation - from the point of view of a Shack-Hartmann sensor S-H lenslet array with a 0.4 mm pitch Inner 12 zones of a diffractive bifocal IOL Inner most lenslets sample 1 zone Next lenslets sample 2 zones Outer lenslets sample multiple zones

Points spreads of S-H lenslets Wavefront from three zones with a 1/2 wave phase jump Wavefront from three zones with a 1/2 wave phase jump Wavefront from single zone S-H lenslet S-H sensor at 1 focal length from a lenslet

Points spreads of S-H lenslets The effect of measuring a wavefront at a wavelength different from the design wavelength Wavefront from two zones with a 1/2 wave phase jump Wavefront from two zones with less than a 1/2 wave phase jump S-H sensor at 1 focal length from a lenslet Doubled spots have equal amplitude Doubled spots have unequal amplitude

Effect on S-H spots of a annular zone multifocal design Rapid changes in power at annular zone transitions can occur within a single lenslet When the spatial variation of the wavefront is comparable to a lenslet size the spot will suffer from higher order aberrations

Experimental verification of this effect A diffractive bifocal or refractive multifocal IOL is placed in a fluid filled model eye The length of the model is adjusted to make the eye emmetropic for the distance focus of the IOL The eye is reconfigured so that it may be measured as a normal eye with a wavefront refractor The wavefront of the model with the IOL is measured The S-H spot pattern and the normal wavefront results are examined

Fluid filled test eye - transmission configuration Threaded central body to allow eye length to be changed Volume change reservoir Test eye main body Pupil/IOL holder disk Microscope slide glass window Removable rear window holder PMMA corneal shell with aspheric anterior surface Fluid with the index of refraction of the aqueous humor Rear body with threads for attached to microscope objective or wavefront refractor holder IOL held in pupil disk by its haptics

Fluid filled test eye - wave front refractor configuration Threaded central body to allow eye length to be changed Volume change reservoir Test eye main body Artificial retinal surface - dark gray matte paint Pupil/IOL holder disk Removable artificial retina PMMA corneal shell with aspheric anterior surface Fluid with the index of refraction of the aqueous humor Rear body with threads for attached to microscope objective or wavefront refractor holder IOL held in pupil disk by its haptics

Fluid filled test eye Reservoir Rear body Corneal shell Main body Rear window holder Central body Main body

Experimental setup - transmission mode to set eye length Microscope objective 100 mm Badal lens 10 micron pinhole Tungsten/halogen lamp CCD camera Fluid filled test eye

Experimental setup - measurement with wavefront eye refractor Wavefront eye refractor objective Threaded test eye holder Wavefront refractor headrest Fluid filled test eye

Shack -Hartmann spot patterns showing spot doubling Centered on pupil Vertically de-centered 0.2 mm Corneal reflex Spot doubling Spot doubling disappears as phase jump location changes ZM900, +25 D diffractive IOL, +4 Add, ‘Technis’ design i.e. aspheric surface to correct spherical aberration

Measurement results corneal shell only Corneal shell design parameters rfront= 7.80 mm, k = -0.10 material - PMMA rback = 7.22 mm, k = 0.0 central thickness = 0.5 mm

Measurement results ZM900

Shack-Hartmann spot patterns - refractive multifocal IOL Centered on pupil Vertically de-centered 0.5 mm Change in centration causes change in spot pattern NXG1 +25 D refractive multifocal IOL, +4 Add, annular alternating distance/near design

Measurement results NXG1

Summary- diffractive IOL Diffractive bifocal IOLs cause S-H spots to double In the presence of spot doubling, one wavefront eye refractor (WaveScan) found the correct distance refractive error value and reasonable higher order aberration values The presence of a diffractive IOL in the eye can be detected by the presence of S-H spot doubling Clinically, the use of wavefront eye refractor finding may be used, with caution, to plan a post IOL implant refractive correction

Summary- refractive IOL Refractive multifocal IOL cause S-H spot pattern distortion In the presence of spot distortion, one wavefront eye refractor (WaveScan) does not finds the correct distance refractive error value and nor does it find reasonable higher order aberration values The presence of a refractive IOL in the eye can be detected by the presence of S-H spot distortion Clinically, it would be better to use subjective refraction findings to plan a post IOL implant refractive correction

Thank you