EXTENDED DEPTH OF FOCUS WITH INDUCED SPHERICAL ABERRATION IN LIGHT ADJUSTABLE IOLs Pablo Artal, Eloy Villegas, Encarna Alcón, Inés Yago*, Elena Rubio*, José M. Marín* LABORATORIO DE OPTICA, UNIVERSIDAD DE MURCIA, SPAIN * Hospital Virgen de la Arrixaca, Murcia, SPAIN Supported by: Reserch funding and consulting reimbuserment provided by Calhoun Vision, USA

* Light-adjustable intraocular lenses (LALs)* allow nearly PERFECT refractive outcomes, but also… customized near vision by extended depth of focus with induced spherical aberration. *

Spherical aberration increases depth of focus

(See example of LAL full treatment in next slide) LAL secondary treatments to induce spherical aberration (asphericity) increasing depth of focus (See example of LAL full treatment in next slide)

Inducing spherical aberration Secondary adjustment Inducing spherical aberration Primary adjustment correcting defocus & astigmatism lock-ins Two weeks Surgery eye’s wave-fronts (examples) This is an example of the complete procedure. After standard surgery, two weeks are waited to allows corneal stabilization. Then light adjustments are performed to correct the remining refractove errors. Once optimum refraction is obtained, the lenses are lock. During this period pateints wear protective spectacles to avoid any change sin the lenses produce by sun light

Patients were implanted bilaterally with LALs One eye was set to near emmetropia and in the fellow eye negative spherical aberration was induced

Visual acuity was measured using a computer-assisted procedure both monocularly (each eye separately) and binocularly Refraction and spherical aberration measured in each patient with a Hartmann-Shack wavefront sensor

and with letters on a micro-display placed at: 60 cm 40 cm 30 cm

Example of induction of negative spherical aberration in LALs Pre-adjusment Post-lockin 2 Myopic M1SA3_60 Aspheric F4.7_b0.5 Z12=+0.12mm Z12 =-0.20mm > |-0.3| mm

Visual acuity as a function of object distance Monocular (“far” eye) Monocular (“near” aspheric eye) Binocular vision 20/20 20/25 J1 20/30 J2 20/40 J3 Z12[-0.14,-0.24 mm] (sample 4)

Visual acuity as a function of object distance Binocular vision 20/20 20/25 J1 20/30 J2 20/40 J3 Z12[-0.14,-0.24 mm] (sample 4)

Conclusions The use of the LALs as an advanced and fully customized approach to produce extended depth of focus modifying the eye’s asphericity has been demonstrated. In a group of 4 patients, the average binocular visual acuity was 1.1 for far and J1 or better for intermediate and near distances. The particular amounts of spherical aberration and defocus can be personalized to maximize quality of vision at all distances.