1. Mayank A. Nanavaty, DO, MRCOphth, MRCS(Ed) David J. Spalton, FRCP, FRCS, FRCOphth James F. Boyce, PhD Thomas J. T. P. Van den berg, PhD St. Thomas’ Hospital, London None of the authors have any financial or proprietary interest

2. Optical quality of vision is dependent on aberrations, PSF, MTF and ocular scatter apart from visual acuity. There is paucity of information on influence of IOL material on optical quality One published study objectively quantifying the relationship between IOL material and ocular scatter Tanaka et al. Limitation of Scheimpflug videophotography system in quantifying posterior capsule opacification after intraocular lens implantation. Am J Ophthalmol 2004 Apr;137(4):732-5.

3. Aim To analyze the effect of IOL material on optical quality in eyes with clear posterior capsules using the asymmetric double pass technique with Optical Quality Analysis System (OQAS II)

4. Methods Retrospective, non-randomized, observational study Patients with clear posterior capsule were recruited from the follow up of two different ongoing prospective, randomized fellow eye controlled studies comparing Hydrophilic - AcriSmart 36A & Akreos MI60 Hydrophobic - AcrySof IQ & AcrySof Natural Single surgeon with standardized surgical technique

5. AcriSmart 36A Akreos MI60 AcrySof IQAcrySof Natural Hydrophobic IOLs Hydrophilic IOLs Eyes with clear capsule in central 4mm zone on POCOman analysis of digital retro-illumination images were recruited

6. Methods Data of: 100% & 9% LogMAR BCVA Entire eye aberrations at 4mm scan size 50% & 10% PSF, MTF and Strehl ratio after correcting LOA was extracted for these eyes with clear posterior capsules Two 20D IOLs of each IOL type was sent for in-vitro analysis of light scatter

7. 160 eyes of 80 patients were screened 71 eyes of 46 patients had clear capsules 58 were white Caucasians, 9 Afro-Caribbean, 2 Indians, 2 Mongolians Hydrophilic IOLs [mean ± standard deviation (95% confidence interval)] (n=28) Hydrophobic IOLs [mean ± standard deviation (95% confidence interval)] (n=43) p values* Postoperative duration (days) 127.7 ± 41.2 (122.3, 133.0) 342.6 ± 65.6 (335.7, 349.4) 0.000 ¥ IOL power (diopters) 19.75 ± 5.20 (19.07, 20.43) 21.13 ± 4.02 (20.71, 21.55) 0.240 Postoperative Spherical Equivalent (Diopters) -0.19 ± 0.60 (-0.27, -0.11) -0.10 ± 0.59 (-0.16, -0.04) 0.534 *Unpaired two tailed t test, ¥ Statistically significant, p < 0.05, BCVA = Best corrected visual acuity, No significant difference in aberrations at 4 mm scan size except Zernicke’s polynomial 4 (defocus)

8. Hydrophobic Acrylic Hydrophilic Acrylic p = 0.127 p = 0.000

9. Optical Quality analysis system (OQAS II) Measurements done after correcting sphere and cylinder p = 0.008 p = 0.005 Hydrophobic Acrylic Hydrophilic Acrylic There was no significant difference in MTF and Strehl ratio between to the two IOL groups PSF measurements

10. Although in-vitro scatter levels are low with acrylic IOLs, hydrophilic acrylic IOLs have more scatter than hydrophobic acrylic IOLs

11. IOL material has no effect on 100% BCVA, entire eye aberrations, MTF and Strehl ratio Hydrophilic Acrylic IOLs have reduced 9% LogMAR BCVA Ocular scatter is more with hydrophilic Acrylic IOLs This may be because of increased opalescence of the hydrophilic acrylic material due to more water content