1. Variations in refractive analysis with different diffractive multifocal intraocular lenses using different wavefront analyzers Mami Yoshino, Hiroko Bissen-Miyajima, Shinichi Oki, Keiichiro Minami, Kunihiko Nakamura Department of Ophthalmology Tokyo Dental College Suidobashi Hospital, Tokyo, Japan Naoyuki Maeda Department of Ophthalmology Osaka University Medical School, Osaka, Japan Yoshino, Bissen-Miyajima, Oki, Minami and Nakamura: No financial Interest Maeda: Research grant recipient from Topcon Corp.

2. PURPOSE It is still under discussion whether the Hartman-Shack wavefront analyzer represents real wavefront aberration of the multifocal intraocular lens (MF-IOL) implanted eye. This study evaluated the refractions of diffractive MF-IOL implanted eyes using two wavefront analyzers with manifest refraction.

3. SUBJECTS 15 eyes of 8 patients who received diffractive MF-IOL

4. METHODS Manifest Refraction Refraction by wavefront analyzer 1.KR-9000PW (Topcon, Japan) 2.WaveScan (AMO, US) VS: 0.9 (1.2 x +0.75D sph. cyl. -0.75 D) Spherical refraction Cylindrical refraction To verify if the wavefront analyzer results represent real wavefront aberration, refraction data were compared with those with manifest

5. Wavefront Analyzer KR-9000PWWaveScan Wavefront sensorHartmann-Shack No of spots (7 mm pupil)169 points240 points Wavelength at measure840 nm785 nm Centering pointCorneal apexPupil center (scotopic) Examination roomRoom lightDim light (5cd/m 2 ) PupilDilatedScotopic RefractionSpectacle plane

6. Optical zone: 4 mm & 6 mm WaveScan Optical zone: 5.94±0.75 mm Hartmann-Shack spot images and evaluation ZM900 SA60D3 Spots were doubledSpots were clearer in the center ZM900 SA60D3 Analysis difficult due to spot irregularity Spots were doubled or not clear Evaluation was possible in all eyes tested3 eyes failed for evaluation KR-9000PW

7. ManifestWavefrontDifference p value (Wilcoxon) Sphere (D) Total0.27±0.520.52±0.490.25±0.30p<0.05 ZM9000.17±0.330.57±0.250.40±0.13p<0.01 SA60D30.42±0.740.45±0.750.04±0.36p=0.917 Cylinder (D) Total-0.62±0.43-0.98±0.450.36±0.38p<0.01 ZM900-0.47±0.46-0.70±0.310.22±0.32p=0.086 SA60D3-0.83±0.30-1.10±0.690.58±0.40p<0.05 RESULTS ： KR-9000PW

8. ManifestWavefrontDifference P value (Wilcoxon) Sphere (D) Total0.27±0.521.04±0.510.71±0.56p<0.05 ZM9000.17±0.331.07±0.500.88±0.41p<0.05 SA60D30.42±0.530.98±0.530.34±0.62p=0.273 Cylinder (D) Total0.62±0.43-0.94±0.600.32±0.41p<0.01 ZM9000.47±0.46-0.69±0.370.16±0.29p<0.05 SA60D30.83±0.30-1.45±0.360.64±0.52p=0.144 RESULTS ： WaveScan

9. The difference of spherical and cylindrical refractions between manifest and wavefront were within 0.5D. Coincidence in refraction may support that Hartmann- Shack analyzer measures distance wavefront of diffractive MF-IOL properly. DISCUSSION ： Reliability of refraction with Hartmann-Shack analyzer

10. Cyrindrical refraction was very close between KR-9000PW and WaveScan. With KR-9000PW, spherical refraction was closer to manifest. DISCUSSION ： Differences between 2 wavefront analyzers Differences between 2 multifocal IOLs Hartmann-Shack images were clearer and easier to be analyzed in eyes with ZM900.

11. CONCLUSION In this preliminary study, the difference between the wavefront refraction and manifest refraction can be influenced by the design of the diffractive MF-IOL and the characteristics of the wavefront analyzer. These effects should be considered for not only 2 nd order aberration, but also higher order aberration in eyes with diffractive MF- IOLs.

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