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Wavefront Automated Refraction Comparison of Three Different IOLs: Aspheric Monofocal and Two Enhanced Monofocal

Arthur Buffara van den Berg1,2,3, Roberta Matschinske van den Berg1,2,3, Bernardo Kaplan Moscovici1,4

  • 1Department of Ophthalmology and Visual Sciences, Federal University of São Paulo (UNIFESP), São Paulo 04038-001, SP, Brazil.

Vision (Basel, Switzerland)
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Summary

Automated refraction using iTrace and LadarWave showed less agreement with subjective manifest refraction in enhanced monofocal intraocular lenses (IOLs) compared to standard IOLs. Manifest refraction remains crucial for postoperative assessment, especially with advanced IOL designs.

Keywords:
aberrometrycataractcataract extractionintraocular lensesrefractionvisual acuity

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Area of Science:

  • Ophthalmology
  • Optical Engineering
  • Biomedical Optics

Background:

  • Enhanced monofocal intraocular lenses (IOLs) offer improved visual quality by managing optical aberrations.
  • Wavefront-based automated refraction technologies, such as iTrace and LadarWave, aim to provide objective refractive measurements.
  • Comparing the agreement between subjective manifest refraction and automated methods is crucial for understanding postoperative refractive outcomes with different IOL designs.

Purpose of the Study:

  • To compare subjective manifest refraction with wavefront-based automated refraction (iTrace and LadarWave) in eyes with enhanced monofocal IOLs (Tecnis Eyhance, RayOne EMV) and a standard aspheric monofocal IOL (Tecnis ZCB00).
  • To evaluate the agreement and refractive variability across different IOL optical designs using automated and subjective refraction methods.

Main Methods:

  • Retrospective cohort study of 84 eyes from 42 patients implanted with three different monofocal IOLs.
  • Postoperative evaluation included visual acuity, subjective manifest refraction, and automated refraction using iTrace (ray tracing) and LadarWave (Hartmann-Shack).
  • Agreement was assessed using statistical methods including Bland-Altman analysis and linear mixed-effect modeling to compare spherical equivalent (SE) across methods and IOL types.

Main Results:

  • Subjective SE differed significantly among IOL types, with RayOne EMV showing a more myopic outcome than Tecnis ZCB00.
  • Automated refraction exhibited greater variability and poorer agreement (wider limits of agreement, fewer eyes within ±0.50 D) for enhanced monofocal IOLs compared to the standard aspheric IOL.
  • Both iTrace and LadarWave demonstrated a myopic bias versus manifest refraction for enhanced monofocal IOLs, with iTrace showing non-significant differences for the standard IOL.

Conclusions:

  • Enhanced monofocal IOLs result in reduced agreement between wavefront-based automated refraction and subjective manifest refraction compared to standard aspheric monofocal IOLs.
  • Subjective manifest refraction remains essential for accurate postoperative assessment.
  • Automated refraction measurements should be considered complementary, particularly for IOLs designed to modify optical aberrations.