Refractive topographic maps in assessing the quality of the ocular optical system with complex-design IOLs

Objective assessment of postoperative eye refraction in patients with implanted intraocular lenses (IOLs) featuring addition zones or a modified wavefront profile is challenging using conventional methods.

Aim. To analyze the diagnostic value of the method of objective refractive topographic mapping of the eye in patients with IOLs of complex optical design.

Material and Methods. A total of 198 patients (mean age 66.4 ± 7.8 years) with various types of IOLs – monofocal, multifocal, and extended depth of focus lenses were initially screened. Inclusion criteria: the absence of pathology of the cornea, vitreous, retina, or optic nerve; a postoperative follow-up period of six months or more. Exclusion criteria: uncorrected distance visual acuity of 0.7 or worse, opacity or folds of the posterior lens capsule. After applying inclusion and exclusion criteria and performing random eye selection (right or left) for eligible participants, 192 eyes were included in the final analysis. One eye per subject was chosen at random to avoid inter-eye correlation. All patients underwent a comprehensive ophthalmological examination, including objective assessment, visometry, tonometry, depth of focus (DoF) calculation based on the defocus curve (the diopter range within which visual acuity remains no lower than 0.5), wavefront aberrometry (Peramis, SCHWIND eye-tech-solutions GmbH, Germany) with refractive topographic map (RTM) construction and calculation of the refractive inhomogeneity index.

Results. The construction of RTMs revealed the distribution of refractive indicators across the entire scanning area and the presence of distinct addition zones in eyes with multifocal IOLs and extended depth of focus IOLs. Significant differences were found in the refractive inhomogeneity index values between groups (H(7) = 46.24, p = 0.0001) and varying levels of its consistency with DoF.

Conclusion. The method of pyramidal sensor-based aberrometry with refractive topographic mapping represents a highly informative approach for the objective assessment of the eye’s optical system in patients with complex-design IOLs and could serve as a foundation for the development of personalized cataract surgery.

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