Transcript Slide 1

Global Meta-Analysis on
Visual and Optical Quality Comparison for
Aspheric vs Spherical IOL Technology
James P. McCulley, MD
Department of Ophthalmology
University of Texas Southwestern Medical Center at Dallas
Dr McCulley is a consultant
for Alcon Laboratories, Inc.
Purpose
To address the question of whether
patient visual and optical quality outcomes
are benefited by implantation with aspheric IOLs
instead of spherical IOLs
Modeling suggests a difference should exist1
Literature of controlled clinical studies has matured enough
to merit systematic review to yield collective answers
1. Holladay JT, et al. J Refract Surg. 2002;18:683-691
Methods:
Literature Searches for Published Articles
OvidSP Database
(MEDLINE, EMBASE pooled)
Keyword searches:
1. “intraocular lens” AND aspheric*
2. “intraocular lens” AND prolate
53 unique English-language results
Discard reviews, editorials, case reports,
methodology recommendations, preclinical trials
Discard studies about
multifocal or accommodative IOLs
Discard studies
without spherical controls
24 journal articles
*Wildcard asterisk symbol returns “aspheric” or “aspherical,” etc.
Methods:
Society Database Searches for Congress Abstracts
2008 only (assumption: abstracts from earlier meetings had time to reach publication)
ASCRS
ESCRS
ARVO
keyword†
keyword†
browsing‡
intraocular + lens + aspheric
Intraocular + lens + aspherical
intraocular + lens + aspheric
Intraocular + lens + aspherical
“Aspheric IOLs,”
“IOL technology”
8 abstracts
24 abstracts
17 abstracts
Discard abstracts without relevant visual acuity outcomes reported
Discard abstracts about multifocals or without spherical controls
2 abstracts
7 abstracts
1 abstract
10 abstracts
†No
wildcard functionality
searchable; browsed free paper sessions
AAO had 15 hits but no relevant results (not shown).
‡Not
Methods:
Pooled Source Data
34 studies, 2832 eyes
Aspheric IOLs
Spherical Control IOLs
Model
Company
Studies, n
Model
Company
Studies, n
Tecnis
AcrySof IQ
Akreos Adapt AO
SofPort AO
XL Stabi ZO
AcriSmart 36 A
AMO
Alcon
B&L
B&L
Zeiss
Acri.Tec
19
13
1
1
1
1
Sensar
AcrySof Natural
AcrySof SA60AT
ClariFlex
CeeOn Edge
XL Stabi Sky
Acri.Smart 46 S
AMO
Alcon
Alcon
AMO
AMO
Zeiss
Acri.Tec
11
9
8
2
5
1
1
ACR6D SE
Corneal
1
AA4207VF
Staar
1
Stabibag
AcrySof MA60BM
Ioltech
Alcon
1
1
Control design
• Groupwise: 17 studies
• Contralateral/intraindividual: 13 studies
• Unclear/unspecified: 4 studies
Older IOL names or manufacturers updated to most recent.
Results:
Optical Quality Outcomes
 In no case did a spherical lens outperform an aspheric lens
 Study marked “yes” if aspheric IOL performed better than
spherical IOL under any condition (eg, pupil size)
Number of studies
with result
– 100% of studies (n = 23) found aspheric  reduction of spherical aberration
– 73% (n = 11) found aspheric  reduction of total high-order aberration
25
Aspheric
significantly
better?
20
15
Yes
10
5
0
0
total high-order
spherical
Aberration type
No
Results:
Visual Acuity
 In no case did a spherical lens outperform an aspheric lens
 Study marked “yes” if aspheric IOL performed better than
spherical IOL at any time point
Number of studies
with result
– 11% of studies (n = 1) found aspheric  superior uncorrected visual acuity
– 7% (n = 2) found aspheric  superior best-corrected visual acuity
– 50% (n = 2) found aspheric  superior low-contrast visual acuity
30
Aspheric
significantly
better?
25
20
Yes
15
10
5
0
uncorrected
best corrected
low contrast
Visual acuity measure
No
Results:
Contrast Sensitivity (CS)
 In no case did a spherical lens outperform an aspheric lens
 Study marked “yes” if aspheric IOL performed better than
spherical IOL at any spatial frequency
Number of studies
with result
– 62% of studies (n = 16) found aspheric  superior photopic CS
– 86% (n = 18) found aspheric  superior mesopic CS
– 82% (n = 9) found aspheric  superior mesopic + glare CS
20
Aspheric
significantly
better?
15
Yes
10
5
0
photopic
mesopic
mesopic + glare
Contrast sensitivity conditions
No
Results:
Depth of Focus (Range of Accommodation)
 Only two studies reported this parameter
– 50% (n = 1) found aspheric IOL superior
• AcrySof IQ superior over AcrySof Natural
– 50% (n = 1) found aspheric not different from spherical IOL
• Akreos Adapt AO not superior over Sensar
Conclusions
 Aspheric IOL performance was never inferior to
spherical IOLs on any metric
 Aspheric IOLs were superior on many metrics of optical
quality and visual quality (especially contrast sensitivity)
 Surgeons should consider aspheric IOLs for their patients
References
(Database for Meta-Analysis)
Journal articles
1. Ricci F, et al. Acta Ophthalmol Scand 2004;82:718-722.
2. Rocha KM, et al. Am J Ophthalmol 2006;142:750-756.
3. Tzelikis PF, et al. Am J Ophthalmol 2008;145:827-833.
4. Kennis H, et al. Bull Soc Belge Ophtalmologie 2004;49-58.
5. Chen WR, et al. Chinese Med J 2006;119:1779-1784.
6. Zeng M, et al. Clin Exp Ophthalmol 2007;35:355-360.
7. Awwad ST, et al. Eur J Ophthalmol 2007;17:320-326.
8. Xu R-F, et al. Int J Ophthalmol 2007;7:319-321.
9. Subrayan V, et al. Int J Ophthalmol 2007;7:918-920.
10. Packer M, et al. J Refract Surg 2002;18:692-696.
11. Padmanabhan P, et al. J Refract Surg 2006;22:172-177.
12. Awwad ST, et al. J Refract Surg 2008;24:619-625.
13. Mester U, et al. JCRS 2003;29:652-660.
14. Kershner RM. JCRS 2003;29:1684-1694.
15. Packer M, et al. JCRS 2004;30:986-992.
16. Bellucci R, et al. JCRS 2005;31:712-717.
17. Munoz G, et al. JCRS 2006;32:1320-1327.
18. Kasper T, et al. JCRS 2006;32:2022-2029.
19. Tzelikis PF, et al. JCRS 2007;33:1918-1924.
20. Bellucci R, et al. JCRS 2007;33:203-209.
21. Pandita D, et al. JCRS 2007;33:603-610.
22. Kurz S, et al. JCRS 2007;33:393-400.
23. Denoyer A, et al. JCRS 2007;33:210-216.
24. Lin IC, et al. JCRS 2008;34:1312-1317.
Abstracts
1. Cox IG, et al. ARVO 2008.
2. Habibollahi, A. ESCRS 2008.
3. Jeong J, et al. ASCRS 2008.
4. Kandil H, et al. ESCRS 2008.
5. Nanavaty M, et al. ESCRS 2008.
6. Seyeddain O, et al. ESCRS 2008.
7. Thiagarajan M, et al. ESCRS 2008.
8. Trüb P, Albach C. ESCRS 2008.
9. Vokrojova M, et al. ASCRS 2008.
10. Zamani M, Feghhi M. ESCRS 2008.