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Purpose : To evaluate the effect of pupil size and decentration from the first Purkinje image on the long term visual outcomes at near, intermediate, and far distance, visual quality, and satisfaction in diffractive trifocal intraocular lense (IOL)
Methods : Twenty-six eyes of 26 cataract patients who underwent diffractive trifocal IOL (FineVision) implantation were enrolled. At 1 year after surgery, a postoperative visual acuity evaluation included the corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), manifest refraction, and defocus curves. OPD-Scan III aberrometer was used to measure the decentration of IOLs from the first Purkinje image. The effect of pupil size was evaluated by dividing the patients into two groups (Group 1; pupil size less than 3.5mm, Group 2; pupil size more than 3.5mm). Dysphotopsia, overall satisfaction, and spectacle independence were evaluated by questionnaire.
Results : Postoperative decentration of IOLs at 1 year was 0.22 ± 0.19mm and most decentered direction was temporal side of the first Purkinje image (14 eyes). The amount of IOL decentration was not associated with visual acuity at all distances. In Group I, pupil size showed negative correlation with spherical power (R=-0.764, P=0.001), visual acuity at 50cm (R=-0.674, P=0.008), 60cm (R=-0.794, P=0.001) and 80cm (R=-0.715, P=0.004). In group II, UCVA (R=0.840, P=0.001), visual acuity at 43cm (R=0.821, P=0.001) and 33cm (R=0.759, P=0.004) showed positive correlation to pupil size. In questionnaire, Group 1 showed more spectacle dependence than Group 2 at near and intermediate (P=0.019, P=0.012), but no significant difference on dysphotopsia (glare and halo) and subjective satisfaction.
Conclusion : Visual outcomes at near, intermediate, and far distance could be affected by the optic design in diffractive multifocal IOL.
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