Intraindividual Comparison of Aspherical

and Spherical Intraocular Lenses of Same

Material and Platform
Shinichiro Ohtani, MD,1 Kazunori Miyata, MD,1 Tomokazu Samejima, COT,1 Masato Honbou, COT,1
Tetsuro Oshika, MD2

Purpose: There have been few studies which compared aspherical and spherical intraocular lenses (IOLs) of
same material and platform in bilateral cataract cases. We performed an intraindividual comparison of ocular
aberration and scotopic, mesopic, and photopic contrast sensitivity with aspherical and spherical IOLs, using the
same IOL material and platform manufactured by the same company.
Design: Prospective, randomized, controlled study.
Participants: Eighty-two eyes of 41 patients undergoing bilateral cataract surgery.
Methods: One eye of a patient was assigned to acrylic foldable aspherical IOL (Tecnis ZA9003, Advanced
Medical Optics), and the contralateral eye was allocated to acrylic foldable spherical IOL (AR40e, Advanced
Medical Optics). All patients were examined at 2 days, 1 week, and 1 month postoperatively.
Main Outcome Measures: Best-corrected visual acuity (BCVA), contrast sensitivity under scotopic (15 lux),
mesopic (70 lux), and photopic (180 lux) conditions, corneal and ocular wavefront aberrations, anterior chamber
depth, amount of IOL decentration and tilt, pupil diameter under scotopic (3 lux) and photopic (250 lux)
conditions, area of anterior capsule opening, degree of posterior capsule opacification, and all-distance visual
acuity.
Results: There was no significant difference between IOLs in BCVA, anterior chamber depth, amount of IOL
decentration and tilt, pupil diameter, area of anterior capsule opening, and degree of posterior capsule opaci-
fication. In corneal wavefront aberrations, there was no difference in 3rd-, 4th-, and total higher-order root-
mean-square (RMS). In ocular wavefront aberration, aspherical IOL showed significantly lower 4th-order
(P⬍0.001) and total higher-order RMS (P⬍0.001) than spherical IOL, but not in 3rd-order RMS (P ⫽ 0.103).
Contrast sensitivity under scotopic conditions was significantly better with aspherical IOL than with spherical IOL
at 3 (P ⫽ 0.0015), 6 (P ⫽ 0.0192), and 12 cycles per degree (P ⫽ 0.0315). Contrast sensitivity under mesopic and
photopic conditions was not significantly different between IOLs. There was no between-group difference in
visual acuity at 0.3, 0.5, 0.7, 1.0, or 5.0 meters measured with full distance correction.
Conclusions: Acrylic foldable aspherical IOL (Tecnis ZA9003) yielded significantly lower ocular wavefront
aberration and better contrast sensitivity under scotopic condition without compromising depth of focus.
Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed
in this article. Ophthalmology 2009;116:896 –901 © 2009 by the American Academy of Ophthalmology.

Aspherical intraocular lenses (IOLs) having negative spher- ing the study an intraindividual comparison, using the
ical aberrations are designed to compensate for the positive same IOL material manufactured by the same company,
spherical aberration of the cornea. There have been many and having the same surgeon perform bilateral surgery
clinical studies comparing clinical outcomes, such as ocular within 1 week using an identical surgical technique.19,20
higher-order aberration and contrast sensitivity, between One of them compared acrylic foldable aspherical (AcrySof
aspherical and spherical IOLs.1–20 IQ, Alcon, Fort Worth, TX; spherical aberration, ⫺0.20
In general, the difference in visual function after im- ␮m) and spherical IOLs (AcrySof Natural, Alcon),19 and
plantation of aspherical and spherical IOLs is rather the other assessed silicone foldable aspherical (Tecnis
small. Moreover, the amount of ocular and corneal aber- Z9001, Advanced Medical Optics, Santa Ana, CA; spher-
rations varies widely among subjects.21–25 There have ical aberration, ⫺0.27 ␮m), and spherical IOLs (ClariFlex,
been few studies comparing corneal aberration before Advanced Medical Optics).20 Several aspheric IOLs with
comparing ocular aberration in eyes with aspherical and a different amount of asphericity in the optic are mar-
spherical IOLs.10,14 Thus, a meticulous study design is keted. In the current study, we compared acrylic foldable
needed to compare these 2 IOLs in clinical settings. Until aspherical (Tecnis ZA9003, Advanced Medical Optics;
now, there have been only 2 studies that made significant spherical aberration, ⫺0.27␮m) and spherical IOLs (Sen-
efforts to reduce the bias that can occur in a comparative sar AR40e, Advanced Medical Optics) in patients under-
clinical study of aspherical and spherical IOLs, by mak- going bilateral cataract surgery.

896 © 2009 by the American Academy of Ophthalmology ISSN 0161-6420/09/$–see front matter
Published by Elsevier Inc. doi:10.1016/j.ophtha.2008.11.022
 Ohtani et al 䡠 Intraindividual Comparison of Aspherical and Spherical IOLs

Patients and Methods degree of posterior capsular opacification was also analyzed using
Scheimpflug slit images of 4 sections from 0° to 135°. The mean
Patient Selection density of the central 3 mm on the posterior capsular area was derived
by densitometry and the scatter light density was expressed as the
The current prospective, randomized study included 82 eyes of 41 computer-compatible tape steps.36,37
patients who were undergoing bilateral cataract surgery. Their ages
ranged from 52 to 82 years (mean ⫾ standard deviation, 75.3⫾5.3),
and there were 13 males and 28 females. They were selected from Statistical Analysis
consecutive cases among the clinic population who matched our The difference in contrast sensitivity was set as primary outcome.
inclusion criteria. None of the eyes had any history of previous ocular A prestudy power calculation using a significance level of 5% (␣)
surgery. Eyes were not included if they had any ocular diseases that and a power of 80% (1⫺␤) revealed that a sample size of 36 in
could affect surgical outcomes. The research protocol had institutional each group would be required to detect a mean log contrast
review board approval, and written informed consent was obtained sensitivity difference of 0.1 between the aspherical and spherical
from each patient. The study adhered to the tenets of the Declaration IOL groups. The study size was also estimated using data from
of Helsinki. previous studies that compared the postoperative performance of 2
acrylic foldable spherical IOLs.38,39 Aiming to detect a difference
Intraocular Lenses in decentration of 0.06 mm with a significance level of 5% and a
power of 80%, a sample size of 64 eyes of 32 patients was
We used acrylic foldable aspherical IOL (Tecnis ZA9003) and spher- calculated. For the detection of a difference in tilt of 0.8° with a
ical IOL (Sensar AR40e). Both lenses have overall length of 13.0 mm significance level of 5% and a power of 80%, a sample size of 60
with the optic of 6.0 mm in diameter, which is made of foldable eyes of 30 patients was calculated. To account for dropouts be-
acrylic material (refractive index, 1.470). The haptics consist of poly- cause of loss to follow-up during the postoperative period, 82 eyes
methylmethacrylate material and have 5° configuration. of 41 patients were included in this study.
One eye of a patient was assigned to aspherical IOL, and the The parameters were statistically compared between eyes in-
contralateral eye was assigned to spherical IOL. The assignment traindividually using Wilcoxon signed-rank test. For statistical
was randomly determined using an envelope method. All cataract analysis of visual acuity, logarithm of the minimum angle of
operations, consisting of phacoemulsification and IOL implanta- resolution was used. Statistical analyses were performed using
tion, were performed by one surgeon (K.M.) using identical sur- SPSS 16.0 software (SPSS, Chicago, IL). P⬍0.05 was considered
gical methods for each eye. significant.

Outcome Measures
Patients were followed at 2 days, 1 week 1, and 1 month after
Results
surgery. Best-corrected visual acuity (BCVA), contrast sensitivity Preoperative pupil diameter under photopic condition was 3.57⫾0.37
under scotopic (15 lux), mesopic (70 lux), and photopic (180 lux) and 3.59⫾0.43 mm (P ⫽ 0.440, Wilcoxon signed-rank test) in the
conditions, corneal and ocular wavefront aberrations, anterior aspherical and spherical IOL groups, respectively. Pupil diameter
chamber depth, amount of IOL decentration and tilt, pupil diam- before surgery under scotopic condition was 5.31⫾0.69 and
eter under scotopic (3 lux) and photopic (250 lux) conditions, area 5.29⫾0.71 mm (P ⫽ 0.367) in the aspherical and spherical IOL
of anterior capsule opening, degree of posterior capsule opacifi- groups, respectively. Table 1 summarizes the postoperative mea-
cation, and all-distance visual acuity were measured. All measure- surement results. There was no significant difference between
ments were conducted by masked examiners who were unaware of IOLs in BCVA, anterior chamber depth, amount of IOL decentra-
the assignment of eyes. tion and tilt, pupil diameter, area of anterior capsule opening, and
All-distance visual acuity was measured using an all-distance degree of posterior capsule opacification.
vision tester (AS-15; KOWA, Tokyo, Japan).26,27 With full dis- In corneal wavefront aberrations, there was no difference in
tance correction, decimal visual acuity at 5.0, 1.0, 0.7, 0.5, and 0.3 3rd-, 4th-, and total higher-order RMS (Fig 1). In ocular wavefront
meters was recorded. This device measures equivalent visual acu- aberration, the aspherical IOL group showed significantly lower
ity from far to near distances by adding various diopters of spher- values in 4th-order (P⬍0.001) and total higher-order RMS
ical lens on a screen. Contrast sensitivity was measured by using (P⬍0.001) than the spherical IOL, but not in 3rd-order RMS (P ⫽
CSV-1000E (Vector Vision, Greenville, OH). The test was per- 0.103; Fig 2).
formed monocularly with undilated pupils at 2.5 meters with full Contrast sensitivity under scotopic condition (15 lux) was
spectacle correction. Corneal and ocular wavefront aberration in significantly better with the aspherical IOL than with the spherical
the central 4-mm area was measured with the Hartmann-Schack IOL at 3 (P ⫽ 0.0015), 6 (P ⫽ 0.0192), and 12 cycles per degree
wavefront analyzer KR-9000PW (Topcon Co., Tokyo, Japan), and (P ⫽ 0.0315; Fig 3). Contrast sensitivity under mesopic (70 lux)
the root-mean-square (RMS) of 3rd-, 4th-, and total higher-order and photopic (180 lux) conditions was not significantly different
aberrations were calculated.28 –31 between IOLs (Figs 4 and 5).
The Anterior Segment Analysis System (NIDEK EAS-1000) was The results of the all-distance vision tester are shown in Figure 6.
used to quantify anterior chamber depth, degree of IOL decentration Visual acuity at 0.3, 0.5, 0.7, and 1.0 meters with full distance
and tilt, area of anterior chamber opening, and degree of posterior correction was slightly worse in the aspherical IOL group than in the
capsule opacification. For decentration and tilt, 4 Scheimpflug images spherical IOL group, but the difference did not reach significance.
of the IOL were taken after full mydriasis at slit angles of 0°, 45°, 90°,
and 135° with the charge-coupled device (CCD) camera. The tilt
angle of the IOL optic axis relative to the visual axis was quantified
by the image analysis computer, and the length of decentration was Discussion
indicated by the distance between the IOL optic vertex and the visual
axis.32,33 The area of anterior capsular opacification was measured on Aspherical IOLs have prolate optic, which is intended to
the retroillumination photograph taken with the EAS-1000.34,35 The compensate for the positive spherical aberration of the cor-

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 Ophthalmology Volume 116, Number 5, May 2009

Table 1. Measurement Results

Aspherical Spherical
(ZA9003) (AR40e) P*
BCVA (logMAR)
2 Days ⫺0.121⫾0.075 ⫺0.125⫾0.086 0.386
1 Week ⫺0.137⫾0.069 ⫺0.143⫾0.064 0.261
1 Month ⫺0.137⫾0.054 ⫺0.140⫾0.057 0.218
Anterior chamber depth (mm)
1 Week 3.80⫾0.26 3.89⫾0.28 0.287
1 Month 3.75⫾0.25 3.79⫾0.26 0.602
IOL decentration (mm)
1 Week 0.232⫾0.097 0.211⫾0.088 0.170
1 Month 0.197⫾0.082 0.218⫾0.096 0.136
IOL tilt (degrees)
1 Week 2.13⫾0.96 1.99⫾1.03 0.302
1 Month 2.19⫾0.88 2.02⫾0.90 0.182
Pupil diameter (mm)
Photopic 3.60⫾0.50 3.61⫾0.51 0.343 Figure 2. Ocular wavefront aberration measured 1 month after surgery.
Scotopic 5.09⫾0.73 5.09⫾0.74 0.797 The aspherical intraocular lens (IOL) group showed significantly lower
Area of anterior capsule values in 4rth-order (P⬍0.001) and total higher-order root-mean-square
opening (mm2) (RMS; P⬍0.001) than the spherical IOL, but not in 3rd-order RMS (P ⫽
1 Week 22.49⫾3.36 21.84⫾3.70 0.242 0.103).
1 Month 21.42⫾3.63 20.42⫾3.90 0.094
Posterior capsule opacification
(CCT) aberration should be first confirmed before comparing the
1 Week 27.30⫾7.84 28.68⫾7.08 0.087 influence of different asphericity of IOLs on ocular aberration.
1 Month 27.62⫾8.27 28.87⫾7.73 0.168 This is especially so if aspherical and spherical IOLs are
compared in different individuals, because the amount of oc-
BCVA ⫽ best-corrected visual acuity; CCT ⫽ computer-compatible tape ular and corneal aberrations varies widely among subjects.21–25
step; IOL ⫽ intraocular lens; logMAR ⫽ logarithm of the minimum angle Tzelikis et al19,20 have reported 2 studies that made
of resolution. significant efforts to reduce the bias that can occur in
Values are presented as means ⫾ standard deviation.
*Wilcoxon signed-rank test. comparative clinical study of aspherical and spherical IOLs,
by making the study an intraindividual comparison, using
the same IOL material manufactured by the same company,
nea. Thus, it is a reasonable result that ocular 4th-order and and having the same surgeon perform bilateral surgery
total higher-order aberrations were significantly lower in the within 1 week using an identical operative technique. It was
aspherical IOL group than in the spherical IOL group, demonstrated that postoperative visual acuity did not differ
although there was no intergroup difference in corneal ab- between the aspherical and spherical IOLs, but there was
errations. Many studies have compared ocular aberrations significant between-group difference in contrast sensitivity,
between aspherical and spherical IOLs, but there have been especially under mesopic conditions, in AcrySof IQ versus
few studies assessing both corneal and ocular aberrations at
the same time.10,14 We believe that compatibility of corneal

Figure 3. Contrast sensitivity under scotopic condition (15 lux) was

Figure 1. Corneal wavefront aberration measured 1 month after surgery. significantly better with the aspherical intraocular lens (IOL) than with
There was no difference in 3rd-, 4th-, and total higher-order root-mean- the spherical IOL at 3 (P ⫽ 0.0015), 6 (P ⫽ 0.0192), and 12 cycles per
square between the aspherical and spherical intraocular lens groups. degree (P ⫽ 0.0315).

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 Ohtani et al 䡠 Intraindividual Comparison of Aspherical and Spherical IOLs

Figure 4. Contrast sensitivity under mesopic condition (70 lux) was not Figure 6. Results of the all-distance vision tester. Visual acuity at 0.3, 0.5,
significantly different between groups. 0.7, 1.0, and 5.0 meters with full distance correction was not different
between the aspherical and spherical intraocular lens groups. logMAR ⫽
logarithm of the minimum angle of resolution.
AcrySof Natural IOLs19 and silicone Tecnis Z9001 versus
ClariFlex IOLs.20 In the current study, we found similar
results using a different pair of aspherical and spherical than in eyes with spherical IOLs.15,41,42 Rocha et al13 mea-
IOLs, acrylic Tecnis ZA9003 versus Sensar AR40e. sured image resolution (visual acuity) in 2 out-of-focus sce-
In the current study, we tested the postoperative stability narios: fixing the focus of each eye to infinity (distance cor-
of aspherical and spherical IOLs. It was revealed that both rected) and measuring visual acuity at 0.33 and 1 meters. They
IOLs had excellent postoperative stability in the eye, in reported that residual spherical aberration after cataract surgery
terms of amount of IOL decentration and tilt, area of ante- can improve depth of focus, and the tolerance to defocus seems
rior capsule opening, and degree of posterior capsule opaci- to be lower in eyes implanted with aspherical IOLs (AcrySof
fication. These data support the fact that both IOLs are made IQ) than in spherical IOLs.13 In our study, visual acuity at 0.3,
of similar material based on similar platform, resulting in 0.5, 0.7, and 1.0 meters with full distance correction was
similar physical and anatomic outcomes. Thus, the current slightly worse in the aspherical IOL group than in the spherical
study could evaluate solely the difference in optical char- IOL group, but the difference did not reach significance. Our
acteristics of the IOLs, asphericity of the optic. results indicate that depth of focus is not compromised in eyes
Theoretically, spherical aberrations increase depth of focus, implanted with aspherical IOLs (Tecnis ZA9003). At present,
but decrease modulation transfer function at high spatial fre- we do not have clear explanation for the discrepancy between
quencies at optimum focus.40 Spherical aberrations, therefore, our and previous studies, but it may be that Tecnis IOL
play an important role in the balance between visual acuity and provides the best compromise between spherical and chro-
depth of focus. In experimental studies, it has been reported matic aberrations and depth of focus as demonstrated by an in
that depth of focus is narrower in eyes with aspherical IOLs vitro computation study.15
There are several limitations to our study, one of which
is the short follow-up period. In our study, postoperative
measurements were conducted only 1 month after surgery.
It may be that different measurements are obtained in a
longer term study. It is unlikely, however, that wavefront
aberration and contrast sensitivity will change considerably
after 1 month, as reported by previous studies.8,13,19
In conclusion, the current prospective, randomized, in-
traindividual study demonstrated that acrylic foldable as-
pherical IOL (Tecnis ZA9003) yielded significantly lower
ocular wavefront aberration and better contrast sensitivity
under scotopic condition without compromising depth of
focus.

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 Ophthalmology Volume 116, Number 5, May 2009

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Footnotes and Financial Disclosures

Originally received: August 27, 2008. Financial Disclosure(s):
Final revision: November 20, 2008. The authors have no proprietary or commercial interest in any materials
Accepted: November 24, 2008. Manuscript no. 2008-1027. discussed in this article.
Supported in part by Grants-in-Aid 19390439 for Scientific Research from
1
Meiwakai Medical Foundation, Miyata Eye Hospital, Miyazaki, the Ministry of Education, Culture, Sports, Science and Technology, Japan.
Japan. Correspondence:
Tetsuro Oshika, MD, Department of Ophthalmology, Institute of Clinical
2
Department of Ophthalmology, Institute of Clinical Medicine, University Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki,
of Tsukuba, Ibaragi, Japan. 305-8575 Japan. E-mail: [email protected]

901