UNDERSTANDING IOL’S

Presenter – Dr. Aarti Rajkumar

Moderator – Dr. Vineet Ratra

Classification of IOLs

1. Material
2. Location
3. Design
4. Vision / Focality

Vision

1. Multifocal
2. Trifocal
3. Extended Depth of Focus
 4. Monofocal Plus
5. Toric
6. Accomodating
7. Newer injectable

Multifocal IOL

• Multiple powers within the same lens

• DiRerent focal points (multiple focal points) at diRerent distances.

a) the distance power

b) the near power

• The goal of MFIOL à minimize contrast loss and halos, while providing improved
range of vision.

• Refractive MFIOL – Early type – Zonal / Annular or Sectoral

• DiRractive MFIOL

o A structure is placed on the lens surface to intentionally induce

diRraction

o Waves exiting the lens will have constructive interference at two distinct
foci.

o consists of concentric annular zones (with the same surface area)

created on the surface of the lens

o the separation between or width of each zone gets progressive smaller

towards the edge of the lens.

o At the junction of each zone, an abrupt step appears.

o Area of Zone – Add power of the lens

o Height of Step – Relative energy that goes into each focus

APODIZATION

• Modify the step height so that the steps gradually reduce to zero towards the
periphery of the lens

• Lower step height – energy shifted from near foci to the distance foci

• Follows the natural dynamics of the eye

TRIFOCAL IOLs

• Emerging technology - Uses DiRractive MF eRect

• Provides an intermediate focal point in addition to near and distance foci

EXTENDED DEPTH OF FOCUS (EDOF)

• Basic Principle – create a single elongated focal point to enhance depth of focus

• Provide excellent intermediate vision but inadequate near vision

1. Small Apperture

Small apperature in the IOL

Only small cone of light entering the centre of lens in allowed

Blocks the light that would lie outside the EDOF channel

Reduces the amount of light and contrast

Disadvantages - Not useful in dim light conditions

2. Spherical Aberration

Various Types –

a. Abberation Free IOL – Positive aberration from cornea increases DOF

b. High SA over small central zone of lens
c. Lenses that mix positive and negative SA over multiple zones

3. DiRractive EDOF

Adopt the MF – diRractive technology to achieve 2 focal points within the EDOF
channel

4. Wavefront Shaping

Convert light beam in such a manner that, when it reaches the retina, the light is
confined to a region within the EDOF channel.

2 Anterior transition elements –

 • A slightly elevated 1um plateau – stretches the wavefront

• Small central curvature change – wavefront shift

MONOFOCAL PLUS LENSES

• Refractive Technology.

• No Rings. No Zones.

• Based on a continuous progression of power

• A small central plateau - a continuous change in power – 1mm

• Basic anterior curvature is aberration correcting with negative primary SA

TORIC IOLs

• Accurate measurement of Keratometric astigmatism (both axis and magnitude)

• Up to more than one-third of cataract patients have preoperative corneal

astigmatism of more than 1.0 diopter (D)

• More than 0.5 D of residual astigmatism can reduce visual performance and
patient satisfaction

ACCOMODATING IOLS

• Designated to produce a dynamic increase in dioptric power of the eye with

accommodative eRort

• Various Designs –

• Position changing single or dual optic IOLs

• Shape changing IOLs

• Refractive index modulating

• Lens filling surgical techniques

• Positional pseudo-accommodative IOLs – 1mm = 2 D change

• CRYSTALENS (B&L) – 4.5mm optic, Silicone, Only FDA approved accommodating

IOL
MODULATION TRANSFER FUNCTION

o MTF is a measurement of the ability of a lens to transfer contrast at a specific

resolution from object to image.
o Speaks of CONTRAST DEGRADATION
o As frequency increases (line spacing decreases) – diRicult for lens to eRiciently
transfer contrast – thereby decreasing the MTF

DEFOCUS CURVE

• Strong, objective, clinical measure of how well a lens is correcting presbyopia

• Can compare the optical performance of IOL technologies

• Involves placing lenses in front of an eye while measuring the change in visual
acuity that results from various amounts of refractive error and plotted for a
population.

• Defocus curve provides Quantitative aspect of the IOL

ABBE NUMBER

• V number or the Constringence

• Defines how prone the given lens material is to dispersion of light

• It is expressed as a numerical value.

• Greater dispersion – Lower Abbe Number

Q FACTOR

• It tells us how the radius of curvature of cornea / IOL varies in the periphery
compared to the centre.

• Prolate – Periphery flat – Q < 0

• Oblate – Centre flat – Q > 0

MONOVISION

• Concept - Anisometropic Blur

• Dominant eye – Distance vision

 • Non Dominant eye – Near vision

• Usually – 1.50D of anisometropia

MINI-MONOVISION

• Similar concept

• For distance vision and intermediate vision

• 0.75D of anisometropia

• Stereoacuity is reduced

OPTICAL PHENOMENON

1. Shining Pupil – External Reflectivity

• Reflections from the highly reflective front surface of the IOL are responsible
for the “twinkle in the eye”.

• The flat anterior surface due to the higher radius of curvature increases the
external reflectivity thus accentuating the shine

• The reflectivity is further increased in flatter corneas (Post-Lasik cases )

2. Ghost Images – Internal Reflectivity

• The internal reflectivity of hydrophobic acrylic is also much more than Silicon
and PMMA

• Formation of a secondary image very close to the primary image

• When viewing bright objects such as a window or the television screen.

3. Glare – Internal Reflectivity

• number of reflections from surface of the IOL onto the surface of the retina

4. Dysphotopsia – Edge eRect

• Positive dysphotopsias - a bright arc of light mostly seen in the temporal field

• The negative dysphotopsia - temporal dark shadow, usually arc shaped.

Illumination Gap Theory
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