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10 1111@aos 12521
10 1111@aos 12521
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Acta Ophthalmologica 2015
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Acta Ophthalmologica 2015
d=2
jjc j ¼ arctan
AL ELP 1
KþPELP
n KP
ð5Þ
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Acta Ophthalmologica 2015
Discussion results was not taken into account. aspheric prolate technology. We evalu-
We confirmed in our previous study ated these four lenses in our study
Angle kappa is defined as the angle (Karhanová et al. 2013) that temporal because of their different central diam-
between the visual axis (connects the decentration of the ReSTOR multifo- eters (d). The mentioned differences in
point of fixation with the fovea) and cal IOL (in cases of a positive angle MIOL design did not influence our
the pupillary axis (a line through the kappa) was associated with the greatest analysis because the MIOL was
centre of the pupil perpendicular to the risk of photic phenomena. By contrast, replaced with a thin lens in our model
cornea). A positive angle kappa is nasal decentration (in cases of a posi- and was represented only by its equiv-
associated with an out-turning of the tive angle kappa) did not cause pro- alent optical power P and central zone
eye (the pupillary axis is temporal nounced photic phenomena. Prakash diameter d. By comparing these four
relative to the visual axis), while a et al. (2011) evaluated the role of angle MIOLs on the pseudophakic eye
negative angle kappa is an inward kappa in the occurrence of photic model, we confirmed that the higher
turning of the eye (the pupillary axis phenomena after MIOL implantation the central zone diameter, the higher
is nasal relative to the visual axis). (Rezoom). They reported that patient must be the angle kappa to reach the
Thus, when an eye fixates on a light complaints about glare and halo edge of the first ring of the IOL. In all
source, the reflection on the cornea showed positive correlation with the four types of MIOLs, the critical angle
(Purkinje image) will not be centred preoperative values of angle kappa. On kappa (reaching the edge of the ring)
but will be located nasal (positive angle the other hand, they found that many calculated was higher than that found
kappa) or temporal (negative angle patients with a high angle kappa were in normal population.
kappa) to the pupillary centre. Accord- asymptomatic. On this theoretical model, we also
ing to the published literature, a The assumed cause of pronounced confirmed the influence of K, AL and
positive kappa angle varies from 3.5 photic phenomena after implantation ELP on the critical angle kappa. For
to 6° in emmetropic eyes and from 6.0 of diffractive-design MIOLs in patients better illustration, we calculated the
to 9.0° in hyperopic eyes. In myopic with a higher angle kappa is that the border values of parameters K, AL and
eyes, the angle kappa is smaller, aver- fovea centric ray would pass closer to ELP corresponding to the critical angle
aging approximately 2.0°, and can even the edge of the rings and not through kappa jc = 7° (which can be found in
be negative (Von Noorden & Campos the central area of the MIOL (Fig. 5A normal population) for all four types of
2002). Basmak et al. (2007a,b) also and B). To date, several MIOLs of this the MIOL as a model case (Table 1).
reported the angle kappa to be higher design have been available and com- Two of the eye model parameters
in hyperopes than in emmetropes and monly used in practice. For the pur- always have standard values and one
myopes. Hashemi et al. (2010) found pose of our study, we evaluated the of them was calculated. The values of K
mean angle kappa values of 5.52 AcrySof ReSTOR (Alcon Laborato- and AL for this particular model case
1.19° in hyperopic eyes, 5.72 1.10° ries, Inc., Fort Worth, Texas) and the are out of normal range, but the border
in emmetropic eyes and 5.13 1.5° in Tecnis (Abbot Illinois, USA) MIOLs. values of ELP achieve a realistic size.
myopic eyes. The AcrySof ReSTOR is designed to According to these results, we suggest
With the development of new types provide quality near and distance that the most important biometric
of intra-ocular lenses, angle kappa is vision by combining apodized diffrac- value that can influence the possible
coming to the forefront of interest of tive and refractive technologies. The occurrence of photic phenomena after
cataract surgeons. Kottler et al. (2004) centre of the lens consists of apodized MIOL implantation in connection with
reported a hyperopic patient with a diffractive optic that focuses light for a higher angle kappa be ELP. When
large angle kappa in whom the residual near through distance vision. Apodiza- the interdependence of ELP and pre-
refractive error after toric phakic intra- tion is the gradual tapering of diffrac- operative anterior chamber depth are
ocular lens implantation was improved tive steps from the centre to the outside taken into account (Olsen et al. 1990;
by displacement of the lens according edge of the lens. It helps to create a Holladay 1993; Olsen 2006), it can be
to the visual axis. De Vries et al. (2011) smooth transition of the light between established that patients with preoper-
suggested that three major causes of distant, intermediate and near focal ative shallow anterior chamber depth
discomfort after MIOL implantation points. The refractive zone surrounds are at a higher risk.
(ReSTOR, Alcon Laboratories; Re- the apodized diffractive region. To In our study, we presumed the
zoom, Abbott Medical Optics; Tecnis, date, three types of the AcrySof MIOL to be perfectly centred to the
Abbott Medical, Optics) were residual ReSTOR IOL have been introduced pupil centre. In the case of a decentred
refractive error, posterior capsule opac- in the market – AcrySof ReSTOR MIOL, the considered border point R
ification and large pupil size. However, SN6AD3 (addition + 4.0 D), SB6AD1 (see Fig. 1) shifts according to the
a large angle kappa and MIOL decen- (addition + 3.0 D) and SV2STO (addi- direction and size of the decentration.
tration from the visual axis should also tion + 2.5 D). They vary not only in Thus, the term d/2 in the equation (2)
be considered. Soda & Yaguchi (2012) add power, but also in central zone as well as (5) must be corrected – it
evaluated the influence of horizontal diameter and in the number of diffrac- must be increased for the decentration
decentration on optical performance in tive rings. The Tecnis MIOL is a full towards the visual axis or decreased for
different MIOLs using an eye model. diffractive optic. The diffraction pat- the opposite direction. In the simplest
He found that clinically relevant effects tern of this lens is on the posterior approximation, the term d/2 can be
are not to be expected up to a decen- surface of the lens (as compared to the replaced by the term d/2 + D or d/2 –
tration of 0.75 mm. But a possible AcrySof ReSTOR lens on the anterior D, where D represents the decentration
influence of angle kappa on these surface of the lens), and the lens has the size (in length units). The resultant
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of the eye, especially on the effective Hashemi H, KhabazKhoob M, Yazdani K, Prakash G, Prakash DR, Agarwal A, Kumar
lens position. According to these Mehravaran S, Jafarzadehpur E & Fotouhi DA, Agarwal A & Jacob S (2011): Predictive
results, it can be concluded that espe- A (2010): Distribution of angle kappa mea- factor and angle kappa analysis for visual
surements with Orbscan II in a population- satisfactions in patients with multifocal IOL
cially shallow anterior chamber depth
based survey. J Cataract Refract Surg 26: implantation. Eye 25: 1187–1193.
in connection with a higher angle 966–971. Soda M & Yaguchi S (2012): Effect of decen-
kappa could be an important risk Hofmann T, Zuberbuhler B, Cervino A & tration on the optical performance in mul-
factor for pronounced photic phenom- Montes-Mic o R & Haefliger E (2009): tifocal intraocular lenses. Ophthalmologica
ena after multifocal IOL implantation. Retinal straylight and complaint scores 227: 197–204.
We incorporated this conclusion in 18 months after implantation of the AcrySof Souza CE, Muccioli C, Soriano ES et al.
our daily practice. We recommend to monofocal and ReSTOR diffractive intraoc- (2006): Visual Performance of AcrySof
evaluate the angle kappa in all patients ular lenses. J Refract Surg 25: 485–492. ReSTOR Apodized Diffractive IOL: a Pro-
Holladay JT (1993): Refractive power calcula- spective Comparative Trial. Am J Ophthal-
with preoperative shallow anterior
tions for intraocular lenses in the phakic eye. mol 141: 827–832.
chamber depth before planned implan- Am J Ophthalmol 116: 63–66. Tassignon MJ, Bartholomeeusen E, Rozema
tation of a diffractive-design MIOL. In Holladay JT (1997): Standardizing constants JJ, Jongenelen S & Mathysen DG (2014):
cases when a larger angle kappa is for ultrasonic biometry, keratometry, and Feasibility of multifocal intra-ocular lens
confirmed, we prefer to implant intraocular lens power calculations. J Cata- exchange and conversion to the bag-in-the-
another type of presbyopia-correcting ract Refract Surg 23: 1356–1370. lens implantation. Acta Ophthalmol 92:
IOLs. By contrast, in patients with Holladay JT (1998): Intraocular lens power 265–269.
normal or deeper anterior chamber, calculations for the refractive surgeon. Oper Tunnacliffe AH (1993): Introduction to visual
Tech Cataract Refract Surg 1: 105–117. optics. London: Gresham Press.
we do not require angle kappa evalu-
Holladay JT (2007): IOL power calculations Von Noorden G & Campos E (2002): Exam-
ation before diffractive-design MIOL for multifocal lenses. Cataract Refract Surg ination of the patient II. In: Von Noorden G
implantation. Today 7: 71–73. & Campos E (eds). Binocular vision and
Hütz WW, Eckhardt HB, Rohring B & Grol- ocular motility – theory and management of
mus R (2008): Intermediate vision and strabismus. 6th Edn. St. Louis: Mosby 168–
reading speed with Array, Tecnis, and 173.
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Received on February 14th, 2014.
exchange with the ReSTOR multifocal intra- intraocular lens. Can J Ophthalmol 46:
Accepted on July 3rd, 2014.
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Correspondence
Kassaby S (2006): ReSTOR intraocular lens and near contrast sensitivity function after
Martin Šı́n, MD, PhD, FEBO
implantation in cataract surgery: quality of multifocal intraocular lens implantation.
Department of Ophthalmology
vision. J Cataract Refract Surg 9: 1459– J Cataract Refract Surg 29: 703–711.
University Hospital Olomouc
1463. Olsen T (2006): Prediction of the effective
I. P. Pavlova 6
De Vries NE, Franssen L, Webers CA et al. postoperative (intraocular lens) anterior
77900 Olomouc, Czech Republic
(2008): Intraocular straylight after implan- chamber depth. J Cataract Refract Surg
Tel: +420 588 444 202
tation of the multifocal AcrySof ReSTOR 32: 419–424.
Fax: +420 588 422 530
SA60D3 diffractive intraocular lens. J Cat- Olsen T, Olesen H, Thim K & Corydon L
Email: sin.martin@seznam.cz
aract Refract Surg 34: 957–962. (1990): Prediction of postoperative intraoc-
De Vries NE, Webers CA, Touwslager WR, de ular lens chamber depth. J Cataract Refract This research was supported by Grant No.
Brabander J, Berendschot TT & Nuijts RM Surg 16: 587–590. PrF_2013_021 from the Faculty of Science of
(2011): Dissatisfaction after implantation of Pepose JS (2008): Maximizing satisfaction with Palacky University, Olomouc, Czech Republic.
multifocal intraocular lenses. J Cataract presbyopia correcting intraocular lenses: the The authors have no financial interest in any
Refract Surg 37: 859–865. missing links. Am J Ophthalmol 146: 641– product mentioned in the text and no potential
648. conflict of interest in this article.
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