Effects of multifocal and monofocal intraocular lenses on swept-source microscope-integrated optical coherence tomography (SS-MIOCT) image quality in a model eye.

Abstract

Purpose : Cataract extraction with intraocular lens (IOL) implantation is common. Advancements in IOL technology have introduced new IOLs that may impact the view to the retina and image quality in intraoperative optical coherence tomography (OCT). We investigate how monofocal and multifocal IOLs impact image quality in swept-source microscope-integrated OCT (SS-MIOCT).

Methods : The posterior surface of a custom 3D-printed model eye with air-filled posterior chamber (Fig 1) was imaged using SS-MIOCT through two monofocal and four multifocal (TECNIS®, SYMFONY®, Johnson&Johnson; ReSTOR®, Alcon) IOLs of similar diopter strengths. Imaging was performed through BIOM visualization during the same imaging session. Image grading of 5 randomized B-scans per test group was performed independently by 5 masked retina fellows-in-training (Fig 2). Graders were asked to evaluate each image as 0-ungradable, 1-poor quality, 2-moderate quality, or 3-excellent quality. Intra-grader and inter-grader agreement was calculated. Statistical analyses (JMP Pro 12, SAS Institute, Inc.) were conducted comparing the monofocal images to the multifocal images.

Results : All images were considered gradable by all 5 graders. Data from 3 of the 5 graders with >80% intra-grader reliability were used. Inter-grader agreement was 82%. Wilcoxon rank sum test showed that images obtained through multifocal IOLs (mean grade ± SD: 1.53±0.340) had significantly less image quality compared to images obtained through monofocal IOLs (2.89±0.162) (P < 0.0001).

Conclusions : SS-MIOCT intraoperative imaging through multifocal IOLs results in poorer image quality. Multifocal IOLs rely on diffractive rings that defocus incoming light to separate focal planes to allow for distance and near vision. This likely occurs with OCT signal which results in degraded images through a multifocal IOL. These findings have implications for SS-MIOCT use during vitreoretinal surgery and solutions are needed to improve image quality in these eyes.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.

 

Figure 1. 3D-printed model eye in which IOLs are interchangeable in stage (A), with separate anterior segment (B) and posterior segment (C) that houses a surface that is imaged using SS-MIOCT.