Clinical ophthalmology (Auckland, N.Z.) · 2025
Clinical Tolerance to Experimentally Induced with-the-Rule and Against-the-Rule Astigmatism After Implantation of an Extended Depth-of-Focus Intraocular Lens: A Defocus-Curve Study.
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Hida Wilson Takashi, Mundim Leandro Pessoa, Moscovici Bernardo Kaplan, Vilar César Martins Cortez, Tzelikis Patrick Frensel De Moraes, Nakano Celso Takashi, de Melo Junior Irineu Ribeiro, de Medeiros André Lins, Lake Jonathan Clive, Chaves Mario Augusto Pereira Dias, Motta Antonio Francisco Pimenta, Nose Walton, Carricondo Pedro C
Аннотация
PURPOSE: To quantify the clinical tolerance to induced with-the-rule (WTR, 90°) and against-the-rule (ATR, 0°/180°) astigmatism after implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL), and to identify axis-specific trade-offs across the defocus curve.
METHODS: In this non-randomized, comparative, cross-sectional study, nine pseudophakic patients (nine dominant eyes) implanted with a Tecnis Symfony® EDOF IOL underwent monocular photopic testing (85 cd/m2) at 4 m using Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Defocus curves were acquired from -5.00 D to +2.50 D in 0.50-D steps over best subjective refraction. Regular myopic astigmatism was optically induced with +1.00 D, +2.00 D, and +3.00 D positive cylindrical lenses at canonical axes (0°, 45°, 90°, 135°); analyses focused on WTR (90°) and ATR (0°/180°). Visual acuity (VA) was converted to logMAR. Repeated-measures ANOVA with Tukey post hoc testing assessed effects of cylinder magnitude, axis, and vergence (α=0.05).
RESULTS: Distance VA remained functionally preserved with +1.00 D, while +2.00 D produced clinically meaningful deterioration and +3.00 D caused broad loss of acuity across vergences. Axis orientation modulated performance: WTR preserved distance acuity around plano, whereas ATR relatively favored intermediate and very near vergences (approximately -2.00 D to -3.50 D). ANOVA confirmed significant effects of cylinder magnitude and vergence (both p<0.01) and a significant axis-by-vergence interaction near plano and +0.50 D (p<0.05). These findings support a practical tolerance envelope of about +1.00 D for EDOF recipients, beyond which functional penalties become evident.
CONCLUSION: After EDOF implantation, regular astigmatism of ~+1.00 D is generally tolerated, while +2.00 D and +3.00 D compromise function across the defocus curve. Axis matters: WTR preferentially preserves distance VA and ATR relatively supports intermediate/near performance. These data provide actionable thresholds and axis-aware guidance for toric planning, residual-targeting, and patient counseling.
METHODS: In this non-randomized, comparative, cross-sectional study, nine pseudophakic patients (nine dominant eyes) implanted with a Tecnis Symfony® EDOF IOL underwent monocular photopic testing (85 cd/m2) at 4 m using Early Treatment Diabetic Retinopathy Study (ETDRS) charts. Defocus curves were acquired from -5.00 D to +2.50 D in 0.50-D steps over best subjective refraction. Regular myopic astigmatism was optically induced with +1.00 D, +2.00 D, and +3.00 D positive cylindrical lenses at canonical axes (0°, 45°, 90°, 135°); analyses focused on WTR (90°) and ATR (0°/180°). Visual acuity (VA) was converted to logMAR. Repeated-measures ANOVA with Tukey post hoc testing assessed effects of cylinder magnitude, axis, and vergence (α=0.05).
RESULTS: Distance VA remained functionally preserved with +1.00 D, while +2.00 D produced clinically meaningful deterioration and +3.00 D caused broad loss of acuity across vergences. Axis orientation modulated performance: WTR preserved distance acuity around plano, whereas ATR relatively favored intermediate and very near vergences (approximately -2.00 D to -3.50 D). ANOVA confirmed significant effects of cylinder magnitude and vergence (both p<0.01) and a significant axis-by-vergence interaction near plano and +0.50 D (p<0.05). These findings support a practical tolerance envelope of about +1.00 D for EDOF recipients, beyond which functional penalties become evident.
CONCLUSION: After EDOF implantation, regular astigmatism of ~+1.00 D is generally tolerated, while +2.00 D and +3.00 D compromise function across the defocus curve. Axis matters: WTR preferentially preserves distance VA and ATR relatively supports intermediate/near performance. These data provide actionable thresholds and axis-aware guidance for toric planning, residual-targeting, and patient counseling.