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Hindawi Publishing Corporation

ISRN Ophthalmology
Volume 2014, Article ID 403432, 6 pages

Clinical Study
Aspheric Intraocular Lenses Implantation for
Cataract Patients with Extreme Myopia
Yanwen Fang, Yi Lu, Aizhu Miao, and Yi Luo
Department of Ophthalmology, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai 200031, China
Correspondence should be addressed to Yi Luo;
Received 26 January 2014; Accepted 6 March 2014; Published 19 March 2014
Academic Editors: I. G. Pallikaris and I.-J. Wang
Copyright © 2014 Yanwen Fang et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective. To evaluate the postoperative visual quality of cataract patients with extreme myopia after implantation of aspheric
intraocular lenses (IOLs). Methods. Thirty-three eyes were enrolled in this prospectivestudy. Eighteen eyes with an axial length
longer than 28 mm were included in the extreme myopia group, and the other 15 eyes were included in the nonextreme myopia
group. Phacoemulsification and aspheric IOL implantation were performed. Six months after cataract surgery, best-corrected visual
acuity (BCVA), contrast sensitivity, and wavefront aberrations were measured, and subjective visual quality was assessed. Results.
The BCVA improved significantly after surgery for both groups, and patients in the nonextreme myopia group achieved better
postoperative BCVA due to better retinal status of the eyes. The evaluation of contrast sensitivity without glare was the same in
both groups, whereas patients in the nonextreme myopia group performed better at intermediate spatial frequencies under glare
conditions. The two groups did not show a significant difference in high-order aberrations. With regard to subjective visual quality,
the composite scores of both groups did not differ significantly. Conclusions. Aspheric IOLs provided good visual outcomes in
cataract patients with extreme myopia. These patients should undergo careful evaluation to determine the maculopathy severity
level before surgery.

1. Introduction
The spherical aberration of the cornea is positive and that
of the lens is negative in the young, healthy eye, and
these differences have a compensatory relationship [1, 2].
Decreased optical quality occurs in the aging eye as the
spherical aberration of the lens becomes gradually positive
and thus loses its ability to compensate for the corneal
aberration, which changes little with increasing age [1–5].
Conventional spherical intraocular lenses (IOLs) act as
an aging lens in which positive spherical aberration cannot
compensate for the corneal aberration. Aspheric IOLs can
decrease the total amount of ocular spherical aberration
after cataract surgery due to their introduction of negative spherical aberration. It has been shown that aspheric
aberration-correcting IOLs effectively reduce ocular aberration and improve contrast sensitivity in patients with agerelated cataracts [6–15]. However, little is known about the
safety and effectiveness of aspheric IOLs in patients with
extreme myopia. Therefore, we performed the current study

to evaluate the clinical effects of aspheric IOL implantation
in cataract patients with extreme myopia by comparing the
objective and subjective visual quality achieved with that
achieved in nonextreme myopic eyes.
We chose the MC X11 ASP lens (HumanOptics AG) as
our experimental IOL because it is currently the only aspheric
IOL with a negative power. The MC X11 ASP lens is a onepiece hydrophilic acrylic IOL with a prolate posterior surface
that introduces negative spherical aberration to the ocular
system. The overall length of this IOL is 11.0 mm. The optic
diameter varies from 5.5 mm to 7.0 mm depending on the
power of the IOL. IOLs with a power of 18.0 diopter or less
have an optic diameter of 7.0 mm. This IOL can be implanted
through a 1.8 mm microincision.

2. Methods
This prospective study included 33 eyes of 22 cataract patients
(12 males and 10 females) who were scheduled to undergo
phacoemulsification and IOL implantation surgery between

After hydrodissection. and patient refusal or inability to maintain followup.0% of eyes with 20/25 or better. Four eyes demonstrated poor vision of less than 20/60 due to severe macular degeneration or macular schisis. After mydriasis.0001. intraocular pressure. Contrast sensitivity was defined as the reciprocal of the contrast threshold. The average composite score was . 𝑃 = 0. and spherical aberration (𝑍4 0 ) as well as the root mean square (RMS) values of the total high-order aberrations and 3rd-order to 7th-order aberrations over a 6.0000). The study was approved by the Ethics Committee of Eye & ENT Hospital. Results Demographic data for patients enrolled in the study are listed in Table 1. myopia. Exclusion criteria included a history of previous ocular surgery. and the nonextreme myopia group performed significantly better than the extreme myopia group (𝜒2 = 5.and postoperative Snellen visual acuities are listed in Figure 1. L. 3.). and subjective visual quality were assessed. Two eyes had visual acuity of 20/60 and 20/50 due to PCO. and this value was converted to log contrast sensitivity for statistical analysis. The incision was closed by hydration without suture. or macular degeneration. We found no maculopathy in the nonextreme myopia group.). axial length. Six months postoperatively. including 80.8% of eyes in the extreme myopia group achieved a BCVA of 20/40 or better.0144). June 2008 and March 2009 at the Eye & ENT Hospital. refraction. Fudan University. Informed consent was obtained from all patients before participation in this study. and a 5.94. In the nonextreme myopia group. contrast sensitivity.2% of eyes with 20/25 or better. including 6 eyes with degenerative myopic maculopathy and 1 eye with macular schisis. Variables were tested for normality and homogeneity of variances. questionnaire scores. wavefront aberration. Logarithm of the minimum angle of resolution (log MAR) visual acuity values were tested by the Wilcoxon rank-sum test. Contrast sensitivity was tested with normal pupil and refractive correction. Pre. Questions within each subscale were averaged to create the subscale score. and the others were included in the nonextreme myopia group. a 2.9%) in the extreme myopia group had preexisting maculopathy before surgery. China. The postoperative BCVA of both groups was significantly better than the respective preoperative BCVA values (𝜒2 = 16. and 1 month after surgery. 86. All surgical procedures were performed by the same surgeon (Y.2 ISRN Ophthalmology 80 60 40 20 0 < – – Extreme myopia Preoperative Extreme myopia Preoperative – – Nonextreme myopia Preoperative Nonextreme myopia Preoperative Figure 1: Best-corrected visual acuity before and 3 months after surgery (Snellen visual acuity).0 mm were included in the extreme myopia group. The recorded contrast sensitivity values were transformed into log values for analysis. Contrast sensitivity was measured using the contrast glare tester CGT-1000 (Takaci) under mesopic illumination (10 cd/m2 ) at a 350 mm testing distance. Inclusion criteria were age-related cataract and age between 45 and 70 years. 7 eyes (38. However. Table 2 lists the postoperative NEI VFQ-25 subscale scores of the two groups. 77.0 mm continuous curvilinear capsulorhexis was created. It includes one general health rating question and 11 vision-targeted subscales as listed in Table 2. Those with an axial length longer than 28. 𝑃 = 0.5–6. with higher scores representing better VRQL.98.2 mm superior clear corneal incision was made. 3 days. Three consecutive measurements were performed on each eye. vertical coma (𝑍3 −1 ). visual acuity and slit-lamp examination were performed.7% of eyes achieved a BCVA of 20/40 or better. The lateral coma (𝑍3 1 ). visual acuity. 2 weeks. the answer was converted to a 0-to-100-point score according to the manual. and corneal endothelial cell density. Carl Zeiss Meditec). 𝑃 = 0.05 was considered statistically significant. The incidence of glare was evaluated with Fisher’s exact test. high-order aberrations were measured with the Hartmann-Shack aberrometer (WASCA Analyzer. Six months after surgery. Preoperative measurements included visual acuity. Comparison of Snellen visual acuity before and after surgery was performed using the CMH chi-square test. Patients were also asked whether they experienced problems with glare. contrast sensitivity. At 1 day. endocapsular phacoemulsification of the nucleus and cortical aspiration were performed using the Intrepid Micro-Coaxial System on the Infiniti (Alcon Laboratories Inc. Complications such as posterior capsule opacification (PCO) and retinal detachment were recorded at the last follow-up visit. including 22. ocular disorders other than cataract. For each question. Independent t-test was used to compare demographic data. A 𝑃 value less than 0. Subjective visual quality was evaluated using the selfadministered edition of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25) [16]. Fudan University.0 mm pupil diameter were automatically calculated by the aberrometer. All surgeries were uneventful and free of intraoperative complications. and wavefront aberrations between the two groups. Patients were divided into two groups according to their ocular axial length. This 25item questionnaire was designed to assess vision-related quality of life (VRQL). Statistical analysis was performed using STATA version 7. The MC X11 ASP IOL was implanted with the associated special IOL delivery system.36. 𝜒2 = 20. Each subscale contains 1 to 4 questions. After topical anesthesia.

92 ± 4.17 𝜇m and 0. High myopia prevalence also varies geographically.6%) in the extreme myopia group.41 ± 29.36 ± 17.03 ± 0. Characteristic Number of patients/number of eyes Age (years) Axial length (mm) Predicted IOL power (diopter) Implanted IOL power (diopter) Preoperative BCVA (log MAR) Postoperative BCVA (log MAR) Postoperative spherical equivalent Extreme myopia 11/18 53. Discussion It is well known that myopia is more common in Asia than in America.54 67.23 85.34 ± 1. 4.0011 0.39 ± 1.52 69.27 ± 18. 𝑃 = 0. two eyes in each group (11. spherical aberration.86 85. evaluation of the VFQ-25 subscale scores revealed that the nonextreme myopia group performed significantly better than the extreme myopia group in terms of mental health and dependency.52 ± 17.75 ± 22.59 months (range 6 to 12) in the nonextreme myopia group.64 ± 1.27 ± 3.00 ± 12.0016∗ / 0.0000 0.50 ± 0.35 ± 28.0693 0.60 ± 1.05 ± 8.09 ± 10.0000 0.1% and 13. the average spherical aberration (𝑍4 0 ) was 0. Table 2: Postoperative NEI VFQ-25 subscale scores.28 ± 14. The average follow-up period was 6.13 ± 4. One patient complained of glare in one eye (5.40 81.08 92.45 ± 24.20 Nonextreme myopia 11/15 59.10 43.0522 0.24 / 100.35 ± 0.44 72.00 𝑃 value / 0. vertical coma. and total highorder aberrations were 0. and Africa with a prevalence of 32.73 ± 17. and three eyes (20%) were associated with complaints of glare in the nonextreme myopia group.0181) (Figure 2(b)).94 ± 1.8407 0. 𝑃 = 0. Other subscale scores were similar between the two groups.68 ± 25.60 0.33 ± 17.45 0. IOL: intraocular lens. However.91 ± 16.92 / 90.34 ± 18.19 78.71 3.97 ± 1. However.8468 0. respectively.7% to 3.5 degrees. Data related to driving were not analyzed. or 3rd-order to 7th-order aberrations (Figure 3).20 Nonextreme myopia 47.47 17.80 83.16 72. At the last followup.15 ± 0. ranging from 1.07 ± 0. BCVA: best-corrected visual acuity.4915 0.00 ± 0. In addition.62 −0.340). which did not represent a statistically significant difference (𝑃 = 0.49 78. For a 6 mm pupil.43 65.31 16.7793 0.ISRN Ophthalmology 3 Table 1: Demographic data of patients enrolled in this study. patients in the nonextreme myopia group showed better contrast sensitivity with glare at intermediate frequencies (visual angle of 2.41 ± 13.64 ± 6.1230 0.52 76.73 ± 17.0879 Significant difference between groups.80 70.30 𝑃 value 0. In this study. because none of the patients in the extreme myopia group and only four patients in nonextreme myopia group drove.36 ± 9.22 ± 4.83 ± 20. we carried out phacoemulsification and aspheric IOL implantation with low or negative power on cataract patients with extreme myopia.11 𝜇m in the extreme myopia group and 0.14 1.96 24. total high-order aberrations. while it affects up to 24% of university students in South-East Asia [18]. the extreme myopia group showed a trend toward lower social functioning.6 degrees.31 31.15 𝜇m.47 ± 9.46 ± 0.61 ± 11.0211 Note. There were no significant differences in lateral coma.3% in the urban adult Chinese population reported by the latest epidemiological study published in 2009 [17].18 −1. and the eye achieved a final visual acuity of 20/30 following anterior capsulotomy. As illustrated in Figure 2(a).3% in Europe.0888 0.83 55.0000 0. resp.2847 0.49 0.10 54.) had moderate PCO but did not require further treatment. Subscales General health General vision Ocular pain Near activity Distance activity Social functioning Mental health Role difficulties Dependency Driving Color vision Peripheral vision Composite score ∗ Extreme myopia 45.07 𝜇m in the nonextreme myopia group. No retinal detachment occurred in either group. not statistically different between the two groups.91 69.0277 and 1.4080 0.8051 0.86 ± 0. contrast sensitivity without glare did not differ between the groups at each spatial frequency.55 ± 25.47 months (range 6 to 10) in the extreme myopia group and 6.00 86. One eye in the extreme myopia group developed capsular block syndrome.06 ± 0. We report the visual performance of aspheric IOLs in terms of functional vision in cataract eyes with extreme myopia . Europe.36 53.3%.36 −2.0236∗ 0.82 ± 14.

These data are in agreement with Stoimenova’s findings [27]. When the seven eyes with maculopathy in the extreme myopia group were excluded from the data analysis. Therefore. This might be attributed to the preoperative visual status of the patients with extreme myopia who always had poor visual function.ISRN Ophthalmology Contrast sensitivity without glare 1.5 1. which fulfilled the aim of compensating the corneal spherical aberration with an IOL.2 0 6.5 0. This questionnaire was designed to capture the impact of visual problems on physical functioning. the optical quality of the ocular system in the extreme myopia group was as good as that in the .5 Contrast sensitivity (log) Contrast sensitivity (log) 4 1 0.3 0. After objective visual acuity measurements. who implanted the aspheric IQ IOL (SN60WF. However. ∗ Significant difference between groups. we assessed the subjective visual quality of the patients using the NEI VFQ-25. The total effect of all monochromatic optical aberrations represents the optical quality of the eye [26]. Aberrations Extreme myopia Nonextreme myopia Figure 3: High-order aberrations over a 6 mm pupil diameter. In this study. Interestingly. 𝑃 = 0. postoperative visual outcomes were similar between the two groups (𝜒2 = 1. the subscale scores of mental health and dependency were significantly lower in this group. emotional well-being.7 Extreme myopia Nonextreme myopia Extreme myopia Nonextreme myopia (a) (b) 7th-order 6th-order 5th-order 4th-order 3rd-order HOA Z4 0 High-order aberrations Z3 1 0. the removal of the cataract along with the correction of the refractive errors likely resulted in a high level of patient satisfaction in terms of visual outcome.6 ∗ 0. HOA: high-order aberration. Contrast sensitivity is a robust indicator of functional vision [26].1 0 Z3 −1 (𝜇m) Figure 2: Postoperative contrast sensitivity of the two groups: (a) under nonglare conditions and (b) under glare conditions. Our results show that aspheric IOL implantation provided good visual outcomes in most eyes with extreme myopia. and the other 5 improved 2 to 8 lines (Snellen chart). TX.2288).6 Spatial frequency 1 0.6 Spatial frequency 1 0. the two groups reported similar subscale scores for near and distance activities.2 0.5 1.6 0. suggesting that these patients worried more about their eyesight and that their quality of life was more affected by vision. Because the spherical and cylindrical refractive errors were fully corrected and high-order aberrations were similar between groups. The score from the extreme myopia group was similar to that reported by Lin et al. Alcon Laboratories Inc.8 ∗ 0. postoperative vision was mostly determined by the severity of the maculopathy.5 0 6.3 4 2. we found that patients with nonextreme myopia had better contrast sensitivity at intermediate spatial frequencies under glare conditions. that is. the patients’ perception of their visual function was similar.3 4 2. visual acuity improved after surgery anyway: one improved from hand moving to 20/400. [23]. We also compared high-order aberrations between the groups and found that postoperative ocular spherical aberration (𝑍4 0 ) was near zero in the two groups. although some patients with extreme myopia had relatively worse retinal status than nonmyopia patients. It has been widely used to evaluate health-related quality of life in patients with various eye diseases and treatments [19–25].45. High-order aberrations of the two groups did not show a significant difference. one improved from 20/2000 to 20/250.4 0. USA). although the nonextreme myopia group had better postoperative BCVA in the present study. Fort Worth. and social functioning [16].4 0..2 1 0. This difference may contribute to the aberrations of the myopic eyes or functional/morphologic changes in the retina of myopic eyes. For the seven excluded eyes. In these patients. in comparison to that achieved in patients with nonextreme myopia.7 Contrast sensitivity with glare 1. which showed that myopes exhibited reduced sensitivity to contrast in comparison to emmetropes and that contrast sensitivity decreased with an increasing degree of myopia.

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