Eyeworld

57 EW INTERNATIONAL December 2015 Best in international Bridgewater, N.J.), AcrySof ReSTOR 3.0 (Alcon, Fort Worth, Texas), and Tecnis Multifocal (Abbott Medical Optics, Abbott Park, Ill.) that were bilaterally implanted to 6-month data from a prospective clinical trial on the KAMRA inlay (AcuFocus, Irvine, Calif.) that was monocularly implanted in the non-dominant eye. Monocular defocus curves were measured from +5.0 D to –5.0 D in 0.50 D steps for the inlay and +4.0 D to –4.0 D in 0.50 D steps for the IOLs. For all patient groups, binocu- lar mesopic contrast sensitivity was measured with and without glare for 1.5, 3, 6, and 12 cycles/degree using the OPTEC 6500 contrast sensitivity tester (Stereo Optical Co., Chicago). Results: Crystalens AO (N=26) and KAMRA inlay (N=327) patients had continuous functional vision of 20/40 or better over 3.0 D and 4.0 D, respectively. ReSTOR 3.0 (N=25) and Tecnis MF (N =22) IOLs had non-continuous functional vision over 4.5 D and 4.0 D, respectively. KAMRA and Crystalens AO patients were superior to multifocal IOLs at intermediate. For binocular mesopic CS without glare, KAMRA patients were better than Crystalens AO and Tecnis MF at all tested spatial frequencies (p<0.05) and were better than ReSTOR 3.0 at 3, 6 and 12 cpd (p<0.001). For binocular mesopic glare, the inlay patients showed sig- nificantly better contrast sensitivity at all spatial frequencies (all p<0.001) versus the three IOLs. Crystalens AO was significantly better than Tecnis MF at 3, 6, and 12 cycles/degree (p< 0.05). Conclusion: Monocular implanta- tion of a small aperture inlay resulted in improved visual perfor- mance across all distances. The inlay patients showed significantly better binocular mesopic contrast sensitivity compared to either ac- commodating or multifocal IOLs. Dr. Assia: The present study demon- strates that all current multifocal and pseudoaccommodative lenses or corneal inlays provide a compromise between visual acuity, visual quality and depth of focus. The corneal inlay provides the best visual quality in terms of con- trast sensitivity with or without glare; however, its depth of focus is limited to the intermediate range, and its monoc- ular vision may also affect its overall performance. Shifting the defocus curve by inducing slight myopia is also a compromise to improve near vision in the cost of reduced distance vision. None of the current polyfocal lenses and corneal inlays provide the optical variability and quality of the natural accommodating system, and therefore, the optical solution should be tailored to the individual patient's needs. Evaluation of markerless alignment system for toric IOLs Daniel Black, MD Purpose: To compare the efficacy of aligning toric IOLs using a corneal ink mark with the Callisto marker- less system from Carl Zeiss Meditec (Jena, Germany). Methods: A prospective non-ran- domized trial of patients with astigmatism presenting for cataract surgery. This is a single centre, single surgeon, single IOL study. Patients prior to August 2014 had corneal ink marks used to align the toric IOL, and for patients after that date the Callisto system for toric IOL align- ment was utilized. Postoperative re- fractions were analyzed to compare the efficacy of these two methods in correcting astigmatism. Results: 507 cases from the ink marking group and 161 cases from the Callisto markerless group were compared. There was no difference in the mean or standard deviation of residual astigmatic refractive error. However, in the ink marking group, 6.0% had more than 0.5 D of astigmatism on refraction postop compared with 0.6% in the Callisto group. Conclusion: Both ink marking and digital markerless methods are accu- rate means of toric IOL alignment. The Callisto group had no outliers and could be considered more accu- rate. Dr. Assia: Automated axis marker provides some potential advantages over manual ink marking. The single surgeon study by Daniel Black, MD, demonstrated that the clinical results using the two techniques were identical in all parameters, pre- and postopera- tively. The absolute mean and median errors were identical to the 1% level, a surprisingly high similarity for such a high volume comparison. The only difference between the two groups was the percentage of achieving +0.5 D astigmatic prediction (94% vs 99.4%); however, this most likely represents a mathematical significance, not a clini- cal one. The excellent results presented in this study do not reflect a limitation of the automated system but rather the high accuracy that can be achieved by practicing a careful and precise manual marking. Intraoperative automated inkless marking will probably gain popularity with the increased use of toric lenses. EW Editors' note: Dr. Assia is professor of ophthalmology, Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel. He has no financial interests related to this article. Contact information Assia: assia@netvision.net.il View Dr. Assia's presentation at Clinical.EWrePlay.org.

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