Impact of Lens Material on Objective Refraction in Eyes with Trifocal Diffractive Intraocular Lenses

Compare subjective (Rx) and objective (ObjRx) refractions outcomes with two autorefractors models and an aberrometer in eyes implanted with a hydrophobic trifocal IOL (FineVision POD F GF, Physiol, Liége, Belgium) and a hydrophilic one (FineVision POD F, Physiol, Liége, Belgium). Prospective comparative cohort study, with 100 subjects randomly assigned to either the POD F group (n = 50) or the POD F-GF group (n = 50). Postoperative eye examinations at 1-month visit included seven result sets, one for each assessment method: Rx, AR (automated refraction measured with the autorefractor KR8800), WF-P (Zernike-coefficients-based objective refraction, photopic pupil size), WF-M (Zernike-coefficients-based objective refraction, mesopic pupil size), WF-4 (Zernike-coefficients-based objective refraction, 4 mm pupil), OPD-C (automated refraction measured with the aberrometer OPD in the central pupil/photopic conditions), and OPD-M (automated refraction measured with the aberrometer OPD under mesopic conditions). Mean differences between ObjRx and Rx reached statistical significance for sphere and spherical equivalent (M) only with OPD-C in the POD F-GF group. All ObjRx methods showed significant differences with Rx in the POD F group, with some values differing by more than 0.50 D (−0.58 D in M for the WF-P). Bland Altman plots showed better agreement for the astigmatic components, and for sphere and spherical equivalents in both IOL groups measured with AR and OPD-M. None of the objective methods of refraction evaluated in this study were as reliable as the subjective refraction, irrespective of the lens material, but POD F-GF ObjRx seems to differ less with Rx than POD F ObjRx values.

本研究针对植入疏水性三焦点人工晶状体（hydrophobic trifocal intraocular lens，IOL，型号FineVision POD F GF，产自比利时列日Physiol公司）和亲水性三焦点人工晶状体（型号FineVision POD F，产自比利时列日Physiol公司）的患眼，对比两种自动验光仪（autorefractor）模型与一台像差仪（aberrometer）测得的主观验光（subjective refraction，Rx）与客观验光（objective refraction，ObjRx）结果。本研究为前瞻性对照队列研究，共纳入100名受试者，按随机分组原则分为POD F组（n=50）与POD F-GF组（n=50）。术后1个月随访的眼部检查包含7组检测结果，分别对应7种评估方式：主观验光（Rx）、KR8800型自动验光仪检测的自动验光结果（AR）、基于泽尼克系数（Zernike coefficients）的明视瞳孔条件下客观验光结果（WF-P）、基于泽尼克系数的暗视瞳孔条件下客观验光结果（WF-M）、基于泽尼克系数的4mm瞳孔条件下客观验光结果（WF-4）、中央瞳孔/明视条件下像差仪OPD检测的自动验光结果（OPD-C），以及暗视条件下像差仪OPD检测的自动验光结果（OPD-M）。在POD F-GF组中，仅OPD-C方法测得的客观验光与主观验光的球镜度数、等效球镜度差值具有统计学显著性；在POD F组中，所有客观验光方法的检测结果与主观验光均存在显著差异，部分差值超过0.50屈光度（diopter，D），其中等效球镜度M的WF-P组差值为-0.58 D。布兰德-奥特曼一致性分析图（Bland Altman plot）分析显示，采用AR与OPD-M方法检测时，两组人工晶状体患眼的散光组分、球镜度数及等效球镜度的一致性更佳。本研究中所有评估的客观验光方法，其可靠性均未及主观验光，且不受人工晶状体材料的影响；但相较POD F组的客观验光结果，POD F-GF组的客观验光结果与主观验光的差值更小。