Effect of Ocular Deviation on Pupil size with Implanted Multifocal Intraocular Lens Yoshihiko Iida,...
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Transcript of Effect of Ocular Deviation on Pupil size with Implanted Multifocal Intraocular Lens Yoshihiko Iida,...
Effect of Ocular Deviation
on Pupil size with Implanted Multifocal I
ntraocular Lens
Yoshihiko Iida, MD Kimiya Shimizu, MDMisae Ito, CO
Kitasato UniversityThe authors have no Financial Interest.
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
Background
• Multifocal intraocular lenses(IOL) are increasingly used to correct presbyopia.
• We experienced unsatisfactory results in a patient who underwent bilateral implantation of refractive multifocal IOLs, and considered that ocular deviation may influence pupil size.
We report a patient with unsatisfactory results, and evaluate the effect of ocular deviation on pupil size using implanted IOLs.
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
54-year old female
Preoperative data :
Vd = 0.04 ( 0.3 x -5.00Vs = 0.04 ( 0.4 x -6.00 )
( ) Cyl-1.00 Ax 80 )
Hirschberg : orthophoria
Alternate prism cover test : 14⊿X’(Near), 4⊿X (Far)
Pupil size (monocular vision) : R) 4.0 mm, L) 4.4 mm
1. Case report
Selected the use of refractive multifocal IOL
(APCT)
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
Near
2.1mm
3.4mm
Far
Implanted refractive multifocal IOL
Bil) PEA + IOL was performed
IOL : Array SA40N (AMO)L) 12.0 D
IOL design
R) 11.5 D
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
Course
Far : Vd = 1.2 x IOL
At 3 months postop.
BV = 1.2 x IOLVs = 1.2 x IOL
Near : BV = 0.4 x IOLVd = 1.0 x IOL Vs = 0.9 x IOL
Binocular uncorrected visual acuity(UCVA) was worsethan monocular UCVA.
APCT : 16⊿X’(Near)
With spectacle lenses of 3Δ base-in to each eye
BV = 1.0 x IOL Binocular near UCVA was improved.
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
1) Far vision / Binocular
FarBV = 1.2 x IOL 2.8 mm2) Near vision / Monocular
Vd=1.0 x IOL Vs=0.9 x IOL 3.1 mm
Evaluation of the Pupil size (1)
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
3) Near vision / Binocular
NearBV = 0.4 x IOL 2.4 mm
Evaluation of the Pupil size (2)
2) Near vision / Monocular
Vd=1.0 x IOL Vs=0.9 x IOL 3.1 mm
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
Evaluation of the Pupil size (3)
3) Near vision / Binocular
NearBV = 0.4 x IOL 2.4 mm4) Near vision / Binocular + 3⊿base in
NearBV = 1.0 x IOL 2.7 mm
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
4 8 12 14 Exophoria angle(⊿)00
1
2
3
4
5
Pup
il d
iam
eter
(m
m)
p=0.0017, R2 = 0.4679
Pupil diameter was negatively correlated with exphoria angle.
n=17
Dominant eye
2. Effect of ocular deviation on pupil size in near vision
17 exphoric patients implanted with IOL
Near vison
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
BinocularNearBV = 0.4
Binocular + 3 ⊿ base inNearBV = 1.0
Near : 3.4mm Near : 3.4mm
Discussion
Far : 2.1mmFar : 2.1mm
pupil diameter 2.4 mmpupil diameter 2.4 mm pupil diameter 2.7 mmpupil diameter 2.7 mm
With spectacle prism lenses for the decrease of exophoria angle, the pupil diameter was increased and the binocular near UCVA was raised.
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
Exophoria
Discussion
When large exophoria angle, excess miosis might be caused by fusional convergence.
Poor near visual acuity with refractive multifocal IOL.
Orthophoria
convergence
miosis excess miosis
Kitasato University School of MedicineKitasato University School of Medicine
Department of OphthalmologyDepartment of Ophthalmology
Conclusions
• Ocular deviation affects pupil size.
• Ocular deviation is an important factor in the selection of patients with refractive multifocal IOLs.