Comparison of the Optical Image Comparison of the Optical Image Quality for Presbyopia Correcting Quality for Presbyopia Correcting IOLs using Modulation Transfer IOLs using Modulation Transfer

Function TestingFunction Testing

W. Maxwell, MD, PhDW. Maxwell, MD, PhDCalifornia Eye InstituteCalifornia Eye Institute

Fresno, CaliforniaFresno, California

Financial Disclosure: Consultant (Alcon Research, Ltd.)

Testing MethodologyTesting Methodology Study Objective

• To compare the image quality of various Presbyopia Correcting IOLs with different designs (accommodative or multifocal; aspheric or spherical) using the modulation transfer function (MTF) testing method and U.S. Air Force 1951 Resolution Target (AFT) testing

Modulation Transfer Function (MTF) Testing• Objective method of measuring image contrast degradation

at different spatial frequencies1

Modified ISO model eye• The standard ISO Model Eye1 configuration incorporates a

35 mm doublet lens to converge light to simulate the refractive power of a human cornea

• The model cornea in the ISO Model Eye is an aberration free lens, and is not representative of a typical human cornea with its inherent positive spherical aberration

• Thus, a modified ISO model eye simulating the spherical aberration of the internal optics of a young eye was used in this study

Study Objective• To compare the image quality of various Presbyopia

Correcting IOLs with different designs (accommodative or multifocal; aspheric or spherical) using the modulation transfer function (MTF) testing method and U.S. Air Force 1951 Resolution Target (AFT) testing

Modulation Transfer Function (MTF) Testing• Objective method of measuring image contrast degradation

at different spatial frequencies1

Modified ISO model eye• The standard ISO Model Eye1 configuration incorporates a

35 mm doublet lens to converge light to simulate the refractive power of a human cornea

• The model cornea in the ISO Model Eye is an aberration free lens, and is not representative of a typical human cornea with its inherent positive spherical aberration

• Thus, a modified ISO model eye simulating the spherical aberration of the internal optics of a young eye was used in this study

Ref 1: ISO 11979-2 Ophthalmic implants – Intraocular lenses – Part 2 Optical properties and test methods, 2000.

The optical bench setup

Pinhole Target

IOLLight

Source

CCD Camera

Optikos Video MTF measurement systemOptikos Video MTF measurement system 1024 element detector, a 550 nm narrow band filter, and a 20X 1024 element detector, a 550 nm narrow band filter, and a 20X

microscope objectivemicroscope objective IOLs were mounted in a lens holder under 10 mm of compression, IOLs were mounted in a lens holder under 10 mm of compression,

and aligned on the optical axis in a wet cell filled with deionized (DI) and aligned on the optical axis in a wet cell filled with deionized (DI) water at 35 ± 2 °C with the anterior side of the IOL facing the incident water at 35 ± 2 °C with the anterior side of the IOL facing the incident lightlight

3 and 5 mm apertures used to simulate pupil size3 and 5 mm apertures used to simulate pupil size Green light illuminates a single slit object located on the front focal Green light illuminates a single slit object located on the front focal

plane of a 180 mm collimator plane of a 180 mm collimator The collimated light passes through the model cornea and IOL system The collimated light passes through the model cornea and IOL system

that simulates the vergence of a human eyethat simulates the vergence of a human eye

Optikos Video MTF measurement systemOptikos Video MTF measurement system 1024 element detector, a 550 nm narrow band filter, and a 20X 1024 element detector, a 550 nm narrow band filter, and a 20X

microscope objectivemicroscope objective IOLs were mounted in a lens holder under 10 mm of compression, IOLs were mounted in a lens holder under 10 mm of compression,

and aligned on the optical axis in a wet cell filled with deionized (DI) and aligned on the optical axis in a wet cell filled with deionized (DI) water at 35 ± 2 °C with the anterior side of the IOL facing the incident water at 35 ± 2 °C with the anterior side of the IOL facing the incident lightlight

3 and 5 mm apertures used to simulate pupil size3 and 5 mm apertures used to simulate pupil size Green light illuminates a single slit object located on the front focal Green light illuminates a single slit object located on the front focal

plane of a 180 mm collimator plane of a 180 mm collimator The collimated light passes through the model cornea and IOL system The collimated light passes through the model cornea and IOL system

that simulates the vergence of a human eyethat simulates the vergence of a human eye

MTF BenchMTF Bench IOL Models Tested (N = 1)IOL Models Tested (N = 1) IQ ReSTORIQ ReSTOR®® SN6AD3 (Aspheric)* SN6AD3 (Aspheric)* ReSTORReSTOR®® SA60D3 (Spherical)* SA60D3 (Spherical)* TECNISTECNIS®® ZM900* ZM900* Acri.LISAAcri.LISA®® 366D* 366D* ReZoomReZoom®® NXG1* NXG1* CrystalensCrystalens®® AT-50SE* AT-50SE* CrystalensCrystalens®® HD500* HD500*

* ReSTOR trademark of Alcon Laboratories, Inc.; ReZOOM & Tecnis trademark of Advanced Medical Optics, Inc.; crystalens trademark of eyeonics, Inc.; Acri.LISA trademark of Carl Zeiss Meditec Inc.

Modulation Transfer FunctionModulation Transfer Function 5 mm Aperture, Distance Focus5 mm Aperture, Distance Focus

Spatial Frequencies of 0 to 100 lp/mmSpatial Frequencies of 0 to 100 lp/mm

0102030405060708090

100

0 20 40 60 80 100Frequency (lp/mm)

Mo

du

lati

on

Tra

nsf

er F

un

ctio

n % ReSTOR Spherical SA60D3

IQ ReSTOR Aspheric SN6AD3TECNIS ZM900Acri.LISA 366DReZOOM NXG1crystalens AT-50SEcrystalens HD-500Diffraction Limited

Modulation Transfer FunctionModulation Transfer Function 5 mm Aperture, Distance Focus, 5 mm Aperture, Distance Focus,

Discrete frequency of 100 lp/mm (20/20 Equivalent)Discrete frequency of 100 lp/mm (20/20 Equivalent)

21%

18%

12%11%

10%

15%14%

0%

5%

10%

15%

20%

25%

IQ ReSTORSN6AD3

(Aspheric)

Acri.LISA366D

crystalensAT-50SE

ReSTORSA60D3

(Spherical)

TECNISZM900

ReZOOMNXG1

crystalensHD-500

MTF @

100 lp/m

m

IQ ReSTOR® SN6AD3 demonstrated the highest MTF.21%

18%

12%11%

10%

15%14%

0%

5%

10%

15%

20%

25%

IQ ReSTORSN6AD3

(Aspheric)

Acri.LISA366D

crystalensAT-50SE

ReSTORSA60D3

(Spherical)

TECNISZM900

ReZOOMNXG1

crystalensHD-500

MTF @

100 lp/m

m

IQ ReSTOR® SN6AD3 demonstrated the highest MTF.

Modulation Transfer Function Modulation Transfer Function 5 mm Aperture, Distance Focus, 5 mm Aperture, Distance Focus,

Discrete frequency of 50 lp/mm (20/40 Equivalent)Discrete frequency of 50 lp/mm (20/40 Equivalent)

29%

25%

18%

24%

16%

24%21%

0%

5%

10%

15%

20%

25%

30%

35%

IQ ReSTORSN6AD3

(Aspheric)

Acri.LISA366D

crystalensAT-50SE

ReSTORSA60D3

(Spherical)

TECNISZM900

ReZOOMNXG1

crystalensHD-500

MTF @

50 lp/m

m

IQ ReSTOR® SN6AD3 demonstrated the highest MTF.29%

25%

18%

24%

16%

24%21%

0%

5%

10%

15%

20%

25%

30%

35%

IQ ReSTORSN6AD3

(Aspheric)

Acri.LISA366D

crystalensAT-50SE

ReSTORSA60D3

(Spherical)

TECNISZM900

ReZOOMNXG1

crystalensHD-500

MTF @

50 lp/m

m

IQ ReSTOR® SN6AD3 demonstrated the highest MTF.

Modulation Transfer Function Modulation Transfer Function 3 mm Aperture, Distance Focus3 mm Aperture, Distance Focus

Spatial Frequencies of 0 to 100 lp/mmSpatial Frequencies of 0 to 100 lp/mm

0

10

20

30

40

50

60

70

80

90

100

0 20 40 60 80 100Spatial Frequency

Mo

du

lati

on

Tra

nsf

er F

un

ctio

n %

ReSTOR Spherical SA60D3IQ ReSTOR Aspheric SN6AD3TECNIS ZM900Acri.LISA 366DReZOOM NXG1crystalens AT-50SEcrystalens HD-500Diffraction Limited

Modulation Transfer FunctionModulation Transfer Function 3 mm Aperture, Distance Focus, 3 mm Aperture, Distance Focus,

Discrete frequency of 100 lp/mm (20/20 Equivalent)Discrete frequency of 100 lp/mm (20/20 Equivalent)

30%

15%

20%

30%31%32%33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

IQ ReSTORSN6AD3

(Aspheric)

Acri.LISA366D

crystalensAT-50SE

ReSTORSA60D3

(Spherical)

TECNISZM900

ReZOOMNXG1

crystalensHD-500

MT

F %

@ 1

00

lp

/mm

With 3 mm aperture the IQ ReSTOR® IOL still provides the highest MTF among the presbyopia correcting IOLs evaluated.

30%

15%

20%

30%31%32%33%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

IQ ReSTORSN6AD3

(Aspheric)

Acri.LISA366D

crystalensAT-50SE

ReSTORSA60D3

(Spherical)

TECNISZM900

ReZOOMNXG1

crystalensHD-500

MT

F %

@ 1

00

lp

/mm

With 3 mm aperture the IQ ReSTOR® IOL still provides the highest MTF among the presbyopia correcting IOLs evaluated.

U.S. Air Force 1951 U.S. Air Force 1951 Resolution Target Test Resolution Target Test

(AFT)(AFT)

Optikos Optical Testing System Optikos Optical Testing System • The setup for the AFT test was identical to that The setup for the AFT test was identical to that

of the MTF test, except the single slit object was of the MTF test, except the single slit object was replaced with the AFT replaced with the AFT

• An image of the AFT was photographed through An image of the AFT was photographed through each IOL each IOL

• The AFT test includes paired 3-bar target sets The AFT test includes paired 3-bar target sets used to qualitatively measure resolution used to qualitatively measure resolution efficiencyefficiency

Optikos Optical Testing System Optikos Optical Testing System • The setup for the AFT test was identical to that The setup for the AFT test was identical to that

of the MTF test, except the single slit object was of the MTF test, except the single slit object was replaced with the AFT replaced with the AFT

• An image of the AFT was photographed through An image of the AFT was photographed through each IOL each IOL

• The AFT test includes paired 3-bar target sets The AFT test includes paired 3-bar target sets used to qualitatively measure resolution used to qualitatively measure resolution efficiencyefficiency

U.S. Air Force 1951 Resolution Target Test U.S. Air Force 1951 Resolution Target Test 5 mm Aperture, Distance Focus5 mm Aperture, Distance Focus

crystalensAT-50SE

ReSTOR SA60D3

(Spherical)

IQ ReSTOR SN6AD3

(Aspheric)

ReZoom NXG1

Acri.Lisa 366D

Tecnis ZM900

crystalensHD-500

Superior image resolution

demonstrated by the IQ ReSTOR® IOL

ConclusionsConclusions The IQ ReSTORThe IQ ReSTOR®® SN6AD3 aspheric IOL produced the SN6AD3 aspheric IOL produced the

highest overall image quality for MTF and AFT testing highest overall image quality for MTF and AFT testing with a 5 mm aperture when compared to various with a 5 mm aperture when compared to various presbyopia-correcting IOLs presbyopia-correcting IOLs

The IQ ReSTORThe IQ ReSTOR®® SN6AD3 aspheric IOL produced the SN6AD3 aspheric IOL produced the highest image resolution for AFT image testing with 5 highest image resolution for AFT image testing with 5 mm aperture when compared to various presbyopia-mm aperture when compared to various presbyopia-correcting IOLs correcting IOLs

MTF performance with a smaller aperture (3 mm) was MTF performance with a smaller aperture (3 mm) was similar among the various IOLs, and slightly higher for similar among the various IOLs, and slightly higher for IQ ReSTORIQ ReSTOR®® SN6AD3 at 100 lp/mm SN6AD3 at 100 lp/mm

Clinical investigation is needed to determine whether Clinical investigation is needed to determine whether superior IOL optical quality demonstrated in optical superior IOL optical quality demonstrated in optical bench testing results in measurable visual bench testing results in measurable visual improvements in clinical practiceimprovements in clinical practice

The IQ ReSTORThe IQ ReSTOR®® SN6AD3 aspheric IOL produced the SN6AD3 aspheric IOL produced the highest overall image quality for MTF and AFT testing highest overall image quality for MTF and AFT testing with a 5 mm aperture when compared to various with a 5 mm aperture when compared to various presbyopia-correcting IOLs presbyopia-correcting IOLs

The IQ ReSTORThe IQ ReSTOR®® SN6AD3 aspheric IOL produced the SN6AD3 aspheric IOL produced the highest image resolution for AFT image testing with 5 highest image resolution for AFT image testing with 5 mm aperture when compared to various presbyopia-mm aperture when compared to various presbyopia-correcting IOLs correcting IOLs

MTF performance with a smaller aperture (3 mm) was MTF performance with a smaller aperture (3 mm) was similar among the various IOLs, and slightly higher for similar among the various IOLs, and slightly higher for IQ ReSTORIQ ReSTOR®® SN6AD3 at 100 lp/mm SN6AD3 at 100 lp/mm

Clinical investigation is needed to determine whether Clinical investigation is needed to determine whether superior IOL optical quality demonstrated in optical superior IOL optical quality demonstrated in optical bench testing results in measurable visual bench testing results in measurable visual improvements in clinical practiceimprovements in clinical practice