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• W2068669227 abstract "In their recent article about the Tecnis intraocular lens (IOL), Muñoz et al.1 report elimination of the spherical aberration (−0.0321 ± 0.2856 μm for the Tecnis IOL versus 0.1511 ± 0.1709 μm for the AR40e IOL and 0.2115 ± 0.2131 μm for the Stabibag IOL) that is consistent with results in previous publications,2–6 which have shown that implantation of a modified prolate IOL with −0.27 μm of spherical aberration produces a mean total ocular spherical aberration equivalent to zero. The authors also found that eyes with the Tecnis Z9000 had a greater Strehl ratio after surgery. However, they did not find a significant difference in contrast sensitivity between eyes implanted with the Tecnis Z9000 and fellow eyes implanted with either control IOL. The absence of a significant difference in contrast sensitivity at any spatial frequency runs counter to previous reports comparing the Tecnis Z9000 IOL and the AR40e,7–9 as well as reports comparing the Tecnis with a variety of other spherical IOLs.10–12 The findings also directly contradict one publication that demonstrates significantly better visual acuity and better (although not statistically significantly better) contrast sensitivity13 and indirectly contradicts the findings of another report that shows significantly better contrast acuity following mydriasis.14 Muñoz et al.1 suggest several possible explanations for their findings, including IOL material, chromatic aberration, and IOL decentration (although they admit that their finding of reduced coma in the eyes implanted with the Tecnis IOL provides evidence against decentration). However, we were surprised they did not mention that the values they show for normalized contrast sensitivity in all eyes are abnormally low under both photopic and mesopic conditions. We are concerned that the normalized contrast sensitivity values reported in this article are lower than expected for all tests, including the Z9000, AR40e, and Stabibag IOL eyes. In a previous publication by some of the same authors,15 normalized contrast sensitivity values in pseudophakic patients with spherical monofocal and multifocal IOLs were close to 1.0 at all spatial frequencies by 3 months postoperatively (Figure 1). It has also been demonstrated that the contrast sensitivity in pseudophakic patients implanted with spherical IOLs is the same as that in age-matched controls without cataract, and thus the pseudophakes would be expected to have normalized contrast sensitivity approximating 1.0.16 The significantly lower values for contrast sensitivity reported in this paper suggest the possibility of an error in testing conditions, protocol, data management, or analysis.Figure 1: The normalized contrast sensitivity reported in a previous publication15 for a spherical monofocal IOL (open squares) and a multifocal IOL (solid squares) at 6 cpd. The values are close to 1.0 for the spherical monofocal at all time points, whereas the values in the current publication vary from 0.6 (mesopic) to 0.8 (photopic). Reprinted with permission from Elsevier.One test condition that could create lower contrast sensitivity in the current study compared with that in the previous publication15 is the different contrast sensitivity testing systems used. The earlier publication used the FACT (Functional Acuity Contrast Test, Vision Sciences Research Corp.) and the present study used the VectorVision test system. The VectorVision contrast sensitivity system is less sensitive than the FACT system.17 Compared with the FACT grating system, the VectorVision gratings change contrast with changes in room illuminance; the white grating surround creates a glare source and the grating patches are considerably smaller than the FACT gratings. An in-house study of 20 normal subjects (mean age 37 years [range 26 to 51 years]) with a best corrected visual acuity of 20/20 compared the contrast sensitivity of FACT and VectorVision at 6 and 12 cycles per degree (cpd) under photopic test conditions (unpublished data). Under normal test conditions, the contrast sensitivity of FACT was slightly, but not significantly, higher. However, under glare (BAT on medium) and low contrast (homogeneous light scatter material), the FACT was twice as sensitive in measuring contrast loss as the VectorVision at 6 and 12 cpd. The relative insensitivity of the VectorVision test to loss of contrast sensitivity also means the VectorVision is a relatively insensitive measure of contrast gains such as those reported previously with the Tecnis IOL and the FACT system.6 The differences in sensitivity to contrast between contrast test systems also cautions interpretation of normalized test results such as that given by Boxer-Wachler and Kruger.18 Two quite different contrast sensitivity values can give similar normalized values, masking significant changes in contrast sensitivity. For example, one contrast sensitivity test system having a normalized value of 0.8 for contrast sensitivity values of 100 and 80 may find the 80 below the normal population curve. However, another contrast sensitivity test system having a normalized value of 0.8 for contrast sensitivity values of 150 and 120 may find the 120 value within the normal population curve. Normalization only works for similar contrast test systems. Measuring and reporting contrast sensitivity remains unfamiliar territory for most cataract and refractive surgeons. Variations in results should be elucidated with reference to differences in testing systems, procedures, and data analysis." @default.
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• W2068669227 date "2007-03-01" @default.
• W2068669227 modified "2023-09-23" @default.
• W2068669227 title "Testing and reporting contrast sensitivity" @default.
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• W2068669227 doi "https://doi.org/10.1016/j.jcrs.2006.10.061" @default.
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