Stereoacuity and Aniseikonia: Evaluation Before and After Bilateral Implantation of Three Types of Presbyopia-Correcting Intraocular Lenses in Uncomplicated Phacoemulsification with Due Consideration of Interocular Differences in Higher Order Aberrations, Axial Lengths, Refractive Errors, and Acuities

Ivana Mravi&ccaron;i&cacute;,&ast; Selma Luka&ccaron;evi&cacute;,&ast; Ante Bariši&cacute;,&ast; Sudi Patel,&ast; Maja Boha&ccaron;,&ast; Alma Biš&ccaron;evi&cacute;,&ast; Nikica Gabri&cacute;&ast; Department of Cataract and Refractive Surgery, University Eye Clinic Svjetlost, Zagreb, 10000, Croatia&ast;These authors contributed equally to this workCorrespondence: Sudi Patel, Department of Cataract and Refractive Surgery, University Eye Clinic Svjetlost, Heinzelova 39, Zagreb, 10000, Croatia, Email [email protected]: To determine if the changes in stereoacuity and aniseikonia, following bilateral implantation of presbyopia correcting intraocular lenses could be predicted from preoperative measurements of higher order aberrations (HOAs), axial lengths (AL), refractive errors (RE) and corrected visual acuities (CVAs).Patients and Methods: Stereoacuity (Randot tests, @6m & 40cm, in steps of 20 arcsecs”) vertical and horizontal aniseikonia (Awaya test @6m, in steps of 1%) with best correction and HOAs (Shack-Hartmann aberrometer) were measured before, 3 and 6 months after uncomplicated bilateral phacoemulsification. Twenty patients (I) underwent a mix-and-match procedure (Tecnis MF, ZKB00 in one eye and ZLB00 in the other), 17 (II) were implanted with a trifocal (AT LISA 839 triMP) and 18 (III) with a one-piece diffractive (Synergy OU) intraocular lens. The resultant aniseikonia (AR) of vertical and horizontal pairs of aniseikonia measurements was calculated using the Pythagorean theorem. Twenty untreated age/gender matched cases were recruited as controls (IV).Results: The key results (p < 0.001) were a) stereoacuity at distance (SAD) and near (SAN) improved, AR reduced in groups I, II & III remaining unchanged in group IV; b) some significant intergroup differences in SAD, SAN & AR were detected at postop; c) at 6 months postop, changes (Δ=pre- minus postoperative value) correlated with preoperative values (x). Linear regression revealed, I ΔSAD=0.66x-57.47 [0.832, ± 66.4], ΔSAN=0.96x-34.59 [0.821, ± 16.9], ΔAR=0.93AR-2.12 [0.795, ± 1.4] II ΔSAD=0.79x-62.91 [0.916, ± 38.1], ΔSAN=0.96x-31.49 [0.892, ± 8.0], ΔAR=0.91AR-0.91 [0.839, ± 1.3] III ΔSAD=0.67x-35.50 [0.991, ± 23.7], ΔSAN=0.88x-38.51[0.988, ± 10.6], ΔAR=0.86AR-0.96 [0.900, ± 1.3]. Figures in parentheses are the corresponding rs and ±limits of agreement between actual and estimated values. Definitive overarching associations connecting interocular differences in HOAs, AL, RE, and CVAs with SAD, SAN and AR were not found.Conclusion: Changes in stereoacuity and aniseikonia can be predicted using preoperative values. ΔSAN can be predicted within ± 1, and ΔAR within ± 2, scale divisions. In group III ΔSAD can be predicted within ± 1, and in group I ± 3, scale divisions.Keywords: presbyopia-correcting intraocular lenses, aberrometry, stereoacuity, aniseikoni