1. Toric IOLs: wavefront aberrometry and quality of life Mencucci Rita Giordano Cristina, Stiko Ermelinda, Miranda Paolo, Eleonora Favuzza, Ugo Menchini Authors do not have any financial interest in the subject matter of the presentation University of Florence Department of Oto-Neuro-Ophthalmological Sciences Prof. U. Menchini

2. Aim of the Study To present the use of aberrometrical evaluation and quality of life test for the assessment of visual performance pre and post implantation of toric intraocular lenses To present the use of aberrometrical evaluation and quality of life test for the assessment of visual performance pre and post implantation of toric intraocular lenses Implantation of toric intraocular lenses (IOLs) is an option to compensate for corneal astigmatism in cataract patients

3. Materials and Methods 60 cataract astigmatic patients (cyl > 1,5 D)60 cataract astigmatic patients (cyl > 1,5 D) Standard uneventful 2.75 mm clear cornea phacoemulsification, incision on the steepest axisStandard uneventful 2.75 mm clear cornea phacoemulsification, incision on the steepest axis Toric group - 36 patients implanted with Alcon Acrysof Toric IOLs: 12 males, 24 females, mean age 73.9, (min 49 – max 86)Toric group - 36 patients implanted with Alcon Acrysof Toric IOLs: 12 males, 24 females, mean age 73.9, (min 49 – max 86) Control group - 24 patients implanted with aspheric Alcon Acrysof SN60WF IOLs : 10 males, 14 females, mean age 77.1 (min 67 – max 86)Control group - 24 patients implanted with aspheric Alcon Acrysof SN60WF IOLs : 10 males, 14 females, mean age 77.1 (min 67 – max 86) Optical Biometry with Zeiss IOL Master (Holladay I Formula)Optical Biometry with Zeiss IOL Master (Holladay I Formula) Corneal TopographyCorneal Topography Toric calculation: www.acrysoftoriccalculator.comToric calculation: www.acrysoftoriccalculator.comwww.acrysoftoriccalculator.com Follow up at least 3 monthsFollow up at least 3 months

4. Materials and Methods Refractive and clinical outcome: Objective refraction: OPD Optical Path Difference evaluation (Nidek OPD Scan II) Objective refraction: OPD Optical Path Difference evaluation (Nidek OPD Scan II) UDVA UDVA Aberrometrical evaluation at 4.00 mm pupil diameter : Nidek OPD Scan II : Nidek OPD Scan II :  Astigmatism RMS (Zernike Polinomial Z 2,2 Z2,-2)  MTF Area Ratio; PSF (Strehl Ratio) Quality of life test: NEI-RQL 42 NEI-RQL 42

5. Results OPD Refractive outcome (Cyl Optical Power D) ** = p<0.001 cyl pre op toric vs cyl postop toric Target SE ( Zeiss IOL Master)= -0,25 Sphere ≤ ± 0,50 D Pupil diameter : 4 mm * ** Cyl optical power (OPD)

6. Results Uncorrected Distance Visual Acuity (UDVA) * = p<0.05 UDVA post op toric vs UDVA postop control Pupil diameter: 4 mm

7. Results Astigmatism Evaluation - Zernike Polynomial Z 2,2 Z 2,-2 (Wavefront error – microns) Pupil diameter 4 mm ** p<0.001 cyl post-op toric vs pre-op toric

8. A/Bis the ratio between AVE and BMTF A/D is the ratio between AVE and Diffraction Limited H/B is the ratio between HOave and BMTF H/D is the ratio between HOave andl Diffraction Limited Area Ratio close to ONE means more image contrast. MTF evaluation: Area Ratio

9. Results MTF Area ratio A/D (Average/Diffraction limited) ** p<0.001 post op toric vs preop toric Pupil diameter 4 mm Area ratio closer to ONE means more image contrast **

10. Results PSF (Strehl Ratio) ** p<0.001 post op toric vs preop toric The Point Spread Function (PSF) describes the light distribution on the retina of a point source. It can be expressed with the Strehl ratio, a measurement of the PSF peak height over the peak height for the same optical system if it is diffraction limited. ** Pupil diameter 4 mm

11. Quality of life NEI-RQL 42 TM Clarity of vision toric vs control postop p<0.001 Far vision toric vs control postop p<0.05 Glare toric vs control postop p<0.05 Overall satisfaction toric vs control postop p=0.001 Four main items, important in astigmatic patients:

12. Conclusions Wavefront aberrometry is an useful tool to test optical and visual performance after Toric IOLs implantation Wavefront aberrometry is an useful tool to test optical and visual performance after Toric IOLs implantation The MTF and PSF data show a relevant better optical quality in Toric IOL group in comparison with control group, related to astigmatism value correction The MTF and PSF data show a relevant better optical quality in Toric IOL group in comparison with control group, related to astigmatism value correction The NEI-RQL 42 quality of life test is a sensitive instrument to detect the visual benefits of Toric IOLs The NEI-RQL 42 quality of life test is a sensitive instrument to detect the visual benefits of Toric IOLs There is an association of objective optical performance of Toric IOLs with a subjective improvement in quality of life There is an association of objective optical performance of Toric IOLs with a subjective improvement in quality of life