Wavefront-customized intraocular lenses

Abstract

Recent advances in ocular wavefront measurement and in intraocular lens materials and manufacturing methods have brought cataract surgery to the brink of a period in which customized correction of higher-order aberrations with intraocular lenses may become standard practice. Retinal image quality in pseudophakic eyes is limited by the wavefront aberrations of the cornea and the intraocular lens. The Tecnis Z9000 is the first commercially available intraocular lens designed to account for the wavefront aberrations of the cornea, specifically spherical aberration. Clinical findings with the Tecnis Z9000 intraocular lens show improved contrast sensitivity at low and mid spatial frequencies. However, if the lens decenters or tilts modestly, higher-order aberrations are created, and the lens may underperform relative to standard intraocular lenses. At present, one firm is developing an intraocular lens that may be modified in vivo with near ultraviolet energy. Such a technology offers tremendous potential for a fully customized intraocular lens. Wavefront-customized intraocular lenses offer the promise of near perfect retinal image quality, such that only diffraction, chromatic aberration, retinal sampling and neural factors will limit vision in pseudophakic eyes.