Purpose: Adaptive optics (AO) vision simulation predicts high-contrast binocular visual acuity following cataract surgery for different IOL designs well (Schwarz, ARVO 2014). The purpose of this study is to compare the clinical contrast sensitivity (CS) measured in patients implanted with different IOL models to those predicted by AO visual simulation for the phase profiles of the same IOLs.
Methods: Phase profiles corresponding to five different IOLs (two monofocal IOLs, one aspheric and one spherical, and three diffractive multifocal IOLs) were generated bilaterally in a binocular AO visual simulator. CS was measured in 5 subjects for a 4.5 mm pupil in white light under mesopic conditions using the quick-CSF procedure. In all cases, natural astigmatism and spherical aberration were corrected. The measured CS was compared to the clinical outcomes measured independently in two different clinical trials in pseudophakic patients bilaterally implanted with the same IOL models. In these clinical trials, mesopic CS was measured without glare at 1.5, 3, 6 and 12 c/deg with either a Vector Vision or an Optec 6500 chart. Measurements were performed at 6 months postoperatively with best distance correction in place, according to common clinical practice.
Results: CS measured in clinical studies was correlated with CS measured in the AO instrument for the IOL models evaluated (r^2=0.73). This correlation was higher for the lower and higher spatial frequencies than for middle spatial frequencies. When considering different IOL models independently, the correlation between clinical and simulated CS decreased (r^2=0.49) for the monofocal IOL design that corrects for spherical aberration, while the remaining models provided correlated well (r^2>0.8 for all models).
Conclusions: AO visual simulation predicts clinical CS following cataract surgery under binocular conditions for refractive and diffractive IOL designs. The correlation was better for high and low spatial frequencies and for multifocal and monofocal spherical designs. These results validate the use of AO instruments as a tool for developing new IOL optics and their impact on the quality of vision.