Editorial

Spherical Aberration of Intraocular Lenses

Majid Moshirfar, MD
John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, Utah, USA

Advancements in cataract surgery and

intraocular lens (IOL) design have optimized
the postoperative optical performance of the
pseudophakic eye. One of the recent spotlights
of IOL design has been formulating optical
properties similar to a clear, young lens and
addressing spherical aberration.
Spherical aberration in the human eye
is a combination of the positive spherical
aberration of the cornea, 1-3 and the negative
spherical aberration of the crystalline lens. 4,5 In
young eyes, the positive spherical aberration
of the cornea is compensated by the negative
spherical aberration of the lens; as a result,
overall spherical aberration in the young eye is
low.2,3,6 As the eye ages, the optical properties
of the crystalline lens change, 4,7 resulting in
overall positive spherical aberration 2,8,9 and
decreased optical performance. Spherical
aberrations generally reduce the contrast of the
retinal image10,11 and affect visual performance,
especially under mesopic conditions.12
Conventional spherical IOLs increase the
positive spherical aberration in the eye following
cataract extraction.13,14 In 2002, an aspheric IOL
design was introduced to compensate for the
positive spherical aberration of the cornea.15
Aspheric IOLs have been designed with an
anterior prolate suface (Tecnis, Advanced
Medical Optics), a posterior prolate surface
(Acrysof IQ, Alcon Laboratories), or with both
anterior and posterior prolate surfaces (Akreos
AO, SofPort AO and L161 AO, Bausch & Lomb)
and compensate for corneal spherical aberration
to varying degrees.
In this issue of JOVR, a double-blind
randomized controlled trial conducted by
Jafarinasab et al16 compares spherical aberration
and contrast sensitivity among 3 different types
of aspheric IOLs (Tecnis, Akreos AO, and
Acrysof IQ) and one spherical IOL (Sensar).

Significantly higher spherical aberration was

reported with the spherical IOL and the zeroaberration aspheric IOL as compered to the
negative aberration aspheric IOLs, however
this advantage was pupil-size dependent. With
increased pupil size from 4 to 6mm, an increase
in spherical aberration was observed for all four
types of IOLs, however significantly more with
the spherical IOL. Contrast sensitivity function
under mesopic conditions and at low spatial
frequencies (1.5 to 3cpd) was significantly
higher in the Tecnis group as compared to
the others. At higher spatial frequencies (12 to
18cpd), Acrysof IQ worked significantly better.
The authors concluded that the performance
of aspheric IOLs is pupil dependent and that
their function deteriorates to some extent under
mesopic conditions, as there was no significant
difference between spherical and aspheric IOLs
in mesopic contrast sensitivity at 6cpd.
Although this study is a well-designed
clinical trial with interesting results, the
readers should keep in mind that the best
way to compare two groups with analysis of
variance (ANOVA) is using post hoc tests such
as Bonferroni adjustment of type one error.
This is one of the reasons for discrepancies in
the results among different studies. Another
explanation could be different measurement
protocols.
There are several studies comparing
different types of spherical and aspheric IOLs
under various conditions and with varying
protocols. The readers should be careful about
applying the results and accepting them as
general rules.
REFERENCES
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Editorial; Moshirfar

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