植入雙焦點以及延伸景像深度人工水晶體後視覺品質比較

Abstract

白內障疾病是目前在全世界造成視力損害以及失明的主要病因之一，而手術方式摘除白內障是目前唯一有效的治療方式。在白內障摘除之後需要植入人工水晶體至完整的囊袋當中，以補足失去水晶體之折射能力。人工水晶體依其形成之焦點數目之能力，可分為單焦點或多焦點。而多焦點人工水晶體之目的是同時可以看遠或中、近距離。依此目的焦點人工水晶體可分為雙焦點，三焦點和延長景深人工水晶體。一般雙焦點人工水晶體含有一個遠焦點及一個近或中距離焦點，而延長景深人工水晶體可將遠焦點景深連續拉長至中距離位置。 本研究目標在分析延伸景像深度人工水晶體的視覺品質表現以作為治療的選擇，並與雙焦點及單焦點人工水晶體做比較，我們著重於遠近視力、對比敏感度、像差以及視覺品質。視覺品質評估的向度包括遠視力、判斷距離、明暗變化夜間眩光或光暈、依賴眼鏡、整體近距離視力滿意度以及整體中距離視力滿意度。視覺品質評估分析使用NEI-RQL-42以及near-activity visual questionnaire。所收集到的問卷結果以羅序分析進行轉換後分析。 本研究共收集到97位患者資料，其中雙焦點組為24位患者、延長景深組為30位患者、以及單焦點組為43位患者。我們的結果顯示在三組間裸眼遠視力以及矯正遠視力並無顯著差異，裸眼近視力延長景深組與雙焦點組織之間無顯著差異。延長景深組相較於另外兩組有較佳的對比敏感度。在像差方面包括彗星像差、球面像差、三葉草像差以及整體高階像差在三組當中皆無顯著差異。在視覺品質問卷方面，患者植入雙焦點或是延長景深人工水晶體後相較於植入單焦點人工水晶體後，較不需依賴眼鏡，而夜間眩光於雙焦點組與延長景深組皆較明顯。單焦點組患者相對於雙焦點組以及延長景深組，對於適應黑暗及夜間開車感到較容易。以線性迴歸分析可得到平均問卷分數與視力具有相關性，而與對比敏感度、像差皆無顯著相關。

Cataract is one of the leading causes of vision impairment and blindness worldwide. Presently, surgical removal is the only therapeutic approach for cataracts. After cataract removal, an artificial intraocular lens is then placed in the intact capsular bag. For IOL model, bifocal multifocal IOLs typically incorporate a far and near focus, and IOLs with an extended depth of focus (EDOF) have an extended far focus area that reaches the intermediate distance. The aim of our study is to analyze the visual performance of the EDOF Symfony IOL for treatment selection, and compared with bifocal Restor IOL and monofocal Sensar AR40e spherical IOL, particularly distance and near visual acuity, CS, wavefront aberration, and quality of vision (QoV). QoV dimensions include far vision, diurnal fluctuation, glare and halos, spectacle dependence, near vision, and intermediate vision using the NEI-RQL-42 and the near-activity visual questionnaire. The questionnaire results were analyzed using Rasch analysis. A total of 97 patients were retrospectively included in this study, with 24 patients in the bifocal group, 30 in the EDOF group, and 43 in the monofocal IOL group. No significant differences in UCVA and CDVA were observed among the 3 groups. For UNVA, no significant difference was noted between the bifocal and EDOF groups. The mesopic CS in all spatial frequencies were higher in the EDOF group than in the bifocal group and monofocal group. No significant differences of 6.0-mm pupil in the RMS of coma aberration, spherical aberration, trefoil aberration and higher order aberration were noted among the 3 groups. Patients implanted with bifocal and EDOF IOLs were less spectacle dependent and experienced more glare than those implanted with monofocal IOLs. Patients in monofocal group felt less difficulty in getting used to the dark and driving at night compared with bifocal and EDOF group. Mean QoV questionnaire scores are correlated to visual acuity among groups by linear regression, and not significantly correlated to contrast sensitivity and wavefront aberration.