Meta-analysis of Randomized Controlled Trials Comparing Aspheric Intraocular Lenseswith Spherical Intraocular Lenses in the Treatment of Cataract Surgery_Chinese Journal of Evidence-Based Medicine

Authors：

 LIU Yanbin ¹ , TAN Shaojian ² , CHEN Yingying ²

1. Department of Ophthalmology, Nanjing Aier Eye Hospital, Jiangsu 210006, China;2. Department of Ophthalmology, First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;

Corresponding author：

LIU Yanbin, Email: lybeye@163.com

Keywords：

Cataract; Aspheric intraocular lenses; Spheric intraocular lenses; Systematic reviews

DOI：

10.7507/1672-2531.20090177

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Objective 　To compare the effectiveness of aspheric intraocular lenses(IOL) versus spherical IOL in the treatment of cataract.
Method 　Randomized controlled trials comparing aspheric IOL with spherical IOL were identified by searching PubMed (2000 to October, 2008), EMbase (2000 to October, 2008), MEDLINE (2000 to October, 2008), and The Cochrane Library (Issue 3, 2008). Two reviewers independently assessed trials for eligibility and quality, as well as the extracted data. Data were synthesized using RevMan software (release 5) provided by the Cochrane Collaboration.
Results 　A total of 14 trials (1383 eyes) were included for systematic review, and 11 out of 14 studies were included in the meta-analysis. Subgroup analyses were used according to different aberrations of aspheric IOL. The results showed a significant difference in the mean best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD -0.02, 95% CI -0.03 to -0.01(P lt;0.0001). It showed a significantly worse difference in the mean of the best corrected visual acuity at 3 months after cataract surgery in the AcrySof IQ IOL group with WMD –0.02, 95%CI –0.03 to –0.01 (P lt;0.000 1). It showed a significant worse in the mean the best corrected visual acuity in the Tecnis Z9000 IOL group with WMD 0.02, 95%CI 0.01 to 0.03 (P=0.002); and there was no significant difference between the two groups with WMD 0.00, 95%CI –0.02 to –0.03 (P=0.71). The results did display markedly less spherical aberration and total higher order aberrations than eyes implanted with the traditional spheric IOL in all subgroups (WMD –0.06, 95%CI –0.07 to –0.06, P lt;0.000 01, WMD –0.06, 95%CI –0.07 to –0.02, P lt;0.000 1, respectively). The majority of studies suggested significant improvement in the aspheric IOL group in contrast sensitivity, especially at mesopic low spatial frequencies, although some trials showed no significant difference.
Conclusion 　The effectiveness of aspheric IOL is superior to spherical IOL during cataract surgery. No differences in aspheric IOL with different aberration are found in this series, and further study is required.

Citation： LIU Yanbin,TAN Shaojian,CHEN Yingying. Meta-analysis of Randomized Controlled Trials Comparing Aspheric Intraocular Lenseswith Spherical Intraocular Lenses in the Treatment of Cataract Surgery. Chinese Journal of Evidence-Based Medicine, 2009, 09(9): 1001-1009. doi: 10.7507/1672-2531.20090177 Copy

1.	Resnikoff S, Pascolini D, Etya’ale D, et al. Global data on visual impairment in the year 2002. Bull WHO, 2004, 82: 844-851.
2.	Mester U, Dillinger P, Anterist N. Impact of a modified optic design on visual function: clinical comparative study. [Clinical Trial, Journal Article, Randomized Controlled Trial]. J Cataract Refract Surg, 2003, 29(4): 652-660.
3.	Kohen T. Aberratioon-correcting intraocular lenses. J Cataract Refract Surg, 2003, 29: 627-628.
4.	Guirao A, Tejedor J, Artal P. Corneal aberrations before and after small-incision cataract surgery. Invest Ophthalmol Vis Sci, 2004, 45(12): 4312-4319.
5.	Artal P, Guirao A, Berrio E, et al. Compensation of corneal aberrations by the internal optics in the human eye. J Vis, 2001, 1(1): 1-8.
6.	Taketani F, Yukawa E, Yoshii T, et al. Influence of intraocular lens optical design on high-order aberrations. J Cataract Refract Surg, 2005, 31(5): 969-972.
7.	Kershner RM. Retinal image contrast and functional visual performance with aspheric, silicone, and acrylic intraocular lenses. Prospective evaluation. J Cataract Refract Surg, 2003, 29(9): 1684-1694.
8.	Packer M, Fine IH, Hoffman RS. Aspheric intraocular lens selection: the evolution of refractive cataract surgery. Curr Opin Ophthalmol, 2008, 19(1): 1-4.
9.	Rocha KM, Soriano ES, Chamon W, et al. Spherical Aberration and Depth of Focus in Eyes Implanted with Aspheric and Spherical Intraocular Lenses A Prospective Randomized Study. Ophthalmology, 2007, 114: 2050-2054.
10.	Muñoz G, Albarrán-Diego C, Montés-Micó R, et al. Spherical aberration and contrast sensitivity after cataract surgery with the Tecnis Z9000 intraocular lens. J Cataract Refract Surg, 2006, 32(8): 1320-1327.
11.	Kasper T, Bühren J, Kohnen T. Visual performance of aspherical and spherical intraocular lenses: Intraindividual comparison of visual acuity, contrast sensitivity, and higher-order aberrations. J Cataract Refract Surg, 2006, 32(12): 2022-2029.
12.	Denoyer A, Le Lez ML, Majzoub S, et al. Quality of vision after cataract surgery after Tecnis Z9000 intraocular lens implantation Effect of contrast sensitivity and wavefront aberration improvements on the quality of daily vision. J Cataract Refract Surg, 2007, 33(2): 210-216.
13.	Johansson B, Sundelin S, Wikberg-Matsson A, et al. Visual and optical performance of the Akreos Adapt Advanced Optics and Tecnis Z9000 intraocular lenses Swedish multicenter study. J Cataract Refract Surg, 2007, 33(9): 1565-1572.
14.	Higgins JPT, Sally Green, editors. Cochrane Reviewers’ Handbook Version 5.0.0. http://www.cochrane.org/resources/handbook/hbook. htm.
15.	Higgins JPT, Altman DG (editors): Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
16.	吴泰相, 刘关键. 隐蔽分鰈 (分配隐藏) 和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 203-207.
17.	The Moorfields IOL Study Group. Binocular implantation of the Tecnis Z9000 or AcrySof MA60AC intraocular lens in routine cataract surgery Prospective randomized controlled trial comparing VF-14 scores. J Cataract Refract Surg, 2007, 33: 1559-1564.
18.	Bellucci R, Morselli S, Pucci V. Spherical aberration and coma with an aspherical and a spherical intraocular lens in normal age-matched eyes. J Cataract Refract Surg, 2007, 33(2): 203-209.
19.	Franchini A. Compromise between spherical and chromatic aberration and depth of focus in aspheric intraocular lenses. J Cataract Refract Surg, 2007, 33(3): 497-509.
20.	Beiko GH. Personalized correction of spherical aberration in cataract surgery. J Cataract Refract Surg, 2007, 33(8): 1455-1460.
21.	Awwad ST, Warmerdam D, Bowman RW, et al. Contrast sensitivity and higher order aberrations in eyes implanted with AcrySof IQ SN60WF and AcrySof SN60AT intraocular lenses. J Refract Surg, 2008, 24(6): 619-625.
22.	Tzelikis PF, Akaishi L, Trindade FC, et al. Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study. J Cataract Refract Surg, 2007, 33(11): 1918-1924.
23.	Casprini F, Balestrazzi A, Tosi GM, et al. Glare disability and spherical aberration with five foldable intraocular lenses: a prospective randomized study. Acta Ophthalmol Scand, 2005, 83(1): 20-25.
24.	Tzelikis PF, Akaishi L, Trindade FC, et al. Spherical Aberration and Contrast Sensitivity in Eyes Implanted with Aspheric and Spherical Intraocular Lenses: A Comparative Study. Am J Ophthalmol, 2008, 145(5): 827-833.
25.	Caporossi A, Martone G, Casprini F, et al. Prospective randomized study of clinical performance of 3 aspheric and 2 spherical intraocular lenses in 250 eyes. J Refract Surg, 2007, 23(7): 639-648.
26.	Bellucci R, Scialdone A, Buratto L, et al. Visual acuity and contrast sensitivity comparison between Tecnis and AcrySof SA60AT intraocular lenses: A multicenter randomized study. J Cataract Refract Surg, 2005, 31(4): 712-717.
27.	Lin IC, Wang IJ, Lei MS, et al. Improvements in vision-related quality of life with AcrySof IQ SN60WF aspherical intraocular lenses. J Cataract Refract Surg, 2008, 34(8): 1312-1317.
28.	Pandita D, Raj SM, Vasavada VA, et al. Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens Prospective randomized masked clinical trial. J Cataract Refract Surg, 2007, 33(4): 603-610.
29.	Holladay JT, Piers PA, Koranyi G, et al. A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. J Refract Surg, 2002, 18(6): 683-691.
30.	Franchini A. Compromise between spherical and chromatic aberration and depth of focus in aspheric intraocular lenses. J Cataract Refract Surg, 2007, 33(3): 497-509.
31.	Milauskas AT. Posterior capsule opacification after silicone lens implantation and its management. J Cataract Refract Surg, 1987, 13(6): 644-648.
32.	Findl O, Buehl W, Bauer P, et al. Interventions for preventing posterior capsule opacification. Cochrane Database Syst Rev, 2007, (3): CD003738.

1. Resnikoff S, Pascolini D, Etya’ale D, et al. Global data on visual impairment in the year 2002. Bull WHO, 2004, 82: 844-851.
2. Mester U, Dillinger P, Anterist N. Impact of a modified optic design on visual function: clinical comparative study. [Clinical Trial, Journal Article, Randomized Controlled Trial]. J Cataract Refract Surg, 2003, 29(4): 652-660.
3. Kohen T. Aberratioon-correcting intraocular lenses. J Cataract Refract Surg, 2003, 29: 627-628.
4. Guirao A, Tejedor J, Artal P. Corneal aberrations before and after small-incision cataract surgery. Invest Ophthalmol Vis Sci, 2004, 45(12): 4312-4319.
5. Artal P, Guirao A, Berrio E, et al. Compensation of corneal aberrations by the internal optics in the human eye. J Vis, 2001, 1(1): 1-8.
6. Taketani F, Yukawa E, Yoshii T, et al. Influence of intraocular lens optical design on high-order aberrations. J Cataract Refract Surg, 2005, 31(5): 969-972.
7. Kershner RM. Retinal image contrast and functional visual performance with aspheric, silicone, and acrylic intraocular lenses. Prospective evaluation. J Cataract Refract Surg, 2003, 29(9): 1684-1694.
8. Packer M, Fine IH, Hoffman RS. Aspheric intraocular lens selection: the evolution of refractive cataract surgery. Curr Opin Ophthalmol, 2008, 19(1): 1-4.
9. Rocha KM, Soriano ES, Chamon W, et al. Spherical Aberration and Depth of Focus in Eyes Implanted with Aspheric and Spherical Intraocular Lenses A Prospective Randomized Study. Ophthalmology, 2007, 114: 2050-2054.
10. Muñoz G, Albarrán-Diego C, Montés-Micó R, et al. Spherical aberration and contrast sensitivity after cataract surgery with the Tecnis Z9000 intraocular lens. J Cataract Refract Surg, 2006, 32(8): 1320-1327.
11. Kasper T, Bühren J, Kohnen T. Visual performance of aspherical and spherical intraocular lenses: Intraindividual comparison of visual acuity, contrast sensitivity, and higher-order aberrations. J Cataract Refract Surg, 2006, 32(12): 2022-2029.
12. Denoyer A, Le Lez ML, Majzoub S, et al. Quality of vision after cataract surgery after Tecnis Z9000 intraocular lens implantation Effect of contrast sensitivity and wavefront aberration improvements on the quality of daily vision. J Cataract Refract Surg, 2007, 33(2): 210-216.
13. Johansson B, Sundelin S, Wikberg-Matsson A, et al. Visual and optical performance of the Akreos Adapt Advanced Optics and Tecnis Z9000 intraocular lenses Swedish multicenter study. J Cataract Refract Surg, 2007, 33(9): 1565-1572.
14. Higgins JPT, Sally Green, editors. Cochrane Reviewers’ Handbook Version 5.0.0. http://www.cochrane.org/resources/handbook/hbook. htm.
15. Higgins JPT, Altman DG (editors): Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0. The Cochrane Collaboration, 2008. Available from www.cochranehandbook. org.
16. 吴泰相, 刘关键. 隐蔽分鰈 (分配隐藏) 和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 203-207.
17. The Moorfields IOL Study Group. Binocular implantation of the Tecnis Z9000 or AcrySof MA60AC intraocular lens in routine cataract surgery Prospective randomized controlled trial comparing VF-14 scores. J Cataract Refract Surg, 2007, 33: 1559-1564.
18. Bellucci R, Morselli S, Pucci V. Spherical aberration and coma with an aspherical and a spherical intraocular lens in normal age-matched eyes. J Cataract Refract Surg, 2007, 33(2): 203-209.
19. Franchini A. Compromise between spherical and chromatic aberration and depth of focus in aspheric intraocular lenses. J Cataract Refract Surg, 2007, 33(3): 497-509.
20. Beiko GH. Personalized correction of spherical aberration in cataract surgery. J Cataract Refract Surg, 2007, 33(8): 1455-1460.
21. Awwad ST, Warmerdam D, Bowman RW, et al. Contrast sensitivity and higher order aberrations in eyes implanted with AcrySof IQ SN60WF and AcrySof SN60AT intraocular lenses. J Refract Surg, 2008, 24(6): 619-625.
22. Tzelikis PF, Akaishi L, Trindade FC, et al. Ocular aberrations and contrast sensitivity after cataract surgery with AcrySof IQ intraocular lens implantation Clinical comparative study. J Cataract Refract Surg, 2007, 33(11): 1918-1924.
23. Casprini F, Balestrazzi A, Tosi GM, et al. Glare disability and spherical aberration with five foldable intraocular lenses: a prospective randomized study. Acta Ophthalmol Scand, 2005, 83(1): 20-25.
24. Tzelikis PF, Akaishi L, Trindade FC, et al. Spherical Aberration and Contrast Sensitivity in Eyes Implanted with Aspheric and Spherical Intraocular Lenses: A Comparative Study. Am J Ophthalmol, 2008, 145(5): 827-833.
25. Caporossi A, Martone G, Casprini F, et al. Prospective randomized study of clinical performance of 3 aspheric and 2 spherical intraocular lenses in 250 eyes. J Refract Surg, 2007, 23(7): 639-648.
26. Bellucci R, Scialdone A, Buratto L, et al. Visual acuity and contrast sensitivity comparison between Tecnis and AcrySof SA60AT intraocular lenses: A multicenter randomized study. J Cataract Refract Surg, 2005, 31(4): 712-717.
27. Lin IC, Wang IJ, Lei MS, et al. Improvements in vision-related quality of life with AcrySof IQ SN60WF aspherical intraocular lenses. J Cataract Refract Surg, 2008, 34(8): 1312-1317.
28. Pandita D, Raj SM, Vasavada VA, et al. Contrast sensitivity and glare disability after implantation of AcrySof IQ Natural aspherical intraocular lens Prospective randomized masked clinical trial. J Cataract Refract Surg, 2007, 33(4): 603-610.
29. Holladay JT, Piers PA, Koranyi G, et al. A new intraocular lens design to reduce spherical aberration of pseudophakic eyes. J Refract Surg, 2002, 18(6): 683-691.
30. Franchini A. Compromise between spherical and chromatic aberration and depth of focus in aspheric intraocular lenses. J Cataract Refract Surg, 2007, 33(3): 497-509.
31. Milauskas AT. Posterior capsule opacification after silicone lens implantation and its management. J Cataract Refract Surg, 1987, 13(6): 644-648.
32. Findl O, Buehl W, Bauer P, et al. Interventions for preventing posterior capsule opacification. Cochrane Database Syst Rev, 2007, (3): CD003738.

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