Aspheric Intraocular Lens Selection Based on Corneal Wavefront

PURPOSE: To determine the feasibility of selectively targeting zero total postoperative spherical aberration by selecting the best fit aspheric intraocular lens (IOL) based on preoperative topographically derived corneal spherical aberration. METHODS: Candidates for cataract surgery were offered selection of aspheric IOLs based on corneal spherical aberration. The target postoperative total wavefront spherical aberration Z4,0 was set at zero. Corneal topographic spherical aberration Z4,0 was measured at the 6-mm optical zone, and one of three aspheric IOLs was chosen so the arithmetic sum of the corneal spherical aberration and pseudophakic spherical aberration came closest to zero. Postoperatively, total ocular wavefront was measured and statistical analysis performed to ascertain the accuracy of customized aspheric IOL selection. RESULTS: Thirty eyes of 18 patients were available for analysis. The SofPort Advanced Optics (Bausch & Lomb) lens was implanted in 1 eye, the AcrySof IQ (Alcon Laboratories Inc) in 11 eyes, and the Tecnis Z9000 or Z9002 (Advanced Medical Optics [AMO]) in 18 eyes. Total postoperative ocular spherical aberration for the entire population measured -0.013+/-0.072 microm (SofPort: +0.025 microm; AcrySof IQ: +0.010+/-0.053 microm; and Tecnis: -0.015+/-0.052 microm [P=.22]). For the entire population, mean absolute predictive error measured 0.058+/-0.056 microm (SofPort: 0.040 microm; AcrySof IQ: 0.052+/-0.040 microm; and Tecnis: 0.063+/-0.066 microm [P=.631). CONCLUSIONS: Customized selection of aspheric IOLs based on corneal wavefront is feasible and produces favorable results compared with studies of unselected patient populations implanted with aspheric IOLs.