Kombination aus Dezentrierung und Verkippung der Linse im phaken und pseudophaken Auge – optische Simulation von Defokus, Astigmatismus und Coma

BACKGROUND AND PURPOSE: The effect of lens decentration and tilt on retinal image quality has been extensively studied in the past in simulations and clinical studies. The purpose of this study was to analyze the effect of combined lens decentration and tilt on the induction of defocus, astigmatism and coma in phakic and pseudophakic eyes. METHODS: Simulations were performed with Zemax on the Liou-Brennan schematic model eye. Based on the position of the gradient lens the image plane was determined (best focus). The lens was decentered horizontally from −1.0 mm to 1.0 mm in steps of 0.2 mm and tilted with respect to the vertical axis from −10° to 10° in steps of 2° (in total 121 combinations of decentration and tilt). For each combination of decentration and tilt defocus, astigmatism (in 0/180°) and horizontal coma was extracted from wave front error and recorded for a pupil size of 4 mm. After replacement of the gradient lens with an aberration correcting artificial lens implant model with the equatorial plane of the artificial lens aligned to the equatorial plane of the gradient lens, the simulations were repeated for the pseudophakic eye model. RESULTS: For the lens positioned according to the Liou-Brennan schematic model eye the simulation yielded a defocus of 0.026 dpt/−0.001 dpt, astigmatism of −0.045 dpt/−0.018 dpt, and a coma of −0.015 µm/0.047 µm for phakic/pseudophakic eyes. Maximum values were observed for a horizontal decentration of 1.0 mm and a tilt with respect to the vertical axis of 10° with 1.547 dpt/2.982 dpt for defocus, 0.971 dpt/1.871 dpt for astigmatism, and 0.441 µm/1.209 µm for coma. Maximum negative values occurred in phakic/pseudophakic eyes with −0.293 dpt/−1.224 dpt for defocus, for astigmatism −0.625 dpt/−0.663 dpt and for coma −0.491 µm /−0.559 µm, respectively. CONCLUSION: In this simulation study the effect of a combination of lens decentration in horizontal direction and tilt with respect to the vertical axis on defocus, astigmatism and horizontal coma was analyzed. The results may help to describe in clinical routine if with a decentered or tilted artificial lens implant the postoperative refraction does not match the target refraction or the resulting astigmatism after cataract surgery is not fully explained by measurement of corneal astigmatism.