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ORIGINAL RESEARCH article
Front. Med.
Sec. Ophthalmology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1518707
This article is part of the Research Topic More than a “Formulas Problem”: IOL power calculation and biometry in the era of “refractive cataract”. View all articles
IN VIVO AND IN VITRO ANALYSIS OF SURFACE WHITENING IN HYDROPHOBIC TRIFOCAL INTRAOCULAR LENSES
Provisionally accepted- 1 Clinica Baviera Sevilla, Seville, Spain
- 2 Clinica Baviera Valencia, Valencia, Spain
- 3 AST Products, Inc., Billerica, MA, United States
- 4 University of Valencia, Valencia, Spain
This study investigates the characteristics and clinical impact of transparency loss due to whitening of trifocal hydrophobic intraocular lenses (IOLs) both in vivo and in vitro. One explanted IOL was analyzed using microscopic and optical bench methods, and two patients with binocular implantation-where one eye exhibited IOL whitening-were clinically examined. Visual performance, light distortion, OCT, and Scheimpflug imaging metrics were obtained for both affected and fellow eyes, serving as controls, along with patient-reported outcomes (PROs). Attempts to replicate whitening in vitro on unused control lenses were unsuccessful. Results showed that the modulation transfer function (MTF) of the explanted IOL was similar to that of unused control IOLs, and clinical findings indicated minimal impact of IOL whitening on visual performance and light distortion metrics. Speckles observed in OCT suggest microstructural changes in the polymer of the affected IOL, while Scheimpflug images and optical density profiles confirmed that whitening is mainly located below the anterior surface of the IOL. PROs revealed no significant difficulty in performing tasks included in CATQuest9SF and fair satisfaction with vision. Laboratory analysis confirms subsurface nanoglistening (SSNG) as the likely cause of transparency loss-the first reported case with this IOL material-indicating that, although infrequent, SSNG can occur in any hydrophobic material. The clinical impact is objectively low, with mild effects on visual performance and minimal impact on PROs. Given the predominantly subjective nature of the visual symptoms associated with SSNG, the decision to explant and exchange the IOL should be made on an individual basis, in close consultation with the patient.
Keywords: Multifocal IOLs, Hydrophobic IOL, Optical quality, IOL transparency Con formato: Fuente: (Predeterminada) +Títulos (Calibri Light), Sin Negrita, Inglés (americano)
Received: 28 Oct 2024; Accepted: 10 Feb 2025.
Copyright: © 2025 Cabanas, Navalon, Luchena, Lee and Cerviño. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Alejandro Cerviño, University of Valencia, Valencia, Spain
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