Evaluating impact of Nd:YAG laser associated defects on optical quality of hydrophilic and hydrophobic intraocular lenses using visualization of light propagation and USAF test targets.

Abstract Introduction: Neodymium:yttrium aluminum garnet (Nd:YAG) laser capsulotomy is a well-accepted, safe, and effective measure in the treatment of posterior capsule opacification. However, iatrogenic intraocular lens damage (YAG-pit/YAG-shot)) is a relatively common side effect that happens due to inappropriate focusing during the procedure. The purpose of this experimental study is to analyze the impact of YAG-pits on the optical bench to obtain qualitative information. Methods: Acrylic, monofocal hydrophilic and hydrophobic intraocular lenses (IOLs) with 6.0mm optic and the with the same power (21D) were studied. First, all measurements were done with unmodified IOLs. Damage was intentionally created, performing YAG-pits (n=5) in the central area of the lens optic (3.0mm) using a photodisruption laser with the same energy level of 1.8mJ. To simulate the cruciate pattern, the 5 defects were created in a cross shape within the 3.0mm optical zone. Afterwards, all laboratory measurements were repeated: These included the United States Air Force (USAF) resolution test chart to study the imaging performance of the IOL, light field measurements to show the course of the rays behind the IOL and the modulation transfer function (MTF) measurements were analysed. Results: Evaluating USAF showed that unmodified lenses produced a sharper image. Damaged lenses led to a more blurred image and to the impression of a lower contrast with a kind of halo/glare effect. The light field measurement showed that YAG-pits led to a kind of dispersion and scattering effect, which was higher in hydrophobic IOLs. The MTF showed a deterioration in damaged hydrophilic and hydrophobic IOLs, respectively. Conclusion: Our experimental study confirms that YAG-pits can reduce imaging quality of intraocular lenses. These defects behave as a new Huygens source, distribute a spherical wave that additionally illuminate the background of the USAF target. It can be assumed that material properties of the IOL (water content, refractive index) play an important role and affect results. The impact level is strongly dependent on the number, size and position of YAG-pits within the optic. Limitation of the study: only monofocal IOLs have been investigated so far, further tests with various lenses are necessary. In addition, tests to simulate the circular pattern of YAG capsulotomy are necessary.