Method for choosing intraocular lenses with yellow or colorless filter

Abstract

FIELD: ophthalmology.SUBSTANCE: used to select an intraocular lens with a yellow or colorless filter in the surgical treatment of cataracts. For this purpose, one day before the operation, in a darkened room with medicinal mydriasis achieved by double instillation of a 1% tropicamide solution, the patient undergoes a biomicroscopic assessment of the opacity and yellowness of the lens according to the LOCS III classification using six reference gradations of opalescence (NO) and staining (NC) of the nucleus. Then, lens densitometry is performed on a Pentacam HR device in automatic mode, obtaining 50 slit sections of the anterior segment of the eye and calculating the Lens Density % and PNS indicators on a five-point scale: 0 points – no nuclear sclerosis, density <10%; 1 point - initial nuclear sclerosis, 10–15%; 2 points – moderate nuclear sclerosis, 15–25%; 3 points – severe nuclear sclerosis, 25–40%; 4 points – severe nuclear sclerosis, 40–60%; 5 points: Hypersclerosis of the nucleus, >60%. Next, optical coherence tomography of the retina is performed according to the Retina Map protocol on the Optovue RTVue-100 XR device with the construction of 36 orthogonal scans with an area of 5 by 5 mm, automatic segmentation of the boundaries of the internal limiting membrane (ILM) and retinal pigment epithelium (RPE) and classification of the state of the macula according to the AREDS scale. The patient's insolation load is determined by summing up the monthly values for 12 months of global horizontal irradiation (GHI), obtained from the Photovoltaic Geographical Information System (PVGIS 5.3) service, based on the coordinates of the patient's place of residence and work. Where GHI < 1000, GHI from 1000 to 1450, GHI from 1450 to 1850, GHI > 1850 kW⋅h / m2. It is converted into an average daily value GHI_day, which, according to the established gradation, is associated with a regional coefficient (RG) equal to 1, 2, 3, 4. The behavioral coefficient (B) Behavior Factor is determined by questioning the patient. Then the integral HEV-Score indicator is calculated. For implantation, a yellow IOL with a UV and HEV filter is selected if at least one of the priority conditions is met: OCT stage ≥ 2 or HEV-Score ≥ 4, and with HEV-Score from 2 to 3 and HEV-Score from 0 to 1. At OCT stage 1, the final choice of light filter is made taking into account the PNS / LOCS III data: with PNS ≥ 2 or Lens Density % ≥15% and LOCS III NO / NC ≥ 3 – a yellow filter; with PNS ≤ 1 or Lens Density % < 15% and LOCS III NO / NC ≤ 2 – a colorless filter. In case of discrepancy between PNS and LOCS III data, priority is given to the LOCS III indicator, while in patients with a high risk of age-related macular degeneration, a yellow IOL is chosen for implantation. One day after diagnosis, cataract phacoemulsification is performed with implantation of an individually selected IOL.EFFECT: reduction in light sensitivity caused by an increased flow of light in the postoperative period, accelerated adaptation to bright lighting, as well as balanced color perception, which contributes to the stabilization of visual perception and optimization of visual functions while maintaining a high degree of photoprotection of the retina.1 cl, 7 tbl, 2 dwg, 6 ex

Description

[0001] The invention relates to medicine, namely to ophthalmology, and can be used in cataract surgery in patients of various age groups in order to determine the tactics of selecting and implanting intraocular lenses with various light filters.

[0002] Cataracts are one of the most common ophthalmological pathologies and a leading reversible cause of blindness. Intraocular lens implantation remains the standard surgical treatment for aphakia. An IOL must simultaneously protect the retina from short-wavelength radiation and provide sufficient light transmission while maintaining natural color perception under any lighting conditions. During healthy vision, the natural crystalline lens performs these functions by selectively absorbing UV and part of the blue spectrum; age-related yellowing enhances this filter, thereby reducing phototoxicity. After removal of the crystalline lens, it becomes necessary to restore the lost spectral barrier, which requires individual selection of the IOL filter.

[0003] Modern intraocular lenses (IOLs) are made of different materials and can filter light in two ways. Clear IOLs with a UV filter absorb radiation with a wavelength of less than ~400 nm, while yellow IOLs additionally block short-wavelength blue light up to approximately 500 nm.

[0004] In 1978, Meinster hypothesized the need to develop IOLs that mimic the spectral transmittance of the natural lens to protect the retina and reduce longitudinal chromatic aberrations. By the 1980s, S.N. Fedorov, in Russian ophthalmology, had already created the yellow "Spectrum" IOL, which reproduces the spectral characteristics of the native lens. Later studies showed that blocking short-wavelength blue light (≤≈500 nm) can reduce twilight sensitivity by approximately 14.6%.

[0005] However, a number of studies have not found a clinical deterioration in night vision when using yellow filters; the authors attribute this to the partial transmittance of lenses to light in the 400-500 nm range and the adaptation of the visual system.

[0006] Spectral analysis showed that yellow IOLs with chromophore can absorb waves of 400-500 nm, which reduces the risk of lipofuscin-mediated phototoxicity of RPE and slows down macular aging (Sparrow 2004).

[0007] To preserve natural color perception, physiological light adaptation, and reduce phototoxic stress on the aging retina, the optimal IOL spectral profile should be individually selected. In elderly patients, the optically dense, yellowed crystalline lens acts as a natural long-wave filter, attenuating the overall light flux and primarily suppressing the short-wavelength (400-460 nm) range. Long-term blue light deficiency forms a persistent sensory adaptation: the image is perceived as less saturated and "warmer," and in severe cataracts, its contrast and clarity are further reduced due to pronounced intraocular scattering of the light flux. After phacoemulsification, a sudden restoration of the short-wavelength component often leads to cyanopsia, photodiscomfort, and photophobia; the severity of these phenomena directly correlates with the initial optical density and the degree of yellowness of the nucleus.

[0008] When selecting an IOL spectral profile, assessing the morphofunctional state of the retina is equally important. Even in the early stages of age-related changes—the appearance of soft drusen, uneven pigment epithelium, and localized hypoautofluorescence—the phototoxic resistance of the macula decreases. Therefore, a lens with a more pronounced "cutoff" of the high-energy blue range (≈380-500 nm) can provide additional protection. Conversely, with an intact foveal zone, excessive filtration will unnecessarily limit spectral stimulation of the cones, which is especially critical for young patients and those with occupationally significant color perception.

[0009] The exophotobiological component is equally important: latitude, altitude, weather conditions, and the proportion of time the patient spends outdoors determine the individual cumulative dose of insolation. In regions with a high UV-B / HEV index or for patients who regularly work in conditions of bright reflected light (snow, water, sand), an IOL with an extended filter of ultraviolet and shortwave spectra is advisable. In more northern and cloudy areas, on the contrary, excessive filtering can lead to a subjective lack of brightness and deterioration of scotopic vision.

[0010] Thus, an integrated assessment of the optical properties of the removed lens, the functional reserve of the retina, and the actual insolation load allows us to create a “light passport” for the eye and select an IOL that simultaneously restores physiological spectral balance, maintains adaptive mechanisms, and provides long-term photoprotection of the retina.

[0011] There is a known method for selecting IOLs with different light filters, which takes into account factors such as the patient's age, the state of the retinal pigment epithelium, the presence of drusen and the potential risks of developing age-related macular degeneration (AMD).

[0012] Because in vitro studies have shown that short-wavelength blue light is phototoxic to the neuroepithelium and retinal pigment epithelium, and that IOLs with a yellow filter and protection from the blue-violet spectrum can prevent damage to pigment epithelial cells, the author suggests that such IOLs may be appropriate for patients at high risk of developing AMD. According to the author, biological studies confirm that blue light promotes the accumulation of lipofuscin and its component A2E, which leads to damage to pigment epithelial cells. Furthermore, it has been shown that IOLs with a yellow filter can reduce the risk of such damage and, consequently, the risk of developing AMD, making their use potentially justified in this group of patients. (Hayashi, K. (2006). Visual function in patients with yellow tinted intraocular lenses compared with vision in patients with non-tinted intraocular lenses. British Journal of Ophthalmology, 90(8), 1019-1023. doi:10.1136 / bjo.2006.090712 ).

[0013] A disadvantage of this method of IOL selection is that the authors proposed criteria for implantation of yellow lenses in patients with a high risk of age-related macular degeneration, but did not consider the question of who should be implanted with colorless IOLs, which leaves open the question of the optimal choice of lens for patients without a significant risk of AMD.

[0014] Furthermore, the authors did not consider the degree of lens opacity and yellowing before surgery, although these factors are significant. Intraocular lenses with a yellow filter were designed to simulate the lens of an elderly patient, whose transmission spectrum changes with age. Therefore, when selecting an IOL, the degree of lens opacity and yellowing must be considered, as this affects the patient's visual perception after surgery and may determine the need for a yellow or colorless filter. This study also did not consider individual patient data, such as the total insolation dose received over a lifetime and in professional activities, which can significantly influence the need for additional spectral protection.

[0015] The closest analogue of the claimed invention is a method for selecting an intraocular lens using a visualization and measurement system for eye parameters, described in U.S. Patent US 11730359 B2. The method is based on the formation of a three-dimensional anatomical model of the patient's eye using diagnostic modules (optical coherence tomography, corneal topography, aberrometry), automated analysis of biometric characteristics (corneal thickness, shape of the anterior and posterior surfaces of the cornea and lens, angle and position of the lens, retinal parameters, etc.) and subsequent calculation of the optimal IOL model. Selection is carried out with a priority on the accuracy of optical correction, prediction of the spherical equivalent, residual astigmatism and the final position of the IOL in the capsular bag.Filtration properties (the presence or absence of a color filter) are not considered separately, but are built into the fixed parameters of each IOL in the database and are selected automatically by the program.

[0016] The disadvantages of this method include the lack of a comprehensive assessment of the morphofunctional state of the retina (e.g., signs of age-related macular degeneration using OCT / AREDS), ignoring age-related changes in the lens (opalescence and yellowing using LOCS III, density using PNS), and the patient's individual cumulative insolation load, calculated based on geographic and behavioral factors. This method does not consider the need for spectral protection depending on the risk of photodamage and does not provide for clinical interpretation by an ophthalmic surgeon: the entire lens selection process, including its filter, is performed automatically, without the possibility of medical correction or consideration of the patient's professional and subjective needs. Furthermore, the filter is not prioritized as a component of IOL selection, limiting the individualization of photoprotection.

[0017] The objective of the proposed invention is to determine the optimal choice of an intraocular lens, the spectral characteristics of which are closest to the natural optical properties of the native human lens individually for a specific patient.

[0018] The technical result is a reduction in light sensitivity caused by an increased flow of light in the postoperative period, accelerated adaptation to bright lighting, as well as ensuring balanced color perception, which contributes to the stabilization of visual perception and optimization of visual functions while maintaining a high degree of photoprotection of the retina.

[0019] The method is carried out as follows.

[0020] Patients undergo examination of the anterior and posterior segments of the eye using a slit lamp under conditions of maximum drug-induced mydriasis achieved by instillation of 2 drops of 1% tropicamide solution.

[0021] Cataract grading and lens yellowness assessment are performed according to the international standardized LOCS III system using 3 reference photographs obtained by biomicroscopy: Nuclear changes: NO (Nuclear Opalescence): 6 gradations (NO0-NO6) to assess the degree of nuclear opacity. NC (Nuclear Color): 6 gradations (NC0-NC6) to assess the color of the nucleus.

[0022] After conducting a biomicroscopic examination, an objective assessment of the optical density of the lens is carried out using the Oculus Pentacam HR Scheimpflug camera (Oculus Inc., Germany) in a fully automated mode using previously achieved drug-induced mydriasis.

[0023] The patient is positioned in front of the measuring system, similar to a standard biomicroscopy procedure. The patient's head is stabilized using a chin rest and forehead crossbar. The patient is asked to focus their gaze on a built-in fixation target located on the optical axis of the device.

[0024] To eliminate operator error, the system automatically determines the optimal eye position relative to the corneal apex and initiates scanning once proper alignment is achieved. During the examination, the system performs a series of 50 slit scans of the anterior segment of the eye with an exposure time of 2 seconds.

[0025] The received data is processed by the built-in software, which performs:

[0026] Three-dimensional reconstruction of the anterior segment of the eye with the reconstruction plane passing through the apex of the cornea.

[0027] Automatic calculation of the optical density of the lens nuclear substance using the Pentacam Nucleus Staging (PNS) algorithm.

[0028] Density analysis of an image obtained at an angle of 45° to the optical axis.

[0029] Determination of the average density value in the central zone of the core with an area of ​​1.60 mm 2 .

[0030] Classification of results according to a five-step PNS scale (0-5 points) using a density cutoff value of 20%.

[0031] The system automatically performs calibration before each study, which ensures the accuracy of the obtained data.

[0032] The obtained PNS / Lens Density % values ​​are interpreted as follows:

[0033] 0 points: No nuclear sclerosis (density <10%)

[0034] 1 point: initial nuclear sclerosis (10-15%)

[0035] 2 points: moderate nuclear sclerosis (15-25%)

[0036] 3 points: severe nuclear sclerosis (25-40%)

[0037] 4 points: Severe nuclear sclerosis (40-60%)

[0038] 5 points: Hypersclerosis of the nucleus (>60%)

[0039] Based on a comprehensive assessment of PNS and LOCS III indicators, an algorithm for spectral IOL selection is formed, which allows for an objective justification for the implantation of a yellow or colorless lens.

[0040] Table 1

[0041] Criterion Threshold value Recommended filter PNS 0-1 or Lens Density% < 15% Low density Colorless UV filter PNS ≥ 2 or Lens Density % ≥ 15% Moderate / severe nuclear sclerosis Yellow (UV + HEV filter) LOCS III NO / NC 0-2 Minor opalescence / staining Colorless UV filter LOCS III NO / NC ≥ 3 Expressed opalescence / coloration Yellow (UV + HEV filter)

[0042] 1. PNS (or Lens Density %) (Fig. 1).

[0043] PNS values ​​of 0-1 or Lens Density% < 15% characterize low optical density and minimal yellowing of the nucleus; in this case, a colorless IOL (UV filter) is selected.

[0044] ○ PNS value ≥ 2 or Lens Density% ≥ 15% indicates moderate to severe nuclear sclerosis; for such patients, a yellow IOL (UV + HEV filter) is selected.

[0045] 2. LOCS III scale (NO / NC gradations) (Fig. 2).

[0046] ○ When NO / NC 0-2, opalescence and nuclear staining are insignificant, a colorless IOL (UV filter) is selected.

[0047] ○ When NO / NC ≥ 3, opalescence and coloration are pronounced, a yellow IOL (UV + HEV filter) is selected.

[0048] 3. If there is a discrepancy between the PNS / Lens Density % and LOCS III data, the LOCS III value takes precedence.

[0049] The next step is optical coherence tomography. The patient is seated in front of the Optovue RTVue-100 XR scanning system (Optovue Inc., USA), with their head fixed with a chin rest and forehead crossbar. Binocular fixation is maintained by an internal light marker located along the optical axis of the device. The Retina Map protocol is manually selected, the image is aligned, then the device is focused on the fovea, and scanning is initiated after precise centering according to the Retina Map protocol. The program with an exposure of 0.78 seconds generates 36 orthogonal slices: 11 horizontal slices of 5 mm, 11 vertical slices of 5 mm, 6 horizontal slices of 3 mm, and 6 vertical slices of 3 mm. The step between lines is 0.5 mm. Analysis zones are an outer square of 5 x 5 mm and an inner square of 3 x 3 mm. Total number of A-scans: 22 lines x 668 A-scans + 12 lines x 400 A-scans = 19,496 points.The device automatically segments the boundaries of the internal limiting membrane (ILM) and retinal pigment epithelium (RPE), creating color maps of retinal thickness and topography.

[0050] Data is exported and verified manually, excluding vessel projection artifacts.

[0051] The detected formations are classified according to the AREDS scale:

[0052] Table 2. OCT staging scale (AREDS Classification):

[0053] Category AREDS Criteria 1. No AMD Absence or small number of small drusen (diameter < 63 microns) 2. Early stage AMD Multiple small drusen, a small number of medium-sized drusen (63 to 124 microns in diameter), or early changes in the retinal pigment epithelium 3. Intermediate stage of AMD Multiple medium-sized drusen, at least one large drusen (diameter ≥ 125 microns) or geographic atrophy sparing the fovea. 4. Late stage AMD Geographic atrophy or neovascular AMD (CNV, neuroepithelial or PES, fibrovascular scars).

[0054] The results are then correlated with the choice of IOL spectral filter.

[0055] Table 3

[0056] OCT stage Additional optical conditions Recommended IOL spectral filter 1 - intact retina PNS 0-1 or Lens Density % < 15% and LOCS III NO / NC 0-2 Colorless (UV filter) 1 - intact retina PNS ≥ 2 or Lens Density % ≥ 15% and LOCS III NO / NC ≥ 3 Yellow (UV + HEV filter) ≥ 2 - decreased functional reserve of the retina Regardless of PNS and lens yellowness Yellow (UV + HEV filter)

[0057] • OCT stage 1 (retina with preserved photostability):

[0058] • - for PNS 0-1 (or Lens Density % < 15%) and LOCS III NO / NC 0-2, select a colorless IOL with a UV filter;

[0059] - when PNS ≥ 2 (or Lens Density % ≥ 15%) and LOCS III NO / NC ≥ 3, an IOL with a yellow (UV + HEV) filter is selected.

[0060] • OCT stage ≥ 2 (decreased retinal functional reserve): an IOL with a yellow filter is installed regardless of the PNS and LOCS III indicators.

[0061] • In case of discrepancy between the results of PNS and LOCS III, priority is given to the degree of yellowness of the lens according to the LOCS III scale.

[0062] All studies (biomicroscopy, Pentacam, OCT) are performed in one room with minimal light sources to eliminate glare and standardize the examination conditions for all patients.

[0063] The final step is to determine the patient's annual insolation dose. For this, the subject is asked to indicate their permanent place of residence and (if applicable) place of work. After this, the web interface of the Photovoltaic Geographical Information System (PVGIS 5.3) developed by the Joint Research Centre of the European Commission is opened, available at: https: / / re.jrc.ec.europa.eu / pvg_tools / en / . The coordinates of the place of residence are entered into the atlas search engine and data on monthly global horizontal radiation (GHI, kWh / m) are requested. 2 ⋅month) for the last twelve months. A CSV file with 12 GHI values ​​is obtained, which are then summed to obtain an annual GHI value (kWh / m 2 ⋅year). It is then classified according to the scale of Skandalos et al., 2022, assigning a regional coefficient, the Regional Factor (RG). To calculate the average daily insolation, the annual value is divided by 365:

[0064] GHI day = GHI year / 365

[0065] GHI_day Value Received (kWh / m 2 (day) are used in the HEV load estimation algorithm.

[0066]

[0067] Thus, RG = 1 corresponds to the lowest insolation load, and RG = 4 to the highest.

[0068] In parallel, the patient fills out an adapted questionnaire (based on the validated SEM-Q and SEPI questionnaires), which forms the B-factor (Behavioural Adjustment) indicator - a behavioral correction reflecting the actual time spent in the sun, the presence of reflective surfaces and the use of protective equipment.

[0069]

[0070] Next, the integral indicator is calculated using the formula: HEV-Score = RG + B. The resulting High-Energy Visible (HEV) Score reflects the total load of high-energy visible light on the eyes and serves as a guide for selecting the spectral filter of the intraocular lens (IOL).

[0071] According to the HEV-Score value, the following recommendations are suggested:

[0072]

[0073] • For HEV-Score 0-1 (low HEV load) and HEV-Score 2-3 (medium load), the IOL spectral filter is selected individually.

[0074] • For HEV-Score ≥ 4 (high load), a yellow IOL is implanted that blocks radiation in the range of 380-500 nm, providing enhanced photoprotection of the retina from high-energy blue-violet light, regardless of other indications.

[0075] HEV-Score data in combination with the results of retinal optical coherence tomography (obtained on the Optovue RTVue-100XR device) complement the classic gradations of age-related lens opacity according to the LOCS III and PNS (Pentacam Nucleus Staging) scales.

[0076] Together, these four components form the following comprehensive personalized IOL spectral profile selection system:

[0077]

[0078] Macular degeneration

[0079] When age-related macular degeneration of category AREDS≥2 is detected, a yellow IOL with an extended (UV + HEV) light filter is implanted, regardless of the HEV-Score value and the characteristics of the lens, in order to provide increased photoprotection of the retina.

[0080] • High insolation load.

[0081] • If the integral HEV-Score is ≥ 4, a yellow IOL is implanted regardless of the degree of natural yellowing of the lens.

[0082] • Average and low insolation load, absence of macular degeneration.

[0083] When the integral HEV-Score is 2-3 and HEV-Score is 0-1, the IOL filter is selected based on the degree of yellowing of the lens according to LOCS III and its optical density according to PNS.

[0084] Surgical treatment is performed after 1 day. The patient is placed on the operating table. The surgical field is treated with a 5% betadine solution. Two 1 mm wide paracenteses are performed at the eight and two o'clock positions. To ensure additional mydriasis, 0.1 ml of a 1% phenylephrine solution is injected into the anterior chamber. Then, 0.1-0.2 ml of dispersive viscoelastic is injected to stabilize the internal structures of the eye. A main corneal incision 1.8-2.2 mm wide is made at the eleven o'clock position. The anterior capsule is opened using a continuous circular capsulorhexis 4.8-5.0 mm in diameter, using collet microtweezers through the main incision. Then, hydrodissection and hydrodelineation are performed to achieve lens mobility. After lens rotation, phacoemulsification is performed. The individually selected IOL is loaded into a cartridge and implanted intracapsularly using an injector.At the end of the surgery, the viscoelastic is flushed from the capsular bag and anterior chamber, after which the incisions are sealed. The surgery concludes with the subconjunctival injection of 0.5 ml of an antibiotic and steroid solution.

[0085] Clinical example 1:

[0086] Patient N., 76 years old, consulted the S.N. Fedorov National Medical Research Center for Scientific and Technical Complex "Eye Microsurgery" of the Ministry of Health of the Russian Federation with complaints of decreased visual acuity in the right eye. History of myopia since age 13, cataract surgery in 2023. Uncorrected visual acuity OD - 0.05, corrected - sph -2.75 cyl -0.75 Ax 175 = 0.3. IOP is within normal limits, eye length according to optical biometry OD - 23.81 mm. Biomicroscopy OD: the cornea is transparent, the anterior chamber is of medium depth, the iris is subatrophic, the pupil is of regular shape, the diameter with drug-induced mydriasis is 5.0 mm, pseudoexfoliation along the pupillary margin, clouding of the nucleus and cortical layers of the lens, the vitreous body is destroyed, the DN is pale pink, the borders are clear, myopic cone, MS is behind the veil.

[0087] The day before surgery, the patient underwent a slit lamp examination to assess the degree of lens opacity and yellowness. The patient underwent lens densitometry using a Pentacam Oculus device, optical coherence tomography (Optovue RTVue-100 XR), and a determination of the insolation dose (HEV score). The lens nuclear density according to the Pentacam PNS-2 and the degree of opacity according to the LOCS III NO / NC classification were 3. The retinal assessment according to AREDS was 2 (early AMD), and the HEV score was 4.

[0088] A patient was diagnosed with complicated cataracts, mild myopia, pseudoexfoliation syndrome, and dry age-related macular degeneration. Based on the diagnostic data and an algorithm, a single-vision Alcon AcrySof Natural SN60AT 22.5 D IOL with a yellow filter providing protection from UV and blue-violet light was individually calculated and selected. Phacoemulsification of the cataract was then performed with IOL implantation in the right eye.

[0089] On the first postoperative day, the corrected visual acuity was 0.85, IOP was 12 mmHg, visual fields were normal, and the IOL was correctly positioned. One month after surgery, the corrected visual acuity was 1.0, IOP was 14 mmHg. Spatial contrast sensitivity was within the age norm. The Yustvoy and Farnsworth-Munsell tests revealed no color vision impairment. Survey data on the first day, as well as one and three months after surgery, indicate consistent satisfaction with the results of the procedure.

[0090] Clinical example 2:

[0091] Patient M., 58, presented to the S.N. Fedorov National Medical Research Center for Scientific and Technical Complex "Eye Microsurgery" of the Russian Ministry of Health with complaints of decreased visual acuity in his right eye. He has a history of mild myopia and has worn glasses since childhood. Uncorrected visual acuity (OD) is 0.2, corrected 0.6 with sph -1.5. IOP and visual fields are normal. Eye length according to optical biometry at OD is 24.68 mm. Biomicroscopy OD: the cornea is transparent, the anterior chamber is of medium depth, the iris is subatrophic, the pupil is of regular shape, the pupil diameter with drug-induced mydriasis is 5.6 mm, the lens is clouded in the cortical layers, the initial opalescence of the nucleus, the vitreous body is destroyed, the optic nerve is pale pink, the borders are clear, the myopic cone, the myopic retina is normal.

[0092] The day before surgery, the degree of lens opacity and yellowness were assessed using a slit lamp, lens densitometry was performed using a Pentacam Oculus device, OCT (Optovue RTVue-100 XR), and the insolation dose (HEV score) was determined. The lens nuclear density according to the Pentacam PNS-1 data, the degree of opacity according to the LOCS III classification was NO / NC - 1. The retinal condition assessment according to the AREDS scale was 1 (absence of age-related macular degeneration), the HEV score was 4.

[0093] A diagnosis of OD was made: Initial cataract, mild myopia. Based on the diagnostic data and the algorithm, an Alcon Acrysof Natural SN60AT 18.0 D IOL with a yellow filter providing protection from ultraviolet and blue-violet light was individually selected and calculated. Phacoemulsification of the cataract was performed with IOL implantation at OD.

[0094] On the first day, the corrected visual acuity was 0.8, IOP was 16 mmHg, visual fields were normal, and the IOL was correctly positioned. After one month, the corrected visual acuity was 1.0, IOP was 14 mmHg. Spatial contrast sensitivity and color perception were normal. Questionnaires conducted on the first day, as well as after one and three months, confirmed the patient's satisfaction with the surgical results.

[0095] Clinical example 3:

[0096] Patient M., 71 years old, consulted the S.N. Fedorov National Medical Research Center for Scientific and Technical Complex "Eye Microsurgery" of the Ministry of Health of the Russian Federation with complaints of decreased visual acuity in the left eye. A history of mild hyperopia and cataract surgery OD in 2023. Uncorrected visual acuity OS - 0.2, corrected sph +2.5 cyl +0.5 Ax96 = 0. IOP and visual fields are normal. Eye length OS according to optical biometry is 23.22 mm. OS biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the iris is subatrophic, the pupil is of regular shape, the pupil diameter with drug-induced mydriasis is 5.5 mm, the lens is clouded in the cortical layers, the initial opalescence of the nucleus, the vitreous body is destroyed, the optic nerve is pale pink, the borders are clear, the myocardial infarction is absent.

[0097] The day before surgery, the degree of lens opacity and yellowness were assessed using a slit lamp, lens densitometry was performed using a Pentacam Oculus device, OCT (Optovue RTVue-100 XR), and the insolation dose (HEV-score) was determined. The lens nuclear density according to the Pentacam PNS-1 data, the degree of opacity according to the LOCS III classification was NO / NC - 1. The retinal condition assessment according to the AREDS scale was 1 (absence of age-related macular degeneration), the HEV-score was 2.

[0098] A diagnosis of OS was made: Incipient cataract, mild hyperopia. Based on the diagnostic data and the algorithm, an Alcon Acrysof SA60AT 22.0 D IOL with a colorless filter providing UV protection was individually selected and calculated. Phacoemulsification of the cataract was performed with IOL implantation on the OS.

[0099] On the first day, the corrected visual acuity was 0.85, IOP was 12 mmHg, visual fields were normal, and the IOL was correctly positioned. After one month, the corrected visual acuity was 1.0, IOP was 14 mmHg. Spatial contrast sensitivity and color perception were normal. Questionnaires conducted on the first day, as well as after one and three months, confirmed the patient's satisfaction with the surgical results.

[0100] Clinical example 4:

[0101] Patient E., 67 years old, presented to the S.N. Fedorov National Medical Research Center of the Scientific and Technical Complex "Eye Microsurgery" of the Ministry of Health of the Russian Federation with complaints of decreased visual acuity in the right eye. Her medical history includes mild hyperopia and complex hyperopic astigmatism. She wears glasses. She denies any eye surgery. Uncorrected visual acuity OD - 0.1, corrected 0.3 sph +2.5 cyl +1.0 Ax 0. IOP and visual fields are normal. The eye length OD according to optical biometry is 22.43 mm. Biomicroscopy OD: the cornea is transparent, the anterior chamber is of medium depth, the iris is subatrophic, the pupil is of regular shape, the pupil diameter with drug-induced mydriasis is 5.5 mm, the lens is clouded in the cortical layers and nucleus, the vitreous body is destroyed, the optic nerve is pale pink, the borders are clear, the mesentery is behind the veil.

[0102] The day before surgery, the degree of lens opacity was assessed using a slit lamp, lens densitometry was performed using a Pentacam Oculus device, optical coherence tomography (OCT), and the light exposure level in the high-energy blue light zone (HEV score) was determined. According to Pentacam, the PNS value was 2, the degree of opacity according to the LOCS III NO / NC classification was 3. The retinal condition assessment according to the AREDS scale was 1 (no signs of age-related macular degeneration), and the HEV score was 3.

[0103] The diagnosis was: OD - immature cataract, mild hyperopia, and complex hyperopic astigmatism. Based on the diagnostic data and individual eye parameters, an Alcon Acrysof Natural SN60AT 25.5 D intraocular lens (IOL) with a yellow filter filtering UV and blue-violet light was calculated and selected. Phacoemulsification of the cataract with IOL implantation was performed at OD.

[0104] On the first postoperative day: corrected visual acuity - 0.65, IOP - 15 mmHg, visual fields - within normal limits, IOL centered. One month later: corrected visual acuity - 0.9, IOP - 14 mmHg, spatial contrast sensitivity and color perception are within normal limits. Questionnaires conducted on the first day, as well as after one and three months, confirmed the patient's satisfaction with the surgical results.

[0105] Clinical example 5:

[0106] Patient N., 69 years old, consulted the Federal State Autonomous Institution "National Medical Research Center "Microsurgery of the Eye" named after Academician S.N. Fedorov" of the Ministry of Health of the Russian Federation with complaints of a gradual decrease in visual acuity in the left eye. The anamnesis includes mild hyperopia, pseudoexfoliation syndrome, and cataract surgery in the right eye performed in 2024 at the "Microsurgery of the Eye" Scientific and Technical Complex. Uncorrected visual acuity OS - 0.1; corrected - 0.2 with sph +2.0. IOP and visual fields are within normal limits. The length of the eye OS according to optical biometry is 22.58 mm.

[0107] Biomicroscopy reveals a clear cornea, medium-depth anterior chamber, subatrophic iris, regular pupil, 5.4 mm in diameter with drug-induced mydriasis; pseudoexfoliation along the pupillary margin, lens opacity in the cortical layers and nucleus. Vitreous body is destroyed. Optic disc is pale pink, with clear borders, and the mesenteric nerve is behind a veil.

[0108] The day before the surgery, the yellowness of the lens was assessed using a slit lamp, lens densitometry was performed on the Pentacam Oculus device, and OCT (Optovue RTVue-100 XR) and light dose determination (HEV-score) were also performed. The density of the lens nucleus according to the Pentacam PNS-3 scale; the degree of opacity according to the LOCS III classification NO / NC is 3. The state of the retina according to the AREDS scale is 1 (no signs of age-related macular degeneration were detected), the HEV-score is 1.

[0109] A patient with OS was diagnosed with complicated cataracts, pseudoexfoliation syndrome, and mild hyperopia. Based on the diagnostics, an Alcon Acrysof Natural SN60AT 24.0 D intraocular lens with a yellow filter filtering ultraviolet and blue-violet light was individually calculated and selected. Phacoemulsification of the cataract with IOL implantation was performed on the OS.

[0110] On the first postoperative day: corrected visual acuity - 0.55; IOP - 17 mmHg; visual fields within normal limits; IOL is centered. One month later: corrected visual acuity - 0.9; IOP - 12 mmHg; spatial contrast sensitivity and color perception are within normal limits. Questionnaires conducted on the first day, as well as after one and three months, confirmed the patient's satisfaction with the results of the surgical intervention.

[0111] Clinical example 6:

[0112] Patient N., 63 years old, consulted the Fedorov National Medical Research Center of the Scientific and Technical Complex “Eye Microsurgery” of the Ministry of Healthcare of the Russian Federation with complaints of gradual deterioration of visual acuity in the right eye. The anamnesis includes emmetropia, no eye surgery. Visual acuity OD is 0.7 n / c. IOP and visual fields are within normal limits. The length of the eye OD according to optical biometry is 23.79 mm. During OD biomicroscopy: the cornea is transparent, the anterior chamber is of medium depth, the iris is structured, the pupil is of regular shape, the diameter with drug-induced mydriasis is 5.6 mm; initial opacities of the lens in the cortical layers. Vitreous body - destruction, DN - pale pink, clear borders, macular zone - no damage.

[0113] The day before the surgery, the yellowness and opacity of the lens were assessed using a slit lamp, lens densitometry was performed on the Pentacam Oculus device, and OCT (Optovue RTVue-100 XR) and light dose determination (HEV-score) were also performed. The density of the lens nucleus according to the Pentacam PNS scale is 0; the degree of opacity according to the LOCS III classification is NO / NC - 1. The state of the retina according to the AREDS scale is 1 (no signs of age-related macular degeneration were detected), the HEV-score is 1.

[0114] A diagnosis of OD was made: incipient cataract. Based on the diagnostics and an algorithm, an Alcon Acrysof SA60AT 18.5 D intraocular lens with a colorless filter providing UV protection was individually calculated and selected. Phacoemulsification of the cataract was performed with IOL implantation at the OD.

[0115] On the first day after surgery: visual acuity - 0.8 n / c; IOP - 16 mmHg; visual fields are normal; the IOL is centered. After one month: corrected visual acuity - 0.95; IOP - 13 mmHg; Contrast sensitivity and color perception are normal. Questionnaires on the first day, as well as after one and three months, confirmed satisfaction with the results of the surgical intervention.

[0116] Twenty patients (40 eyes) underwent surgery using the proposed algorithm. The control group consisted of 20 patients (40 eyes) who received IOL implantation according to standard indications, without regard to the described criteria. Objective ophthalmological examinations revealed no negative results in either group. However, questionnaires (VFQ-25, Visual Function-14 with additional questions) aimed at assessing subjective parameters of vision quality and comfort revealed higher patient satisfaction and faster postoperative light adaptation in the study group compared to the control group.

Claims

A method for selecting an intraocular lens (IOL) with a yellow or colorless filter in cataract surgery, including an analysis of the biometric characteristics of the lens and optical coherence tomography of the retina, characterized in that one day before surgery, in a darkened room with medicinal mydriasis achieved by double instillation of a 1% tropicamide solution, the patient undergoes a biomicroscopic assessment of the opacity and yellowness of the lens according to the LOCS III classification using six reference gradations of opalescence (NO) and staining (NC) of the nucleus, then densitometry of the lens is performed on a Pentacam HR device in automatic mode with the acquisition of 50 slit sections of the anterior segment of the eye and the calculation of Lens Density% and PNS indicators on a five-point scale with a threshold optical density of 20%: 0 points: No nuclear sclerosis, density <10% 1 point: initial sclerosis of the nucleus, 10-15% 2 points: moderate nuclear sclerosis, 15-25% 3 points: severe sclerosis of the nucleus, 25-40% 4 points: Severe nuclear sclerosis, 40-60% 5 points: Hypersclerosis of the nucleus, >60%; Next, optical coherence tomography of the retina is performed according to the Retina Map protocol on an Optovue RTVue-100 XR device with the construction of 36 orthogonal scans with an area of ​​5 by 5 mm, automatic segmentation of the boundaries of the internal limiting membrane (ILM) and retinal pigment epithelium (RPE) and classification of the state of the macular according to the AREDS scale; the patient's insolation load is determined by summing up the monthly values ​​for 12 months of global horizontal radiation (GHI), obtained from the Photovoltaic Geographical Information System (PVGIS 5.3) service based on the coordinates of the patient's place of residence and work, where GHI < 1000, GHI from 1000 to 1450, GHI from 1450 to 1850, GHI > 1850 kWh / m 2, convert it into the average daily value GHI_day, which, according to the established gradation, is compared with the regional coefficient (RG) equal to 1, 2, 3, 4, according to Table 4 contained in the description, determine the behavioral coefficient (B) Behavior Factor by questioning the patient according to Table 5 contained in the description, and calculate the integral indicator HEV-Score = RG + B; for implantation, a yellow IOL with a UV and HEV filter is selected if at least one of the priority conditions is met: OCT stage ≥ 2 or HEV-Score ≥ 4, and with an HEV-Score from 2 to 3 and an HEV-Score from 0 to 1 at OCT stage 1, the final choice of the light filter is made taking into account the PNS / LOCS III data, with PNS ≥ 2 or Lens Density % ≥ 15% and LOCS III NO / NC ≥ 3 - a yellow filter;with PNS ≤ 1 or Lens Density % < 15% and LOCS III NO / NC ≤ 2 - a colorless filter, and in case of discrepancy between the PNS and LOCS III data, priority is given to the LOCS III indicator, while for patients with a high risk of age-related macular degeneration, a yellow IOL is selected for implantation; 24 hours after diagnosis, cataract phacoemulsification is performed with implantation of an individually selected IOL.

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