Visual Performance of a New Extended Depth-of-Focus Intraocular Lens Compared to a Distance-Dominant Diffractive Multifocal Intraocular Lens

Optical and visual quality assessment of an extended depth-of-focus intraocular lens based on spherical aberration of different sign

PURPOSE

To assess the optical quality and the visual performance of patients implanted with an extended depth-of-focus (EDOF) intraocular lens (IOL).

METHODS

Thirty-eight eyes underwent implantation of the Mini WELL Ready EDOF IOL and were evaluated at 3-months postsurgery. Higher-order aberrations (HOAs) and modular transfer function (MTF) were measured at 3- and 5-mm pupils. Binocular uncorrected-distance visual acuity (UDVA) and corrected-distance visual acuity (CDVA), uncorrected-distance intermediate visual acuity (UIVA) and corrected-distance intermediate visual acuity (CDIVA) at 80 cm, and uncorrected-distance near visual acuity (UNVA) and corrected-distance near visual acuity (CDNVA) at 40 cm were obtained. Postoperative refraction, binocular defocus curve, halometry and subjective ad hoc patients' questionnaire were also evaluated.

RESULTS

HOAs were 0.171 ± 0.046 µm and 0.406 ± 0.137 µm at 3 and 5 mm, respectively. MTFs decreased as the spatial frequency increased being comparable for both pupils. 92.10% of eyes were within ± 1.00D, and the mean postoperative spherical equivalent was - 0.25 ± 0.65D. Mean UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.05 ± 0.10 and 0.26 ± 0.28 logMAR, respectively. Mean CDVA, CDIVA and CDNVA were - 0.01 ± 0.08, 0.06 ± 0.11 and 0.24 ± 0.12 logMAR, respectively. Defocus curve showed a continuous range of vision, especially at intermediate distances. Mean discrimination index was 0.79 ± 0.04. Questionnaire revealed that about 79% of patients reported a high or moderately high satisfaction with the procedure, and about 95% of patients would undergo the same procedure again.

CONCLUSIONS

The Mini WELL Ready EDOF IOL provided good optical and visual quality with high level of patient satisfaction and seems to be a valuable option to provide unaided vision at different distances minimizing visual disturbances.

Future Intraocular Lens Technologies

The future of intraocular lens (IOL) technology has already begun with a number of recent innovations. The postoperative change of refractive power will lead to a customized fine-tuning that provides patients with the individual vision they expect and with as much spectacle independence as possible. The latest-generation (2.0) Light-Adjustable Lens (RxSight) was recently introduced into clinical practice, with the first results being very encouraging. Other methods of altering the power of an already implanted IOL are under development. The same can be said about the correction of presbyopia, the so-called last frontier in refractive surgery. Extended depth-of-focus IOLs have been introduced, as has the technology of the pinhole IOL. The latter has therapeutic potential beyond the refractive aspect and has already proven helpful in cases of iris defects and irregular corneas. Several technologies are currently being tested to achieve-finally-an accommodative IOL. One such concept uses the (remaining) strength of the ciliary muscle, whereas another is triggered by the pupil reaction when shifting focus from far to near. Not an IOL itself, but rather a high-tech innovation that so far has mostly been implanted during cataract surgery, is a microelectronic sensor that measures habitual intraocular pressure (IOP) at any given time and promises to revolutionize the management of glaucoma patients. The last generation of this device (Eyemate; Implandata Opthalmics Products GmbH) is implanted during small-incision cataract surgery; the latest development is an even smaller sensor that will be inserted suprachoroidally before, in the near future, such a device will be part of a capsular ring. These IOP sensors are a prime example that IOL technology will continue to be a driving force in ophthalmology, with a positive impact far beyond cataract surgery.

A Comparative Evaluation of Diffractive Trifocal and New Refractive/Extended Depth of Focus Intraocular Lenses for Refractive Lens Exchange

PURPOSE

To evaluate and compare the visual performance and quality of life (QOL) associated with refractive/extended depth of focus (EDOF) intraocular lenses (IOLs) and diffractive trifocal IOLs in refractive lens exchange patients.

MATERIALS AND METHODS

This was a comparative interventional study of patients undergoing implantation of Lucidis (Swiss Advanced Vision, SAV‑IOL SA, Neuchâtel, Switzerland) or AT LISA tri 839MP (Carl Zeiss Meditec AG, Germany) IOLs. Near, intermediate, and distance best corrected and uncorrected visual acuities were collected at 1 and 3 months postoperatively. The vision-related QOL was evaluated 1 and 3 months after surgery, using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire).

RESULTS

A total of 74 patients underwent refractive lens exchange and IOL implantation, with 38 patients in the EDOF group and 36 in the trifocal group. Among all visual acuities, uncorrected near visual acuity was statistically significantly better with the Lucidis IOL at the first month (p = .02) and diminished at the third-month visit (p = .16). When we compared the VF-14 QOL questionnaire scores, reading small print, reading a newspaper or book, and driving at night were statistically significantly better in the Lucidis group at the first month (p = .00, for each). That difference persisted only in driving at night at the third-month visit (p = .04). Reading small print, driving at night, and doing fine handwork were the most difficult tasks in the AT LISA group at the first month, and only driving at night remained so at the third-month visit.

CONCLUSIONS

The refractive results and visual outcomes at all distances of EDOF and trifocal IOLs were highly satisfactory. However, the EDOF design in the Lucidis IOL achieves lower rates of glare in the early period after refractive lens exchange.

Comparing the visual outcome, visual quality, and satisfaction among three types of multi-focal intraocular lenses

This study compared the visual outcome, visual quality, and satisfaction following implantation of the Mix-and-Match bifocal IOLs (+ 2.75 D and + 3.25 D add power Tecnis Multifocal Model), EDOF IOL (Tecnis Symfony IOL), and Trifocal IOL (FineVision PodFT, PhysIOL). All outcomes were compared among the three groups. The manifest refraction indicated that the EDOF group had significantly higher myopic spherical equivalent values than did the others. In the terms of visual acuity, there were no significant differences in far or intermediate visual acuity among the three groups. Only in near (33 cm), the EDOF group had significantly worse binocular visual acuity than did the Trifocal group (p = 0.002). Regarding to defocus curve, the Trifocal group had better defocus curves at near distances (− 2.0 to − 3.5 D; p = 0.001 vs. EDOF) than did the other two groups. In contrast sensitivity test, the EDOF group had relatively lower value than did the other two groups. In reading speed, only at 0.3 logMAR (6.5-point font), Mix-and-Match group had a significantly higher reading speed than did the other two groups (p =  < 0.001 vs. EDOF, p = 0.007 vs. Trifocal). also Mix-and-Match group showed significantly fewer visual artifacts. There were no differences between the three groups in terms of patient satisfaction.

ClinicalTrials.gov number: NCT04019691.

Lens-based surgical correction of presbyopia. Where are we in 2020?

INTRODUCTION

Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists impulsed by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years.

MATERIAL AND METHODS

This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodative, refractive, and diffractive multifocal lenses, and finally the most recent extended depth of focus/field lenses known as EDOFs.

RESULTS

Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients.

CONCLUSIONS

It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.

Clinical outcomes after mix-and-match implantation of diffractive multifocal intraocular lenses with + 2.75 and + 4.00 diopter add powers

Background

To evaluate the clinical outcomes of bilateral mix-and-match implantation of diffractive multifocal intraocular lenses (IOLs) with different add powers.

Methods

We retrospectively reviewed the medical records of 18 patients who underwent bilateral mix-and-match implantation of diffractive multifocal IOLs with different add powers. Multifocal IOLs with add powers of + 2.75 diopters (D) and + 4.00 D were implanted into the patients’ dominant and nondominant eyes, respectively. At 1 and 3-month postoperatively, monocular and binocular visual acuity was measured using logMAR charts and manifest refraction was performed. Specifically, logMAR charts were used to measure uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA). Defocus curves, contrast sensitivity, and patient satisfaction were assessed at 3-month postoperatively.

Results

Binocular logMAR measurements (mean ± standard deviation) at 3-month postoperatively were 0.01 ± 0.04 (UDVA), 0.16 ± 0.05 (UIVA), and 0.11 ± 0.07 (UNVA). Postoperative spherical equivalent was − 0.43 ± 0.35 D and − 0.39 ± 0.21 D in the dominant and nondominant eyes, respectively. Defocus curves showed significant differences between − 1.50 and − 4.00 D among binocular, dominant, and nondominant eye measurements, except between − 2.50 and − 3.00 D. Eyes implanted with + 2.75 and + 4.00 D IOLs showed good contrast sensitivity under photopic and mesopic conditions. Over 80% of patients reported high satisfaction with their near vision.

Conclusions

Bilateral mix-and-match implantation of diffractive multifocal IOLs with add powers of + 2.75 D and + 4.00 D showed good near, intermediate, and far vision.

How does the world appear to patients with multifocal intraocular lenses?: a mobile model eye experiment

Background

To show how the world appear to patients with multifocal intraocular lens (IOL) using a novel mobile model eye.

Methods

The mobile model eye was composed of an artificial cornea, IOL, IOL chamber, and a camera. A monofocal IOL (Tecnis monofocal IOL) and two diffractive multifocal IOL (ReSTOR, Tecnis multifocal IOL) were used in the study. We went outside to take a picture of the scenery. At night, we stood on a road and took pictures to see how the traffic lights and headlights of cars looked. For an indoor analysis, we approached the Early Treatment Diabetic Retinopathy Study (ETDRS) chart to the model eye from a distance of 95 cm to check the multifocal function of the lenses. In the car, we took pictures of the street and a cell phone in turn to check the multifocal function of the lenses.

Results

Two multifocal IOLs showed definite multifocal function. Far objects appeared either similarly clear or slightly hazier (depending on the IOL model) than those with the monofocal IOL. In the night vision, there was a mild or severe halo around light sources compared to those with the monofocal IOL.

Conclusion

We believe that this mobile model eye can be used to evaluate how the real world appear to a patient with a multifocal IOL, to explain multifocal function of the IOLs, and possible complications in the patients, before performing a surgery.

Extended Depth-of-Field Intraocular Lenses: An Update

Extended depth-of-focus (EDOF) is a new intraocular lens (IOL) technology in the treatment of presbyopia. In contrast to multifocal (MF) IOLs, EDOF lenses create a single elongated focal point, rather than several foci, to enhance depth of focus. In this way, EDOF IOLs aim to reduce photic phenomena, glare, and halos, which have been reported in MF IOLs. A potential disadvantage is a decrease of retinal image quality if the amount of the aberrations is excessively increased. Frequently, EDOF IOLs are combined with MF optical designs; for this reason, EDOF IOLs are commonly a subject of confusion with optical multifocality concepts. The aim of this article is to clarify what an EDOF IOL is and to discuss the recently reported outcomes with these IOLs. We propose naming lenses that have combined optical designs as "hybrid IOLs."

Optimum Refractive Target in Patients with Bilateral Implantation of Extended Depth of Focus Intraocular Lenses

Purpose

To determine the refractive target of extended depth of focus (EDOF) intraocular lenses in dominant and non-dominant eyes which provides the best binocular vision at all ranges after cataract surgery.

Patients and Methods

This retrospective, single-center, non-comparative study included 47 patients who had undergone bilateral cataract surgery with implantation of EDOF IOLs (Tecnis Symfony or Tecnis Symfony Toric) targeting emmetropia in both eyes. Binocular uncorrected visual acuity at distance (UDVA), near (UNVA), intermediate (UIVA), and manifest refraction spherical equivalent (MRSE) were recorded between 1 and 3 months after the second-eye cataract surgery. Scattergrams for combined binocular UDVA, UIVA, UNVA and postoperative MRSE were plotted and the points of minima of the quadratic regression curve for the dominant and non-dominant eyes were considered as the optimum MRSE corresponding to the best overall visual acuity. Subgroup analysis of patients who achieved UDVA and UIVA ≥20/20 and UNVA ≥20/30 was also performed.

Results

For the overall group, the optimum MRSE was −0.08 D for dominant and −0.63 D for non-dominant eyes. In a subset of 17 patients who achieved excellent acuity at all distances, the mean MRSE for the dominant and non-dominant eyes was −0.07 ± 0.14 D and −0.21 ± 0.24 D, respectively.

Conclusion

Excellent visual acuity at all ranges can be achieved with bilateral EDOF intraocular lenses implanted after cataract surgery. Our results indicate the best results when the dominant eye is targeted at emmetropia and the nondominant eye is targeted between −0.21D and −0.63D, with excellent results shown with mild myopia of −0.21 in the non-dominant eyes. Future studies with larger sample sizes and subjective patient-reported outcomes may validate current study outcomes.

Functional Outcomes and Reading Performance After Combined Implantation of a Small-Aperture Lens and a Segmental Refractive Bifocal Lens

PURPOSE

Clinical evaluation of the visual outcomes after implantation of a small-aperture extended depth of focus (EDOF) intraocular lens (IOL) and a segmental refractive bifocal lens.

METHODS

In this prospective study, 13 patients with cataract received a small-aperture IC-8 IOL (AcuFocus, Irvine, CA) in one eye and a segmental-refractive Lentis Mplus LS-313 MF20 IOL (Oculentis, Berlin, Germany) in the fellow eye. The clinical examination included measurements of uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity. Additionally, a defocus curve was obtained from +2.00 to -5.00 diopters (D) and a Salzburg Reading Desk was used to assess the patients' reading acuity at intermediate and near distances. A halo and glare simulator was used to evaluate the postoperative perception of dysphotopsia.

RESULTS

At 5 months postoperatively, the mean binocular visual results demonstrated UDVA, UIVA, and UNVA values of -0.04 ± 0.11, 0.00 ± 0.10, and 0.11 ± 0.08 logMAR, respectively. The binocular distance-corrected reading performance test also confirmed the improved visual function, with an intermediate reading acuity of 0.12 logMAR at 69.21 cm and a near reading acuity of 0.19 logMAR at 41.63 cm. The mean halo size was 32.54 ± 22.38, mean halo intensity was 34.46 ± 21.95, mean glare size was 9.00 ± 17.47, and mean glare intensity was 9.92 ± 16.84.

CONCLUSIONS

The new concept of a combined implantation of a small-aperture IOL and a segmental-refractive bifocal lens showed good results in far and intermediate distances and functional results at near distance, while causing minimal photic phenomena. [J Refract Surg. 2019;35(9):551-558.].

Initial Clinical Outcomes of a New Extended Depth of Focus Intraocular Lens

PURPOSE

To evaluate clinical and patient-reported outcomes of a new extended depth of focus intraocular lens (IOL).

METHODS

Data of patients treated between September 2017 and September 2018 who underwent a refractive lens exchange/cataract surgery with an implantation of the AT LARA 829MP IOL (Carl Zeiss Meditec AG, Jena, Germany) and attended the 1-week, 1-month, and 3-month follow-up visit were reviewed.

RESULTS

At 3 months, the percentage of eyes within ±0.50 diopters (D) of emmetropia was 86.7%. The mean binocular uncorrected distance visual acuity was -0.05 ± 0.09 logMAR and the mean binocular unaided near vision was 0.26 ± 0.14 logMAR. Of all patients, 90.3% were satisfied with their vision. The percentage of patients spectacle-free for near and distance vision was 83.6% and 95.4%, respectively. On a scale from 1 (no difficulty) to 7 (severe difficulty), there was an average 1.2 to 1.4 units increase in glare, halo, and starburst between the preoperative and 1-month visit, and a decrease of 0.2 to 0.3 units between the 1- and 3-month visit.

CONCLUSIONS

The new extended depth of focus IOL provided reasonable unaided near and distance vision, as well as spectacle independence and patient satisfaction. Some optical side effects were reported in the early postoperative period. [J Refract Surg. 2019;35(7):426-433.].

Nationwide Prospective Cohort Study on Cataract Surgery With Multifocal Intraocular Lens Implantation in Japan

PURPOSE

To conduct a nationwide prospective cohort study of multifocal intraocular lens (mfIOL) implantation to determine clinical outcomes and patient satisfaction and assess factors affecting patient satisfaction.

DESIGN

Prospective, multicenter cohort study.

METHODS

Setting: institutional; patient population: a total of 1051 consecutive patients (1631 eyes) who underwent cataract surgery with mfIOL implantation at 65 Japanese institutions from January 2017 to June 2018. The inclusion criteria were patient age of 20 years and older and cataract surgery with mfIOL implantation. The exclusion criteria were the absence of informed consent, completed postoperative questionnaires, and no record of the IOL models implanted.

OBSERVATION PROCEDURES

the uncorrected and corrected distance visual acuities (UDVAs and CDVAs) at 5 m; uncorrected VAs at 50, 40, and 30 cm; and questionnaires regarding subjective visual symptoms, spectacle independence, and surgical satisfaction were assessed 3 months postoperatively.

MAIN OUTCOME MEASURE

odds ratios for the overall surgical satisfaction were computed for the preoperative/postoperative factors.

RESULTS

We analyzed data from 1384 eyes of 871 patients. The UDVAs and CDVAs, respectively, improved significantly at 3 months postoperatively. The intermediate and near VAs varied with the IOL models; 68.4% of patients were almost or totally spectacle-independent; 3.9% of patients reported surgical dissatisfaction. In patients implanted bilaterally with the same mfIOLs, postoperative blurred vision and/or decreased contrast was the most important factor in the overall surgical satisfaction.

CONCLUSIONS

MfIOLs provided good visual outcomes and high satisfaction rates in this large patient cohort. The difference in the outcomes with the extended depth-of-focus IOLs did not differ significantly from the bifocal IOLs. The postoperative blurred vision is important to the overall surgical satisfaction.

Visual acuity and defocus curves with six multifocal intraocular lenses

PURPOSE

The purpose of this prospective, randomized, double-masked, study was to compare the visual performance of patients after bilateral implantation of six different IOLs.

METHODS

The following IOLs were used in the study: SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA Tri 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). Visual performance was assessed by the monocular distance-corrected visual acuity at 4 m (CDVA), distance-corrected intermediate visual acuity (DCIVA) at 60 cm and distance-corrected near visual acuity (DCNVA) at 40 cm. Binocular defocus curves were obtained for a range of defocus from + 1.50 D to - 4.50 D, in 0.50 D steps. Quality of life was assessed with the VF-14 questionnaire.

RESULTS

CDVA was better with the Symfony ZXR00 than with the SV25T0 (p = 0.032), ATLISA Tri 839MP (p = 0.032) and ATLISA 809M (p = 0.018). The Symfony ZXR00 offered the best DCIVA, followed by the ZKB00. The best and worst DCNVA results corresponded to the ZLB00, and the SV25T0 and Symfony ZXR00, respectively. Defocus curves at distance were good in all groups, although the Symfony had a wider range of clear vision (- 1.50 D to + 0.50 D), with no decay. For intermediate vision, only the Symfony obtained sharp visual acuity. The ATLISA 809M, ATLISA Tri 839MP and ZLB00 were superior at near distance.

CONCLUSIONS

The extended depth of focus of the Symfony ZXR00 offers a superior range of clear vision at far and intermediate distances than other multifocal designs, with worse results at near distance. Visual outcomes reflect the particular optical, geometrical and power distribution characteristics of each IOL.

Comparison of the Clinical Outcomes between Echelette Extended Range of Vision and Diffractive Bifocal Intraocular Lenses

Purpose

To compare the clinical outcomes of echelette extended range of vision (ERV) and diffractive bifocal intraocular lenses (IOLs).

Methods

This is a prospective, consecutive, nonrandomized clinical trial. Seventy-three eligible patients (109 eyes) received the implantation of echelette ERV IOL (Tecnis Symfony ZXR00) or diffractive bifocal IOL (Tecnis ZMB00). 1 week, 1 month, and 3 months after surgery, visual acuities at different distances were examined. At 3 months, defocus curves, contrast sensitivities (CSs) with and without glare, optic path difference (OPD) scans, and questionnaires were evaluated. Regression analyses were applied to discover influence factors on postoperative vision.

Results

ZXR00 showed better distance (P < 0.05) and intermediate (P < 0.001) visual acuities, while ZMB00 was better at distance-corrected near visual acuity (P < 0.001). Multivariate analyses indicated that worse intermediate (P < 0.001) and near vision (P=0.013) of ZMB00 might occur in patients with longer axial length. ZXR00 demonstrated smoother defocus curve and higher CSs. Superior modulation transfer function (MTF) and higher Strehl ratio (P < 0.05) were shown in ZXR00. In questionnaire evaluation, ZXR00 received better outcomes in self-reported vision, Visual Function-14 (VF-14) questionnaire, Quality of Vision (QoV) questionnaire, satisfaction, and recommendation grades. Spectacle dependence did not differ between ZXR00 and ZMB00 statistically.

Conclusion

ZXR00 proved to be remarkable in distance and intermediate vision, defocus curve smoothness, CSs, and visual comfort, while ZMB00 achieved better near vision. ZXR00 may attain better near vision if postoperative SE remains slightly negative. Patients with relatively longer axial length might receive less favorable intermediate and near vision after ZMB00 implantation. This trial is registered with ChiCTR-ONC-17011119.

Clinical and aberrometric evaluation of a new extended depth-of-focus intraocular lens based on spherical aberration

PURPOSE

To compare the refractive, visual, and aberrometric results with a new extended depth-of-focus intraocular lens (EDOF IOL) based on alternating positive and negative spherical aberration in the central 3.0 mm optical zone and an aspheric monofocal IOL of the same platform.

SETTING

Ophthalmology, University Hospital of Verona, Italy.

DESIGN

Prospective case series.

METHODS

Cataract patients free from other ocular disease had bilateral implantation of the EDOF Mini Well IOL or the monofocal Mini IOL. Four to 6 weeks after second-eye surgery, the refraction, visual acuity, defocus curve, contrast sensitivity, and photic symptoms were assessed. Wavefront analysis was performed. The primary endpoint of was the amplitude of the dioptric interval for 0.1 logarithm of the minimum angle of resolution (logMAR) visual acuity. The secondary endpoint was an aberration comparison between the two IOLs.

RESULTS

The study comprised two groups of 25 patients each. The corrected distance visual acuity was better with the monofocal IOL by 0.02 logMAR (P = .03). The 0.1 logMAR dioptric interval was 2.0 diopters (D) for the EDOF IOL and 1.0 D for the monofocal IOL (P < .001). The mean CDVA at -2.0 defocus was 0.15 logMAR ± 0.08 (SD) and 0.52 ± 0.14 logMAR, respectively (P < .001). There was no difference in contrast sensitivity or photic symptoms. The optical aberrations at 4.0 mm and 6.0 mm aperture diameters were similar in the two groups.

CONCLUSION

The EDOF IOL based on spherical aberration provided greater depth of focus than the aspheric monofocal IOL without increasing optical aberrations and with few photic symptoms.

Methods for evaluating quality of life and vision in patients undergoing lens refractive surgery

PURPOSE

Cataract surgery has evolved into a procedure that generally yields the best postoperative refractive result attainable. Patients with multifocal intraocular lenses (IOLs) present higher rates of spectacle independence, although reduced intermediate vision, dysphotopsias, and a loss of image quality might also be experienced. The aim of the study was to review the methods for assessing quality of life and vision in patients undergoing lens refractive surgery in randomized controlled trials.

METHODS

We reviewed the PubMed web platform to identify relevant studies using the following keywords: quality of life, quality of vision, lens surgery, lens exchange, refractive lens exchange, cataract, cataract surgery, intraocular lens, IOL, multifocal, and monovision.

RESULTS

An increasing number of studies have focused on patient-reported outcomes (PROs). Only a few of the available visual function questionnaires can be regarded as useful in lens refractive surgery with multifocal IOL implantation. Many self-developed questionnaires have emerged that have not been adequately validated or found to feature properly evaluated repeatability, hampering the possibility of comparing outcomes.

CONCLUSIONS

This review describes the existing PROs instruments and informs the choice of an appropriate measure in lens refractive surgery. Rasch-developed tools should be utilized for measuring quality of life and vision in patients undergoing lens refractive surgery and there is a number of highly robust tools available.

Intraocular lens correction of presbyopia

The continued development of intraocular lens (IOL) technology has led to a dramatic improvement in refractive outcomes. New and innovative ways of achieving the desired postoperative refractive goals continue to be developed. This article aims to review the currently available IOL modalities for correction of presbyopia at the time of cataract surgery, including reference to high-quality comparative studies, where available, and discussion of strengths as well as limitations of the currently available IOL technologies. It has been shown that multifocal compared to monofocal IOL was associated with higher rates of spectacle independence, but higher rates and severity of symptomatic glare as well as reduced contrast sensitivity. Within multifocal IOLs, diffractive compared to refractive IOLs tended to have better near vision and a lower rate of symptomatic glare. Extended depth-of-focus IOLs compared to diffractive multifocal IOL demonstrated equal or superior intermediate visual acuity, with less than or equal rates of glare. Accommodative IOLs represent a broad range of technologies that continue to develop, and new technologies offering opportunities for postoperative adjustment of refractive outcome are emerging.

Functional assessment of a new extended depth-of-focus intraocular lens

BACKGROUND/OBJECTIVE

This study aimed to investigate the visual performance of a new extended depth-of-focus intraocular lens (EDOF-IOL).

SUBJECTS/METHODS

In this multicenter, prospective, observational study, we enrolled 97 patients who underwent cataract surgery or refractive lens exchange with implantation of the Mini Well EDOF-IOL (SIFI, Italy). Patients underwent postoperatively the following examinations between 4 and 8 weeks after surgery: corrected distance visual acuity (CDVA), reading speed with Radner's chart, distance-corrected near visual acuity (DCNVA), defocus curve, contrast sensitivity, and haloes quantitative assessment.

RESULTS

In the whole sample, the mean monocular CDVA and DCNVA were, respectively, 0.02 ± 0.07 logMAR and 0.38 ± 0.15 logRAD (logarithm of the reading acuity determination). In the 67 bilaterally implanted patients, binocular CDVA and DCNVA were better (0.00 ± 0.05 logMAR and 0.26 ± 0.13 logRAD) than the corresponding monocular values (p = 0.02 and p = 0.0002, respectively). Ninety-two percent of patients bilaterally implanted reached a binocular reading speed >80 words per minute at a 0.5 logRAD print size (corresponding to the common book print size). The defocus curves showed that the EDOF-IOL provided increased depth of focus through 2.0 D of defocus, with the best performance at 1.0 and 1.5 D. Contrast sensitivity was within normal limits at all spatial frequencies. The mean visual disturbance index was 0.08 ± 0.12, suggesting low night visual disturbances.

CONCLUSIONS

The new EDOF-IOL provided good visual acuity for distance, intermediate, and near vision, with no loss of contrast sensitivity and low risk of night visual disturbances.