Comparison of new monofocal innovative and standard monofocal intraocular lens after phacoemulsification

Intraindividual Comparison of an Enhanced Monofocal and an Aspheric Monofocal Intraocular Lens of the Same Platform

PURPOSE

To compare intraindividual differences in visual performance of a monofocal and enhanced monofocal intraocular lens (IOL) of the same platform.

DESIGN

Prospective, interventional, fellow-eye comparison clinical study.

METHODS

In total, 55 patients (110 eyes) with bilateral age-related cataract were enrolled. All patients received a monofocal ZCB00 IOL in the dominant and an enhanced monofocal Eyhance ICB00 IOL in the nondominant eye. After 2 to 4 months, monocular best-corrected distant visual acuity (BCDVA), distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), contrast visual acuity, monocular defocus curves, internal higher-order aberrations (HOAs) and spherical aberrations (SA), decentration, and tilt were compared.

RESULTS

The monocular mean BCDVA, DCIVA at 80 cm and 66 cm, and DCNVA were -0.03 ± 0.07, 0.24 ± 0.12, 0.32 ± 0.13, and 0.50 ± 0.13 logarithm of the minimum angle of resolution for the enhanced ICB00 and -0.06 ± 0.06 (P = .014), 0.30 ± 0.11 (P = .005), 0.38 ± 0.12 (P = .004), and 0.55 ± 0.14 (P = .034) logarithm of the minimum angle of resolution for the ZCB00, respectively. Internal HOAs (P = .001) and negative SA (P < .001) were increased with the ICB00 at 3 mm and comparable at 5 mm (P > .05). Contrast acuity, tilt, and decentration were similar (P > .05).

CONCLUSIONS

Significantly increased monocular DCIVA at 80 cm and 66 cm and DCNVA at 40 cm were observed with the enhanced ICB00 IOL, and the ZCB00 IOL demonstrated better BCDVA. This would result in a mean gain of 2 to 3 Early Treatment of Diabetic Retinopathy Study letters at near and intermediate distance. Monocular defocus curves displayed highest differences of 5 Early Treatment of Diabetic Retinopathy Study letters at -1.25 diopters (D) and -1.50 D levels of defocus and a depth of focus of 1.23 D for the ICB00 IOL and 0.94 D for the ZCB00 IOL. Decentration, tilt, and HOAs were generally low.

Comparative Analysis of Clinical and Patient-Reported Outcomes of a New Enhanced Monofocal IOL and a Conventional Monofocal IOL

Purpose

To compare the outcomes of the Tecnis Eyhance ICB00 IOL, designed to enhance intermediate vision, to a conventional Tecnis Monofocal ZCB00 IOL.

Methods

This retrospective analysis compared two cohorts of patients undergoing lens replacement surgery with bilateral implantation of the Tecnis ICB00 or the Tecnis ZCB00 IOL (383 patients in each group). Monocular and binocular uncorrected distance (UDVA), intermediate (UIVA; 66cm), and near (UNVA; 40cm) visual acuities, refractive predictability, and patient-reported outcomes were compared. A sub-analysis of patients with the Eyhance IOL was performed to compare patients who achieved bilateral emmetropia to those with mini-monovision. One-month postoperative outcomes were analyzed.

Results

Both groups had comparable UDVA outcomes. On average, both monocular and binocular UIVAs were approximately one Snellen line better in patients implanted with Eyhance IOL (monocular UIVA: ICB00 0.23 ± 0.18 logMAR, ZCB00 0.33 ± 0.19 logMAR; binocular UIVA: ICB00 0.18 ± 0.18 logMAR, ZCB00 0.26 ± 0.20 logMAR, p < 0.01). Likewise, the mean UNVA was also one Snellen line better with the ICB00 model (monocular UNVA: ICB00 0.51 ± 0.20 logMAR, ZCB00 0.61 ± 0.18 logMAR; binocular UNVA: ICB00 0.42 ± 0.19 logMAR, ZCB00 0.51 ± 0.22 logMAR, p < 0.01). There was no difference between the two groups in overall satisfaction or visual phenomena. A subgroup of patients who achieved mini-monovision with Eyhance IOL had, on average, one Snellen line better UIVA and UNVA compared to patients with bilateral emmetropia.

Conclusion

Patients receiving the enhanced monofocal IOL had better intermediate and near vision compared to those receiving the conventional monofocal IOL, with similar levels of patient-reported photic phenomena in both groups.

Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis

PURPOSE

To assess the efficacy and safety of various intraocular lenses (IOLs), including standard monofocal, bifocal, trifocal, extended depth of focus (EDOF), and enhanced monofocal IOLs, post-cataract surgery through a network meta-analysis.

METHODS

A systematic search of PubMed, Cochrane Library, and Web of Science was conducted to identify relevant studies from the past 5 years. Parameters such as binocular visual acuities, spectacle independence, contrast sensitivity (CS), and optical quality were used to evaluate efficacy and safety. Data from the selected studies were analyzed using Review Manager 5.4 and STATA 17.0 software.

RESULTS

Twenty-eight Randomized Controlled Trials (RCTs) comprising 2465 subjects were included. Trifocal IOLs exhibited superior uncorrected near visual acuity (UNVA) compared to monofocal IOLs (MD: -0.35; 95% CI: -0.48, -0.22). Both trifocal (AcrySof IQ PanOptix IOLs group MD: -0.13; 95% CI: -0.21, -0.06) and EDOF IOLs (MD: -0.13; 95% CI: -0.17, -0.09) showed better uncorrected intermediate visual acuity (UIVA) than monofocal IOLs. Trifocal IOLs ranked highest in spectacle independence at various distances (AT LISAtri 839MP group: SUCRA 97.5% for distance, 80.7% for intermediate; AcrySof IQ PanOptix group: SUCRA 83.0% for near).

CONCLUSIONS

For cataract patients who want to treat presbyopia, trifocal IOLs demonstrated better visual acuity and spectacle independence at near distances. Different types of trifocal IOL characteristics differ. EDOF and enhanced monofocal IOLs have improved visual quality at intermediate distances.Therefore, It is very important to select the appropriate IOLs based on the lens characteristics and patient needs.

Refractive extended depth-of-focus lens design based on periodic power profile for presbyopia correction

PURPOSE

Limitations of existing diffractive multifocal designs for presbyopia correction include discrete foci and photic phenomena such as halos and glare. This study aimed to explore a methodology for developing refractive extended depth-of-focus (EDoF) lenses based on a periodic power profile.

METHODS

The proposed design technique employed an optical power profile that periodically alternated between far, intermediate and near distances across the pupil radius. To evaluate the lens designs, optical bench testing was conducted. The impact on visual performance was assessed using a spatial light modulator-based adaptive optics vision simulator in human subjects. Additionally, the effects of pupil size change and lens decentration on retinal image quality were examined. A comparative performance analysis was carried out against a typical diffractive trifocal design and a monofocal lens.

RESULTS

The proposed design method was found to be effective in uniformly distributing light energy across all object distances within the desired depth of focus (DoF). While trade-offs between overall image quality and DoF still exist, the EDoF lens design, when tested in human subjects, provided a continuous DoF spanning over 2.25 D. The results also revealed that the EDoF design had a slightly higher dependence on changes in pupil size and lens decentration than the diffractive trifocal design.

CONCLUSION

The proposed design method showed significant potential as an approach for developing refractive EDoF ophthalmic lenses. These lenses offer a continuous DoF but are slightly more susceptible to variations in pupil size and decentration compared with the diffractive trifocal design.

Visual outcomes and patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens: a single-masked prospective randomized study

PURPOSE

To evaluate and compare the visual outcomes of an enhanced monofocal intraocular lens (IOL) with two different monofocal IOLs.

SETTING

Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy.

DESIGN

Prospective, single-center, single-masked, randomized controlled clinical study.

METHODS

The study included patients undergoing phacoemulsification and IOL implantation. Patients were consecutively randomized by block randomization and assigned in a 1:1:1 allocation ratio to three study arms to bilaterally receive Tecnis Eyhance™ (model ICB00) or Tecnis® monofocal 1-piece (model PCB00) or Clareon® monofocal (model CNA0T0), respectively. Monocular and binocular (both corrected and uncorrected) visual acuities for far, intermediate and near were registered and compared among groups at 3 months. To track changes in patient quality of life, the Catquest-9SF questionnaire was administered to each patient before and after cataract extraction.

RESULTS

Ninety patients (30 for each group) were enrolled. At 3 months follow-up, statistically significant differences for intermediate visual acuities were found between the three groups. Nonstatistically significant differences were observed for distance visual acuities and the changes in Catquest-9SF scores.

CONCLUSION

Tecnis Eyhance™ provided better results in intermediate visual outcomes without adverse effects on patients' quality of life.

Cataract surgery with new monofocal intraocular lens enhanced for intermediate vision and standard monofocal intraocular lens for retinal disorder

AIM

To investigate the difference in the initial surgical results between a new monofocal intraocular lens (IOL) with enhanced intermediate vision and the standard monofocal IOL in patients with retinal disease.

METHODS

We retrospectively reviewed the medical records of patients with retinal disease who underwent cataract surgery due to accompanying cataracts. Types of retinal diseases were investigated and best-corrected distant visual acuity, distant uncorrected visual acuity (UCVA), intermediate UCVA, near UCVA, and spherical equivalent were recorded at each visit. The surgical results were investigated at 1 day, 1 week, and 1 month after surgery.

RESULTS

Seventeen eyes treated with a new monofocal IOL enhanced for intermediate vision (ICB00 group) and 18 eyes treated with the standard monofocal IOL (AAB00 group) were included in this study. There were no significant differences in the baseline characteristics, including the type of underlying retinal disease, between the groups. There were no significant differences between the groups in terms of distant, intermediate, or near UCVA at day 1 and week 1 after surgery. However, at 1 month after surgery, the ICB00 group showed a significantly better intermediate vision improvement than the AAB00 group (p = 0.001).

CONCLUSION

Even in patients with cataract accompanied by retinal disease, the use of the ICB00 IOL showed significant improvement in intermediate vision compared to the use of the AAB00 (standard monofocal) IOL. The ICB00 IOL might be a good option for patients with cataract and retinal disease in the era of increased intermediate vision needs in daily life.

Blue-Light Filtering Monofocal Intraocular Lenses: A Study on Optical Function and Tolerance to Misalignment

PURPOSE

To investigate the optical performance and tolerance to misalignment of blue-light filtering monofocal intraocular lenses (IOLs).

METHODS

The optical properties of two monofocal IOLs featuring yellow chromophores, CT Lucia 621 PY (Carl Zeiss Meditec AG) and Clareon CNA0T0 (Alcon Laboratories, Inc), were assessed in monochromatic and polychromatic light while introducing spherical aberration (SA). Optical quality metrics derived from the modulation transfer function were assessed after optimal IOL centration at 3- and 4.5-mm pupils. In addition, each IOL's tolerance to misalignment was examined by inducing up to 1 mm of decentration and the effect of tilting it by 5 degrees at 3 mm.

RESULTS

The IOLs' resolution and contrast, while tested using a 3-mm aperture and an SA-neutral corneal model, indicated the CT Lucia 621 PY had a slightly higher modulation transfer function (MTF) at 50 lp/mm than the CNA0T0 under monochromatic conditions (0.77 vs 0.69). On introducing SA with (0.49 vs 0.40) and without (0.75 vs. 0.70) chromatic aberration, the CT Lucia 621 PY maintained its minimally better performance. When assessed with a 4.5-mm aperture in monochromatic light, the CT Lucia 621 PY displayed improved MTF with aberration-free cornea (0.71 vs 0.40) but performed worse after introducing SA (0.44 vs 0.62). However, both lenses achieved comparable MTF values under spherical and chromatic aberrations (0.28 vs 0.27). The IOL misalignment test revealed a better tolerance to tilt and decentration of the CT Lucia 621 PY across all conditions.

CONCLUSIONS

The CT Lucia 621 PY and CNA0T0 showed similar optical quality in different situations, with equal simulated distance visual acuity for both models. However, the CT Lucia 621 PY's aspheric design offers an advantage when dealing with often imperfect physiological conditions, displaying a more robust performance under tilt and decentration. [J Refract Surg. 2024;40(2):e79-e88.].

Refractive Predictability between Standard and Total Keratometry during the Femtosecond Laser-Assisted Cataract Surgery with Monofocal Intraocular Lens with Enhanced Intermediate Function

PURPOSE

We aimed to compare the accuracy of the intraocular lens (IOL) calculation formula using the standard keratometry (K) and total K (TK) during the femtosecond laser-assisted cataract surgery (FLACS) with a monofocal IOL with enhanced intermediate function using currently used formulas.

METHODS

A retrospective review of 125 eyes from 125 patients who had undergone FLACS with implantation of monofocal IOL with enhanced intermediate function was conducted. The predicted refractive power was calculated using an optical biometer (IOLmaster 700) according to the K and TK in the Barrett Universal II, SRK/T, Haigis, and Holladay 2 formulas. Absolute prediction error (APE) obtained from the actual postoperative refractive outcomes and the refractive error predicted in each formula was compared one month after surgery.

RESULTS

Mean APE ranged between 0.29 and 0.39 diopters (D) regardless of the calculation formula and the method of measuring corneal curvature. Significant differences were observed in the APE from the four formulas and the two keratometric measurements (p = 0.014). In a total of 125 eyes from 125 patients, the mean APE was lowest with the Barrett Universal II formula. Across all formulas, both the mean APE and the median APE tended to be lower for K than for TK, although there was no significant difference. Approximately 70% to 80% of the patients were included within 0.5 D of the refractive error across all formulas. The percentage of eyes within 0.5 D of APE outcomes was not statistically different between the K and TK data when using each formula.

CONCLUSIONS

Keratometric measurements considering the poster corneal curvature did not show any additional advantages when implanting the monofocal IOL with enhanced intermediate function during the FLACS.

Clinical outcomes after implantation of a new monofocal intraocular lens with enhanced intermediate function in patients with preperimetric glaucoma

Purpose

We evaluated the clinical outcomes after implantation of a new monofocal intraocular lens (IOL) with enhanced intermediate function in patients with preperimetric glaucoma and compared those with patients without retinal nerve fiber layer (RNFL) defects.

Methods

All patients were implanted bilaterally a new monofocal IOL with enhanced intermediate function. Patients with bilateral RNFL defects and no glaucomatous visual field defects were classified as the preperimetric glaucoma group. A total of 60 eyes of 30 patients with preperimetric glaucoma were compared with 60 eyes of 30 patients without RNFL defects. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), defocus curve, contrast sensitivity, and questionnaire were evaluated 1 month and 3 months after surgery.

Results

No difference in binocular UDVA, UIVA, and UNVA was evident between the two groups at 1 and 3 months postoperatively. Additionally, there were no significant differences between the two groups regarding the proportion of severe or very severe photic phenomena, such as glare and halos, or the overall satisfaction.

Conclusion

Bilateral implantation of a new monofocal IOL with enhanced intermediate function in patients with preperimetric glaucoma demonstrated commensurate clinical outcomes and could be considered a feasible alternative.

Head-to-Head Comparison of Intermediate Vision of Two Monofocal Intraocular Lenses

Purpose

To compare intermediate visual outcomes in patients previously implanted with bilateral Clareon monofocal IOLs versus bilateral Eyhance IOLs.

Methods

This was a non-interventional, single-center, examiner-masked, comparative study. Participants were cataract patients presenting at least 3 months after uncomplicated, bilateral implantation of either Clareon or Eyhance non-toric and toric IOLs. Outcomes measures included binocular distance-corrected intermediate visual acuity (DCIVA), binocular corrected distance visual acuity (CDVA), binocular best-corrected defocus curve, postoperative mean residual spherical equivalent (MRSE), and residual astigmatism.

Results

A total of 620 eyes of 310 subjects (155 subjects per group) were evaluated. The mean difference in DCIVA was 0.05 logMAR between the Eyhance and Clareon IOLs which was significant (p < 0.01), but within the 0.1 logMAR non-inferiority margin. Mean CDVA of the Clareon group was 0.01 ± 0.03 logMAR compared to 0.02 ± 0.03 logMAR of the Eyhance Group (p > 0.05). Defocus curves from +1.0 D to -3.0 D were not clinically nor statistically different between the Clareon and Eyhance groups (p > 0.05).

Conclusion

The results of this study show that bilateral implantation of Clareon monofocal IOLs and Eyhance monofocal IOLs lead to similar distance and intermediate visual outcomes.

Analysis of higher-order aberrations in relation to the clinical outcome of an enhanced monofocal IOL

PURPOSE

To analyse higher-order aberrations of an enhanced monofocal aspheric intraocular lens (IOL) in relation to the clinical outcome compared to a monofocal aspheric IOL.

SETTING

Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Germany.

DESIGN

Prospective, monocentric, controlled, non-randomized, two-armed study.

METHODS

After phacoemulsification, a total of 30 patients (60 eyes) were bilaterally implanted with either TECNIS Eyhance IOL model ICB00 (Johnson & Johnson Surgical Vision, Inc.) or TECNIS Monofocal 1-Piece IOL model ZCB00 (Johnson & Johnson Surgical Vision, Inc.) in 30 eyes each. Assessments were performed 1 and 3 months after surgery including refraction, uncorrected and best-corrected distance, intermediate and near visual acuity, defocus curves, contrast sensitivities under photopic, mesopic and mesopic conditions with glare, higher-order aberrations (HOAs) at pupil sizes of 5, 4, 3 and 2 mm and patient satisfaction.

RESULTS

At 3-month follow-up, measurements of HOAs revealed significant higher negative internal and ocular primary spherical aberrations in the ICB00 group at pupil sizes of 5, 4, 3 and 2 mm. The ICB00 showed significant better results in intermediate and near visual acuity, but no difference in distance visual acuity. No significant difference was found in contrast sensitivities at any condition or spatial frequency. Spectacle independence was significant better without significant higher rates of dysphotopsia in the ICB00 group.

CONCLUSIONS

Higher negative spherical aberrations in the ICB00 group at all measured pupil sizes appear to lead to a superior clinical outcome in intermediate and near vision compared to the ZCB00 group without compromising contrast sensitivity or distance visual acuity.

Short-term clinical outcomes after implantation of monofocal intraocular lens with enhanced intermediate function in eyes with epiretinal membrane

Our study evaluated the clinical outcomes after implantation of a monofocal intraocular lens (IOL) with enhanced intermediate function in eyes with epiretinal membrane (ERM). Patients with preexisting ERM who underwent cataract surgery with implantation of monofocal IOL with enhanced intermediate function were included retrospectively. According to the ERM grade and central subfield thickness (CST) obtained from preoperative optical coherence tomography, patients were divided into non-fovea-involving and fovea-involving ERM groups. At 1 month after surgery, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), contrast sensitivity, defocus curve, and satisfaction questionnaire were evaluated. Postoperative clinical findings were compared with age-matched controls without ERM. A total of 50 patients' eyes (28 and 22 in the non-fovea-involving and fovea-involving ERM groups, respectively) were compared with 42 control eyes. One month post-surgery, significant differences in UDVA, CDVA, and CST (corrected P was < 0.001, = 0.001, and < 0.001, respectively) were observed between the fovea-involving ERM and control group; however, no significant differences in UIVA and UNVA were observed between the two groups. Contrast sensitivity showed inferior results in the fovea-involving group without significance. Photic phenomena were reported less in the fovea-involving group than in the non-fovea-involving group. More than 70% of patients in both ERM groups were satisfied. Implantation of monofocal IOL with enhanced intermediate function could be a good option for patients with ERM that need intermediate vision.

Evaluation of a New Monofocal Intraocular Lens in Patients Undergoing Cataract and Vitrectomy Surgery for Idiopathic Macular Hole

PURPOSE

To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients who underwent combined cataract and pars plana vitrectomy (PPV) surgery for idiopathic macular hole (MH).

METHODS

A prospective study was conducted on 89 eyes of 89 patients who underwent combined cataract and PPV surgery for MH. The patients were divided into two groups: Eyhance ICB00 and Tecnis ZCB00. Pre-operative characteristics, post-operative visual outcomes, contrast sensitivity, and complications were compared between the two groups. A univariate regression analysis was performed to identify the factors that may affect the postoperative visual outcomes.

RESULTS

Both groups showed significant improvement in mean corrected distance visual acuity (CDVA) six months post-operation (p < 0.001). There was no significant difference in pre-operative characteristics or complications between the two groups. However, the Eyhance ICB00 group showed a significantly higher uncorrected intermediate visual acuity (UCIVA) value at 6 months after surgery than the Tecnis ZCB00 group (p = 0.014). Contrast sensitivity values were not significantly different between the two groups. The univariate regression analysis revealed a significant correlation between preoperative CDVA and minimum linear diameter of MH with postoperative UCIVA in the Eyhance ICB00 group.

CONCLUSIONS

The newly generated Eyhance ICB00 IOL showed promising results in terms of post-operative UCIVA, with no significant difference in complications or contrast sensitivity values compared to the Tecnis ZCB00 IOL. These findings suggest that the Eyhance ICB00 IOL may be a useful option for patients who undergo combined cataract and PPV surgery for idiopathic MH, particularly for those who require intermediate visual acuity.

Improved Intermediate Visual Function with New Monofocal Intraocular Lens in Combined Cataract and Vitrectomy Surgery for Retinal Disease

PURPOSE

To evaluate the usefulness of a newly generated monofocal intraocular lens (IOL) in patients with various retinal diseases who underwent combined cataract and pars plana vitrectomy surgery.

METHODS

This prospective observational study included 33 patients with various retinal diseases. Monocular best-corrected distance visual acuity (BCDVA), uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA), and contrast sensitivity were measured and compared with 40 age-matched patients in the standard monofocal IOL.

RESULTS

The Eyhance IOL group demonstrated significantly better UCIVA at 6 months follow-up compared to the standard monofocal IOL group. No significant differences were observed between the two groups in contrast sensitivity, BCDVA, UCDVA, or UCNVA. The regression analysis showed a significant association between preoperative corrected distance visual acuity and improved UCIVA in the Eyhance IOL group.

CONCLUSIONS

The Eyhance ICB00 IOL proved to be a valuable option for patients with retinal diseases undergoing combined cataract surgery and vitrectomy. It effectively improved intermediate vision without compromising contrast sensitivity or distance visual acuity.

Premium Intraocular Lenses in Glaucoma-A Systematic Review

The incidence of both cataract and glaucoma is increasing globally. With increasing patient expectation and improved technology, premium intraocular lenses (IOLs), including presbyopia-correcting and toric IOLs, are being increasingly implanted today. However, concerns remain regarding the use of premium IOLs, particularly presbyopia-correcting IOLs, in eyes with glaucoma. This systematic review evaluates the use of premium IOLs in glaucoma. A comprehensive search of the MEDLINE database was performed from inception until 1 June 2023. Initial search yielded 1404 records, of which 12 were included in the final review of post-operative outcomes. Studies demonstrated high spectacle independence for distance and good patient satisfaction in glaucomatous eyes, with positive outcomes also in post-operative visual acuity, residual astigmatism, and contrast sensitivity. Considerations in patient selection include anatomical and functional factors, such as the type and severity of glaucomatous visual field defects, glaucoma subtype, presence of ocular surface disease, ocular changes after glaucoma surgery, and the reliability of disease monitoring, all of which may be affected by, or influence, the outcomes of premium IOL implantation in glaucoma patients. Regular reviews on this topic are needed in order to keep up with the rapid advancements in IOL technology and glaucoma surgical treatments.

Enhanced vs conventional monofocal intraocular lens clinical results in patients with cataract: randomized clinical trial

PURPOSE

To compare clinical outcomes between an enhanced and a conventional monofocal intraocular lens (IOL) after cataract surgery.

SETTING

Ophthalmology Unit, Hospital del Salvador, University of Chile (tertiary care hospital).

DESIGN

Double-masked, prospective randomized controlled trial.

METHODS

66 healthy adults with corneal astigmatism less than 1.50 diopters and axial length between 21 and 27 mm were randomly allocated (1:1) for bilateral phacoemulsification with either an enhanced monofocal IOL (ICB00) or a conventional aspheric monofocal IOL (ZCB00) implant. The refractive target was emmetropia in both eyes. Visual acuities, defocus curves, Catquest-9SF, and quality of vision (QoV) were measured 3 months postoperatively.

RESULTS

Binocular uncorrected intermediate visual acuity was improved in patients implanted with the enhanced monofocal lens (0.37 ± 0.12) compared with the conventional monofocal (0.45 ± 0.10) ( P < .01). There were no significant differences in corrected distance visual acuity (CDVA), Catquest-9SF, or QoV scores.

CONCLUSIONS

The enhanced monofocal IOL provided 1 additional line of intermediate visual acuity after cataract surgery. There was no significant change in either CDVA or QoV.

Clinical outcomes with an aspheric monofocal and a new enhanced monofocal intraocular lens with modified optical profile

PURPOSE

This study aimed to evaluate and compare the clinical outcomes obtained after cataract surgery with an aspheric monofocal intraocular lens (IOL) and an enhanced IOL with a modified optical profile.

METHODS

Randomised clinical trial enrolling 70 patients (age, 52-87 years) undergoing cataract surgery. Two groups were created according to the type of IOL implanted: Vivinex iSert from Hoya Surgical Optics (Vivinex group, 35 patients) and Tecnis Eyhance ICB00 from Johnson & Johnson Vision (Eyhance group, 35 patients). Uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), refraction, and self-perceived visual function (Catquest-9SF) were evaluated during a 3-month follow-up.

RESULTS

No significant differences were found between IOL groups in UDVA and CDVA (p ≥ 0.093). In contrast, monocular and binocular UIVA and DCIVA were significantly better in the Eyhance group at 1 (p ≤ 0.015) and 3 months postoperatively (p ≤ 0.002). Postoperative DCIVA 20/25 or better was obtained in 71.4% and 20.0% of patients in Eyhance and Vivinex groups, respectively. Differences in postoperative Rasch calibrated Catquest scores between Eyhance and Vivinex groups did not reach statistical significance (p ≥ 0.102). However, significant correlations were only found between the change in UIVA and Catquest scores (0.364 ≤ r ≤ 0.444, p ≤ 0.041) in the Eyhance group.

CONCLUSIONS

The modified monofocal IOL evaluated provides better intermediate visual function in comparison with a standard aspheric monofocal IOL, but the impact of this benefit on the self-perceived level of vision achieved after surgery according to the patient seemed to be limited.

Comparison of visual performances of enhanced monofocal versus standard monofocal IOLs in a mini-monovision approach

PURPOSE

To compare visual performance and quality of life in patients who received either monofocal intraocular lenses (IOLs) or an enhanced monofocal IOL in a mini-monovision target approach.

BACKGROUND

Monofocal lenses are the most common intraocular IOLs employed during cataract surgery because of their relatively low cost and good performance for distance sight. However, these lenses, generally, do not exonerate patients from spectacle use for near or intermediate tasks. On the other hand, enhanced monofocal IOLs (e.g., Tecnis Eyhance®) feature optical properties providing patients with good intermediate visual outcomes. Satisfactory near visual acuity results, regardless of IOL type, may be achieved through mini-monovision. We assessed visual performance outcomes between these IOLs, in a mini-monovision approach.

METHODS

Retrospective case series of patients who underwent bilateral cataract surgery at our institution with implantation of Alcon SN60WF, J&J Tecnis DCB00 or J&J Tecnis Eyhance® DIB00 with a pre-operative mini-monovision target. The postoperative spherical equivalent was measured by a Nidek® auto-refractometer. Best-uncorrected binocular visual acuity (BUBVA) at far (3 m), intermediate (66 cm), and near (40 cm) distance and binocular contrast sensitivity (100%, 25%, and 5%, all at 1 m) were measured using Snellen and Pelli-Robson charts, respectively. Visual performance in daily life was evaluated with the Cataract VF-14 quality of life survey.

RESULTS

71 patients (35 in the monofocal IOL and 37 enhanced IOL group) were enrolled. Patients implanted with enhanced IOL exhibited statistically significant better BUBVA results at 66 cm and 40 cm distances compared to patients in the monofocal group. Additionally, patients in the enhanced IOL group presented a better contrast sensitivity in lower contrast conditions (5%) than patients with monofocal IOL. The quality of life survey showed statistically significant higher scores in daily activities without spectacles for patients with enhanced IOL.

CONCLUSION

Enhanced monofocal IOLs, combined with a mini-monovision approach, provided patients with good visual performance at all tested distances, with superiority of enhanced monofocal IOLs at near and intermediate distances.

Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population

BACKGROUND

To compare the clinical outcomes of bilateral implantation of enhanced intermediate function intraocular lenses (IOLs) and standard monofocal IOLs.

METHODS

In this prospective, randomized, comparative controlled study, we compared the visual outcomes of patients who underwent bilateral cataract surgery at the Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, with either enhanced monofocal IOLs (Tecnis Eyhance, ICB00, Johnson and Johnson Vision Care, Inc) (Group 1) or standard monofocal IOLs (Tecnis, ZCB00, Johnson and Johnson Vision Care, Inc) (Group 2). The assessment included monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate (UIVA at 60 cm) and near (UNVA at 40 cm) visual acuity, uncorrected defocus curves, contrast sensitivity testing (CST), and reading speed test using Quality of vision was evaluated using the Visual Function Questionnaire (VFQ-25).

RESULTS

At 3-months postoperatively, monocular and binocular outcomes of UIVA and UNVA were statistically significantly better in Group 1 (P < 0.05). The binocular uncorrected defocus curve of Group 1 showed statistically significantly better outcomes at vergence ranges of -1.5 to -4.0 D (P < 0.05). Significantly higher reading speed test was also observed in Group 1 in all ranges tested (1.0 to 0.1 LogMAR) (P < 0.05). There were no statistically significant differences in CST between groups.

CONCLUSIONS

Bilateral implantation of enhanced monofocal IOLs provided better vision at intermediate and near distances compared to standard monofocal IOLs, while maintaining good distance vision and contrast sensitivity.

Positioning of enhanced monofocal intraocular lenses between conventional monofocal and extended depth of focus lenses: a scoping review

BACKGROUND

New intraocular lenses (IOLs) have emerged since the originally coined monofocal and multifocal IOLs. The extended depth of focus (EDoF) and enhanced monofocal IOLs (mono-EDoF) that have appeared in the last decade have caused some confusion in their classification. The aim of this review was to summarize the outcomes provided by mono-EDOF IOLs and to determine which of the endpoints, described by the American National Standard (ANSI) for EDoF IOLs, are fulfilled.

METHODS

The MEDLINE, EMBASE, and WEB OF SCIENCE databases were searched. Two independent reviewers screened the studies for inclusion and data extraction. The search strategy was limited to studies published between 2020 and 2022, but not by language. The results are presented as a narrative summary accompanied by tables, in alignment with the objectives of this scoping review. Compliance with the endpoints for clinical outcomes described in the American National Standard Z80.35-2018 (ANSI) for EDoF lenses was checked and additional endpoints were defined.

RESULTS

Two systematic reviews, 13 laboratory, 21 clinical, and two mixed studies were included. Tecnis Eyhance was the mono-EDOF with the highest volume of evidence to date. Although laboratory studies included other IOLs, clinical evidence for them is still scarce, with only one study of IsoPure compared to a standard monofocal IOL. Evidence in comparison to EDoF lenses is also scarce, even for Tecnis Eyhance, with only three studies including this lens in comparison to an EDoF lens. After evaluation of the ANSI criteria, agreement was found in the failure for the increase in depth of field equal to or greater than 0.5 D for a visual acuity (VA) level of 0.2 logMAR and none of the studies supported that the median monocular VA at intermediate distance was at least 0.2 logMAR.

CONCLUSIONS

Additional clinical evidence is required for other mono-EDOF IOLs beyond Tecnis Eyhance. Until the arrival of a standard classification, mono-EDOF should be better still classified as monofocal because the ANSI standards were not fully met.

Visual outcomes of non-diffractive extended-depth-of-focus and enhanced monofocal intraocular lenses: A case-control study

OBJECTIVE

To compare the visual outcomes of a non-diffractive extended-depth-of-focus (EDoF) intraocular lens (IOL) with an enhanced monofocal IOL.

METHODS

We evaluated 76 eyes from 38 patients who had undergone bilateral cataract surgery with implantation of either an EDoF IOL (AcrySof IQ Vivity, n = 40 eyes) or an enhanced monofocal IOL (Tecnis Eyhance, n = 36 eyes). Objective refraction, monocular and binocular uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and distance-corrected intermediate visual acuity (UIVA, DCIVA), uncorrected and distance-corrected near visual acuity (UNVA, DCNVA), binocular defocus curves, contrast sensitivity, halo and glare perception, and spectacle independence were compared.

RESULTS

Monocular and binocular UDVA, CDVA, UIVA, and DCIVA were comparable in both groups, whereas UNVA and DCNVA were significantly better with the Vivity group than with the Eyhance group. The two groups had no statistically significant difference regarding photopic and scotopic contrast sensitivities or halo and glare perception. Compared to the Eyhance IOL, the Vivity IOL had a larger landing zone in the defocus curve and provided higher spectacle independence for near vision.

CONCLUSION

Both the AcrySof IQ Vivity and Tecnis Eyhance IOLs had excellent distant and intermediate visual acuity, while the former had more satisfactory near vision outcomes with greater spectacle independence rate. No differences were obtained between two IOLs in terms of patient satisfaction and visual disturbances such as halo and glare.

Evaluation of Postoperative Total Ocular Aberrations After Bilateral Implantation of Monofocal IOL with Extended Depth of Focus in Phacoemulsification

Purpose

To evaluate postoperative visual performance and total ocular aberration in cataract patients after implantation of the TECNIS Eyhance™ intraocular lens (IOL).

Methods

Our study is a prospective interventional non-comparative study that was conducted on 34 eyes of 17 patients who underwent phacoemulsification and Eyhance IOL implantation. Postoperative corrected and uncorrected near and far visual acuity and total ocular aberration were assessed 3 months after surgery.

Results

Our study included 34 eyes of 17 patients. At the third postoperative month, the mean spherical equivalent (SE) was -0.32 diopters (D) (SD ±0.62), and the mean distance-corrected near visual acuity (DCNVA) was 0.33 (SD ±0.15) and 0.42 (SD ±0.17) decimal notation (DN) monocular and binocular, respectively. The mean near distance with maximum visual acuity was 79.47 cm (SD ±7.70) and 74.76 cm (SD ±7.90) monocular and binocular, respectively. The mean postoperative minimum reading addition (add) was 1.6 D (SD ±0.47). The mean spherical aberration (SA) was 0.13 µm (SD ±0.09). The correlation of amount of spherical aberration with power of minimum reading add at 40 cm was not statistically significant (p=0.324).

Conclusion

The TECNIS Eyhance IOL provides good intermediate visual acuity and decreases the power of the reading add needed after phacoemulsification.

Improvement of intermediate vision with new monofocal intraocular lenses: A systematic review and meta-analysis

PURPOSE

Monofocal intraocular lenses (IOLs) used in cataract surgery are designed to improve visual acuity (VA). The available evidence of new monofocal IOLs" functional benefits is limited. The aim of this meta-analysis was to analyze the improvement in VA using Tecnis Eyhance monofocal IOLs compared to standard monofocal IOLs Tecnis ZCB00.

METHODS

MEDLINE, Web of Science and Scopus were searched for studies assessing improvement in intermediate VA using Tecnis Eyhance IOLs versus Tecnis ZCB00 IOLs. Studies evaluating post-operative VA in patients who underwent cataract surgery were selected. This meta-analysis followed PRISMA guidelines and was registered in PROSPERO. The Cochrane Risk of Bias Tool 2.0. was used to assess the methodological quality of the included studies, risk of selection bias and comparability of cohorts and outcomes.

RESULTS

The search resulted in 1153 articles. Five studies met the inclusion criteria and were included in the meta-analysis. A total of 604 eyes were evaluated, of which 309 received Tecnis Eyhance IOLs and 295 were implanted with Tecnis ZCB00 IOLs. Mean binocular distant-corrected intermediate VA with Tecnis Eyhance IOLs at 2 weeks-1 month showed a significant difference of -0,21 logMAR, p < 0.001; and mean binocular distance-corrected intermediate VA with Tecnis Eyhance IOLs at 6 months showed a significant difference of -0,11 logMAR, p < 0.001.

CONCLUSION

Near VA could not be assessed in this meta-analysis as it was measured in very few studies. Preliminary pooled evidence indicates that intermediate VA improved with Tecnis Eyhance IOLs. Further studies evaluating near VA and with longer follow-up are still necessary.

Analysis of a novel hydrophobic acrylic enhanced monofocal intraocular lens compared to its standard monofocal type on the optical bench

Introduction

The aim of this laboratory study is to objectively analyze the new hydrophobic, acrylic, enhanced monofocal intraocular lens Acunex Quantum (AN6Q) and compare it with the monofocal platform Acunex AN6. 

Methods

Two IOL models were analyzed (Acunex Quantum AN6Q and Acunex AN6, Teleon Surgical, Spankeren, Netherlands), each having the same refractive power of + 22.0 D, on the optical bench with the OptiSpheric IOL PRO 2. The measurements followed the guidelines of the International Standard Organization with following parameters: ISO 2 cornea (+ 0,28 µ), ISO 11979/2, lens placement in situ in NaCl with 35° temperature, 546 nm and selection of different aperture sizes (3.0 mm vs 4.5 mm). The aberrations of each IOL were evaluated by the WaveMaster IOL 2, a high-resolution Shack-Hartmann sensor in reverse projection setup. An in-situ model eye was used according to ISO 11979 in NaCl (n = 1.337) with 546 nm, mask width 4.51. Zernike polynomials up to 10th order were determined by means of the measured wavefront that describe the optical properties of the IOL.

Results

Through frequency modulation transfer function (mean) at 50 lp/mm (AN6Q/AN6 centered) was 0.687/0.731 (3.0 mm aperture) and 0.400/0.509 (4.5 mm aperture). The SR (mean) was 0.592/0.809 (3.0 mm) and 0.332/0.372 (4.5 mm). The MTF (mean) at 50 lp/mm (AN6Q/AN6 decentered by 1 mm) was 0.413/0.478 (3.0 mm) and 0.257/0.229 (4.5 mm). The SR (mean) was 0.393/0.404 (3.0 mm) and 0.183/0.212 (4.5 mm). The MTF (mean) at 50 lp/mm (AN6Q/AN6 tilted by 5°) was 0.508/0.710 (3.0 mm) and 0.337/0.513 (4.5 mm). The SR (mean) was 0.508/0.760 (3.0 mm) and 0.235/0.2372 (4.5 mm). AN6Q showed MTF peak of 0.55 with an enlarged depth of power of about 2.5 D and two cusps in the MTF curve. The spherical aberration Z 4–0 was about -0.21 µm and the secondary spherical aberration Z 6–0 was about 0.16 µm. No other relevant aberration showed up.

Conclusion

The new, enhanced monofocal AN6Q provides an extended range of focus with only slight decrease in contrast quality. Both types of the hydrophobic, acrylic Acunex IOL platform have its particular advantages in clinical settings and therefore its importance, respectively.

Optical and Clinical Outcomes of an Enhanced Monofocal Intraocular Lens for High Hyperopia

PURPOSE

To evaluate the optical and clinical performance of an enhanced monofocal intraocular lens (IOL) (TECNIS Eyhance ICB00; Johnson & Johnson Vision) in patients with high hyperopia and a short axial length.

METHODS

Power mapping, wavefront analysis, and the through-focus modulation transfer function area (TF-MTFa) were measured in vitro for three IOL powers (10.00, 20.00, and 30.00 diopters [D]). The clinical study included 22 patients with an axial length of less than 22.5 mm. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity and binocular defocus curve were evaluated 6 months postoperatively.

RESULTS

For the three IOL powers, the power mapping revealed an increase in positive power from the periphery to the center of the lens, providing an extra positive correction of 1.00 D for a 2-mm pupil size. The TF-MTFa curves showed only a peak of maximum MTFa at the distance focus. As the pupil size became smaller, there was a focus extension effect, providing an extended depth of focus of up to -1.50 D for a 2-mm pupil size. No significant dependency of the IOL base power on the power profile, wavefront, or optical quality was found. The clinical outcomes showed that all patients achieved a binocular CDVA of 0.1 logMAR or better. The mean visual acuity was better than 0.1 logMAR between +0.50 and -1.50 D of defocus. At a vergence of -2.00 D, the visual acuity was 0.11 ± 0.13 logMAR.

CONCLUSIONS

The monofocal enhanced IOL provided good distance optical and visual quality and optimal visual acuity up to an intermediate-near vision distance of 50 to 40 cm in patients with high hyperopia and a short axial length. [J Refract Surg. 2022;38(9):572-579.].

Enhanced Monofocal Versus Conventional Monofocal Intraocular Lens in Cataract Surgery: A Meta-analysis

PURPOSE

To compare different outcomes of an enhanced monofocal intraocular lens (IOL) versus a conventional monofocal IOL implantation after cataract surgery.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for abstracting data and assessing quality. Comparative studies between enhanced monofocal versus conventional monofocal IOL implantations reporting outcomes in monocular and binocular visual acuities at various distances, spectacle independence, contrast sensitivity, optical quality, and adverse effects were identified from three databases. Meta-analysis, sensitivity analysis, and subgroup analysis were performed.

RESULTS

A total of 680 eyes implanted with an enhanced monofocal IOL (Tecnis Eyhance ICB00; Johnson & Johnson) and 647 eyes with a conventional monofocal IOL from 3 randomized controlled trials and 9 comparative studies were included. The enhanced monofocal IOL showed better monocular uncorrected intermediate visual acuity (UIVA) (mean difference [MD]: -0.11 logMAR; 95% CI: -0.12 to -0.09), binocular UIVA (MD: -0.17 logMAR; 95% CI: -0.23 to -0.11), and binocular uncorrected near visual acuity performance (MD: -0.17 logMAR; 95% CI: -0.29 to -0.04) than the conventional monofocal IOL. More patients were spectacle free at intermediate distance with the enhanced monofocal IOL (odds ratio: 12.9; 95% CI: 6.2 to 27.0). Both monocular (MD: -0.002 logMAR; 95% CI: -0.01 to 0.01) and binocular (MD: 0.01 logMAR; 95% CI: -0.02 to 0.03) uncorrected distance visual acuity revealed non-significant differences between the IOL designs. Contrast sensitivity, photic phenomenon, and adverse effects were comparable.

CONCLUSIONS

Enhanced monofocal IOLs effectively improved unaided intermediate vision with similar distance performance relative to conventional monofocal IOLs. This was achieved without compromising the contrast sensitivity or inducing photic phenomena. [J Refract Surg. 2022;38(8):538-546.].

Monofocal intraocular lens with enhanced intermediate function as substitute for multifocal intraocular lens in positive dysphotopsia

Purpose

To present a case of a 62-year-old patient implanted with multifocal intraocular lenses (IOLs) who underwent a bilateral IOL exchange due to positive dysphotopsia. In an attempt to reduce the symptoms and compensate for the loss of multifocality, we implanted an aspheric monofocal IOL with enhanced intermediate function in one eye and a spherical monofocal IOL in the other eye.

Observations

The patient presented with complaints of halo and glare, measured with a simulator, following the implantation of segmented multifocal IOLs two years earlier. The uncorrected distance visual acuity (UDVA) was 20/20 in both eyes. Before presentation at our clinic, a laser capsulotomy had been performed on the right eye. We proceeded with a bilateral IOL exchange. Because of capsular insufficiency in the right eye, we implanted a spherical monofocal three-piece IOL in the ciliary sulcus with optic capture. In the left eye, we used a monofocal IOL with an enhanced intermediate function. Two weeks postoperatively, UDVA (monocularly) was 20/20 in OD and OS, the uncorrected intermediate visual acuity (UIVA) was 20/32, and the uncorrected near visual acuity (UNVA) was 20/50. Binocularly, UDVA was 20/20, UIVA was 20/25 and UNVA was 20/25. The patient reported a marked decrease in halos and glare.

Conclusions and importance

When planning IOL exchange surgery, in cases of intolerance to multifocal IOLs, the clinician should consider the dilemma of loss of multifocality. Recent developments in monofocal IOL technology present new options to improve visual function in cases of multifocal IOL explantation.

Exploration of the Visual Function after the Implantation of Continuous Visual Range Human Cocrystal Micromonocular Vision in Both Eyes of the Patient

Eye diseases such as myopia, hyperopia, astigmatism, and cataract are have affected most people at home and abroad for many years. With the development of science and technology, people who wear glasses are now younger, and they are on the rise over time. This paper is to explore the visual function after the implantation of continuous visual range human cocrystal micromonocular vision in both eyes of the patient. On this basis, the latest visual sensor technology is used to conduct clinical research on the operation, a case-control study is performed on the patient's eyes, followed by intraocular lens insertion surgery, one eye is hemitrope and the other eye has a certain degree of intraocular lens inserted, and it is recorded within a period of time after the operation. According to the analysis of the experimental results, the patient's naked eye and corrected distance vision is (t = 2.102, P = 0.049), middle distance vision (t = 1.403, P = 0.200), and near vision (t = 1.463, P = 0.216). After the operation, the ratio of patients taking off glasses 91.8%. After the continuous visual range intraocular lens micromonocular vision design, it can well correct the patient's near and far vision of the naked eye of both eyes.

Comparison Between an Intraocular Lens With Extended Depth of Focus (Tecnis Symfony ZXR00) and a New Monofocal Intraocular Lens With Enhanced Intermediate Vision (Tecnis Eyhance ICB00)

PURPOSE

This study compared the extended depth of focus (EDOF) intraocular lens (IOL) (ZXR00; Tecnis Symfony, Johnson & Johnson Vision, Santa Ana, CA, US) to a novel, higher-order aspheric monofocal IOL (ICB00; Tecnis Eyhance, Johnson & Johnson Vision, Santa Ana, CA, US) which uses the same platform and material.

METHODS

Medical records of patients undergoing cataract surgery with ZXR00 or ICB00 implantation between March 2020 and January 2021 and with the data available for the 3-month visit were reviewed. The uncorrected near, intermediate, and distance visual acuity (VA); corrected distance VA; and optical quality parameters were the main outcome measures.

RESULTS

Among the 174 enrolled patients, 72 and 102 received the ZXR00 and ICB00, respectively. The average patient ages were 59.6 ± 10.6 (range: 49 to 70) and 65.2 ± 8.2 (range: 45 to 82) years in the ZXR00 and ICB00 groups, respectively, with significantly older patients in the ICB00 group. The other baseline parameters were not different for the 2 groups. Compared to the ICB00 group, the ZXR00 group showed markedly superior near VA (P < 0.05) at 3 months postoperatively. In terms of optical quality, ICB00 was, statistically, significantly superior to ZXR00.

CONCLUSIONS

The ZXR00 showed remarkable near vision and defocus curve smoothness, while the ICB00 achieved better optical quality. The 2 IOLs had comparable distance and intermediate vision.

Enhanced Monofocal Extended Depth of Focus IOL With a Diffractive Surface Design

PURPOSE

To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new enhanced monofocal extended depth of focus (EDOF) intraocular lens (IOL).

METHODS

Fifty eyes of 25 consecutive patients who underwent implantation of the xact Mono-EDoF IOL (Santen Pharmaceutical Co, Ltd) were enrolled in this study. Main outcome measures were refractive error and monocular corrected (CDVA) and uncorrected (UDVA) distance visual acuity values. Monocular visual acuity at different vergences (defocus curve) was obtained. Patients were evaluated at 12 months postoperatively.

RESULTS

At 1 year of follow-up, all eyes showed a postoperative spherical equivalent within ±1.00 diopters (D) and 95% of eyes within ±0.50 D. The mean postoperative spherical equivalent was -0.15 ± 0.28 D. A total of 88% and 100% of eyes showed UDVA and CDVA of 20/25 or better, respectively. The mean values of UDVA and CDVA (Snellen decimal) were 0.94 ± 0.09 (range: 0.70 to 1.00) and 0.99 ± 0.03 (range: 0.79 to 1.00), respectively. Defocus curve showed good visual acuity at distance and intermediate distances with a depth of focus value of 1.25 D. No visual disturbances were reported in the whole sample during the entire follow-up.

CONCLUSIONS

The current study shows that this EDOF IOL provides good visual performance at far and intermediate distances. The lens may be considered for patients interested in reducing spectacle independence at intermediate distances. [J Refract Surg. 2021;37(9):595-600.].

Analysis of higher order aberrations in recently developed wavefront-shaped IOLs

PURPOSE

A new class of enhanced range of vision intraocular lenses (IOLs) has been introduced recently to cope with compromises of diffractive optics in patients aiming for spectacle independence. Few information is available about their optical function. We aimed to analyze higher order aberrations of four of these new wavefront-shaped IOLs under standardized conditions.

METHODS

Two recently developed enhanced monofocal and two recently developed enhanced depth of focus IOLs (power 22 D) were analyzed by a Shack-Hartmann sensor in an in-situ model eye according to ISO 11,979 in NaCl with 546 nm. We determined the Zernike polynomials up to the 10th order.

RESULTS

Only spherical aberration (SA) of different orders was considerably modified. Whereas RaySof EMV showed a moderate increase in Z 4-0, Eyhance and Vivity produced a considerable increase of negative Z 4-0. A combination of Z 4-0 and Z 6-0 with an opposite sign was found in LuxSmart.

CONCLUSION

SAs of different orders are the only relevant Zernike polynomials in this new class of wavefront-shaped IOLs. RaySof EMV proved to be a monofocal IOL with increased positive SA. The central change in radial power and the resulting increase in negative SA in Eyhance IOL might produce some depth of field. The magnitude of SA modification of Vivity and LuxSmart is expected to extend the depth of focus considerably. Surgeons can select among these novel IOLs depending on corneal asphericity and the patient's wish for spectacle independence.

Clinical Outcomes of New Monofocal Intraocular Lenses with Enhanced Intermediate Function Compared with Extended Depth of Focus Intraocular Lenses

PURPOSE

To compare clinical outcomes of a new monofocal intraocular lens (IOL) with enhanced intermediate function and an extended-depth-of-focus (EDOF) IOL.

SETTING

Asan Medical Center, Seoul, Korea.

DESIGN

Nonrandomized prospective comparative case series.

METHODS

Patients presenting for cataract surgery and meeting all inclusion and exclusion criteria were implanted with new monofocal IOLs with enhanced intermediate function (Tecnis Eyhance ICB00) or EDOF IOLs (Tecnis Symfony ZXR00) bilaterally. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), defocus curves, and contrast sensitivity were compared after 3 months. Patients were administered questionnaires regarding visual symptoms, spectacle independence, overall satisfaction, and lens recommendations.

RESULTS

Twenty-four patients (48 eyes) were enrolled in the Eyhance group and 20 patients (40 eyes) in the Symfony group. Monocular and binocular UDVA, UIVA, and CDVA were similar in the two groups. Monocular UNVA and spectacle independence for near distance were better in the Symfony group, whereas binocular UNVA did not differ significantly in the two groups. Contrast sensitivity, glare and halo, satisfaction, and recommendation rates were similar in the two groups. Although some dissatisfaction and severe glare and halo were reported in the Symfony group, none of these was reported in the Eyhance group.

CONCLUSIONS

Bilateral implantation of the new Eyhance ICB00 IOLs provided comparable clinical performances as bilateral implantation of Symfony ZXR00 IOLs. Binocular UNVA was similar, although spectacle independence was higher in the Symfony group, but this was at the expense of more glare and halos.

Comparative analysis of visual outcome with three intraocular lenses: monofocal, enhanced monofocal, and extended range of vision

PURPOSE

To compare the visual performance, spectacle independence and subjective visual quality of three intraocular lenses (IOLs): monofocal, enhanced monofocal, and extended range of vision.

SETTING

Ophthalmology Department, San Raffaele Scientific Institute, Milan, Italy.

DESIGN

Prospective case series.

METHODS

We included patients without ocular comorbidities and corneal astigmatism <0.75 diopters (D) undergoing cataract surgery with bilateral implantation of: monofocal Tecnis ZCB00, enhanced monofocal Eyhance ICB00, and extended range of vision Symfony ZXR00. Six months postoperatively we analyzed the following parameters: subjective and objective refraction; monocular and binocular corrected distance (4 m) and uncorrected distance visual acuity (UDVA); corrected distance, intermediate (66 cm) and near (40 cm) visual acuity, as well as uncorrected intermediate (UIVA) and uncorrected near (UNVA) visual acuity; photopic contrast sensitivity, binocular defocus curve; halo and glare perception; spectacle independence.

RESULTS

We evaluated 150 eyes of 75 patients (25 patients per IOL group). Monocular and binocular UDVA was excellent in all three groups. Eyhance achieved binocular UIVA similar to that of Symfony, the latter showing the highest binocular UNVA. The defocus curves at -1 D were equivalent for both Eyhance and Symfony, whereas contrast sensitivity was similar in all three groups. The Eyhance spectacle independence score was comparable to Symfony's for intermediate-distance activities, the latter however achieving the worst results for halos and glare.

CONCLUSIONS

Enhanced monofocal Eyhance was not inferior to Symfony as regards intermediate-distance visual outcome and spectacle independence, also providing lower subjective perception of halos and glare.

Visual Performance and Optical Quality after Implantation of a New Generation Monofocal Intraocular Lens

Purpose

To evaluate the performance of two intraocular lenses (IOLs). The new monofocal IOL using a higher-order aspheric optic (Tecnis Eyhance ICB00) was compared to a standard monofocal IOL (Tecnis monofocal ZCB00) of the identical platform and material.

Methods

The medical records of the patients who had undergone cataract surgery with implantation of either the ZCB00 or the ICB00 in the dominant eye from March 2020 to August 2020 and with available data from the 3-month visit were reviewed. Subjects with ocular comorbidities or corneal astigmatism greater than 1.00 diopters were excluded. The uncorrected near, intermediate, distance visual acuity and corrected distance visual acuity were the main outcome measures. Optical quality parameters measured using an optical quality analysis system, clinical records including age, sex, laterality, ocular dominance, and information related to refractory errors was also collected. Parameters related to the refractory errors were all uniformly based on the Barrett Universal II formula.

Results

Of the 197 recruited patients, 111 and 86 were implanted with the ICB00 and ZCB00, respectively. No statistically significant differences in baseline parameters were observed between the two groups. While no statistically significant differences in distance visual acuity or optical quality were found between the two groups, compared to the ZCB00 group, the ICB00 group showed significantly higher intermediate visual acuity (p < 0.001) and near visual acuity (p < 0.05) 3 months postoperatively.

Conclusions

ICB00 provided superior intermediate vision and comparable distance performance and photic phenomena compared to a standard monofocal IOL.