Clinical outcome comparison: bilateral trifocal vs. mix-match extended depth of focus and trifocal intraocular lenses

Customizing Clinical Outcomes with Implantation of Two Diffractive Trifocal IOLs of Identical Design but Differing Light Distributions to the Far, Intermediate and Near Foci

Purpose

To evaluate clinical outcomes after bilateral or contralateral implantation of the Gemetric™ (G) and Gemetric™ Plus (GPlus) diffractive trifocal intraocular lenses (IOLs).

Methods

This was a prospective, randomized, multi-center open-label study comparing clinical results and subjective patient responses around 6 months after implantation of the study lenses (toric and non-toric) in three different groups (bilateral G, bilateral GPlus and contralateral G/GPlus implantation). Results included the manifest refraction, uncorrected and distance corrected monocular and binocular visual acuity (VA) at distance, intermediate and near; the defocus curve; contrast sensitivity; and patient reported outcomes regarding spectacle independence, satisfaction and visual disturbances.

Results

There was no statistically significant difference in the mean refraction spherical equivalent between the two lens models (p = 0.33) or between the toric and non-toric lenses (p = 0.06). Monocular VA was better at distance with the G lens and better at near with the GPlus lens (p < 0.01). Mean binocular VA was better than 0.1 logMAR at all distances for all groups, both uncorrected and distance corrected. The mean binocular distance corrected VA was better than 0.15 logMAR from 0.0 D to -3.50 D for all groups. All VA data for the contralateral group was as good or better than for the bilateral GPlus group. Questionnaire results showed no difference between groups for the frequency, severity, or degree of bother of visual disturbances (p > 0.24).

Conclusion

The two diffractive trifocal IOLs studied here may be used either bilaterally or contralaterally for the correction of presbyopia in cataract patients, providing excellent visual acuity with low levels of visual disturbances and high rates of overall spectacle independence. Bilateral Gemetric implantation resulted in slightly better distance and intermediate vision while contralateral implantation provided slightly better near vision. There was no apparent advantage to implanting the GPlus IOL bilaterally.

Long-term Results after Bilateral Implantation of Extended Depth of Focus Intraocular Lenses with Mini-Monovision

PURPOSE

To assess long-term clinical results following bilateral Tecnis Symfony ZXR00 intraocular lens implantation with mini-monovision.

METHODS

The medical records of cataract patients who underwent bilateral implantation of ZXR00 with intended mini-monovision (target refraction of -0.3 diopters [D] in dominant eye and -0.6 D in nondominant eye) between April 2019 and March 2021 were assessed. Postoperative uncorrected distance visual acuity (UDVA), corrected distance VA (CDVA), uncorrected intermediate VA (UIVA), uncorrected near VA (UNVA), and rate of spectacle dependence for near distance were investigated at 3 months and 2 years after surgery.

RESULTS

This study included 61 patients (122 eyes) with average age of 61.8 ± 7.7 years. At 2 years postoperatively, binocular logarithm of the minimum angle of resolution UDVA, UIVA, UNVA, and CDVA were 0.086 ± 0.094, 0.056 ± 0.041, 0.140 ± 0.045, and 0.012 ± 0.024, respectively. The monocular manifest refraction spherical equivalent was -0.31 ± 0.38 in the dominant eye and -0.53 ± 0.47 in the nondominant eye at 3 months postoperatively, and -0.38 ± 0.43 in the dominant eye and -0.61 ± 0.54 in the nondominant eye at 2 years postoperatively. Eight out of 61 patients (13.1%) needed glasses 3 months after surgery, and nine out of 61 patients (14.8%) needed glasses 2 years after surgery.

CONCLUSIONS

The bilateral implantation of ZXR00s with mini-monovision allows for a good VA at wide range of distance from far to near, thereby resulting in high rate of spectacle independence. These results have held up well even after 2 years after surgery.

Comparison of visual outcomes of bilateral dual-technology diffractive intraocular lens vs blended enhanced monofocal with dual-technology intraocular lens

PURPOSE

To compare clinical outcomes after implantation of TECNIS Synergy (ZFR00V) intraocular lenses (IOLs) in both eyes and implantation of the TECNIS Synergy and TECNIS Eyhance (ICB00) combination in patients undergoing cataract surgery.

SETTING

Department of Cataract, Hospital Oftalmológico de Brasilia (HOB), Brasília, Brazil.

DESIGN

Prospective, interventional, randomized, parallel-group study.

METHODS

Patients were categorized into 2 groups: Group 1: ZFR00V IOL was implanted in both eyes. Group 2: An ICB00 IOL was implanted in the dominant eye, and a ZFR00V IOL was implanted in the nondominant eye.

RESULTS

Visual acuity was similar between the 2 groups (95% CI <0.1 logMAR). A superior visual acuity of ≥ 20/25 (at -2.00 to -2.50 diopters [D]) was achieved in Group 1 (bilateral ZFR00V) than in Group 2 (combination of ZFR00V/ICB00). The binocular defocus curve demonstrated better visual acuity at 40 cm (-2.00 D) and 50 cm (-2.50 D) in Group 1 than in Group 2 ( P < .05). Similar contrast sensitivity values were observed between the 2 groups. Patients in Group 1 reported higher satisfaction (completely satisfied) than those in Group 2 ( P < .05). However, halos and glare were more pronounced in Group 1 than in Group 2 ( P < .05).

CONCLUSIONS

Both presbyopia-correcting IOL combinations showed similar binocular visual acuity results. Group 1 demonstrated enhanced visual acuity in the defocus curve at 40 cm (-2.00 D) and 50 cm (-2.50 D). Comparable contrast sensitivity outcomes were observed in both groups. Patients were more completely satisfied in Group 1 than in Group 2, despite the higher frequency of postoperative nighttime halos and glare.

Visual performance and patient preference with bilateral implantation of an extended depth of focus or combined implantation of an extended depth of focus/trifocal intraocular lens

PURPOSE

Evaluate postoperative visual performance in patients with bilaterally implanted AT LARA or AT LARA/AT LISA tri (Carl Zeiss AG, Jena, Germany) intraocular lenses.

METHODS

Multicentered, comparative, open-label, retrospective/prospective study. Post-IOL implantation, patients were prospectively enrolled into this study; preoperative patient data were collected retrospectively. Follow-up was at 2-4 and 5-8 months post-surgery. The primary endpoint was binocular best corrected distance visual acuity (CDVA). The study was retrospectively registered on clinicaltrials.gov (#NCT05462067).

RESULTS

Seventy-one patients (142 eyes) were enrolled; 67 patients (134 eyes) have 5-8 months data. The mean binocular CDVA at 2-4 months was -0.10 ± 0.06 logMAR in the bilateral AT LARA group ("bilateral") and -0.11 ± 0.09 logMAR in the combined implantation AT LARA/ AT LISA tri group ("combined implantation"); (P = 0.4856). At 5-8 months, mean binocular CDVA was -0.13 ± 0.06 logMAR in the bilateral group and -0.11 ± 0.09 in the combined implantation group (P = 0.4003). At 5-8 months, more eyes in the bilateral group attained 0.2 logMAR or better binocular uncorrected intermediate VA (UIVA; 67 cm) than those in the combined implantation group (100% vs. 94%, respectively). The bilateral group achieved a mean of 0.24 ± 0.11 logMAR in uncorrected near VA (UCNVA), compared to a mean of 0.16 ± 0.12 logMAR in the combined implantation group at 5-8 months (P = 0.0041).

CONCLUSIONS

A combined implantation approach (AT LARA in the distance dominant eye/AT LISA tri in the non-dominant eye) produced similar CDVA outcomes but better UCNVA as bilateral implantation with the AT LARA. UIVA was comparable between groups. No new safety concerns were reported.

Comparison of bilateral implantation of an extended depth of focus lenses and a blend approach of extended depth of focus lenses and bifocal lenses in cataract patients

BACKGROUND

To compare the visual outcomes, spectacle independent rate and stereopsis in patients who underwent bilateral implantation of extended depth of focus (EDOF) intraocular lens (IOL), or a blend approach of EDOF and bifocal IOL.

METHODS

A total of 60 cataract patients, who were scheduled for phacoemulsification and intraocular lens implantation in both eyes in West China Hospital of Sichuan University, were enrolled and divided into Micro monovision group(-0.5D~-1.0D), Non-micro monovision group (< 0.5D) with Symfony IOL, and Mixed group with Symfony and ZMB00 IOLs. Three months postoperatively, we compared the visual acuity, modulation transfer function (MTF), defocus curve, stereopsis, spectacle independence, and photic phenomena among the three groups.

RESULTS

Compared to the Non-micro monovision group (UNVA: 0.07 ± 0.04), Micro monovision group (UNVA: 0.00 ± 0.07, P < 0.001) and Mixed group (UNVA: -0.02 ± 0.06, P < 0.001) showed improvement in binocular uncorrected near visual acuity (UNVA). Additionally, Mixed group exhibited lower MTF10 (MTF10: 0.38 ± 0.24) and point spread function (PSF: 0.192 ± 0.269) results in their non-dominant eye compared to both Micro monovision group (MTF10: 0.56 ± 0.21, P = 0.027; PSF: 0.417 ± 0.282, P = 0.034) and Non-micro monovision group (MTF10: 0.55 ± 0.19, P = 0.038; PSF: 0.408 ± 0.285, P = 0.003). Spectacle independence for near vision were higher in both the Micro monovision (45%) and Mixed (55%) group compared to the Non-micro monovision group (40%). The Mixed group also reported higher incidence of photic phenomena (25%). However, there were no significant differences in stereoscopic function among the three groups.

CONCLUSION

Both micro monovision and mix-and-match methods can help patients to obtain better visual outcomes at different distances. Mix-and-match method has better near visual acuity, while micro monovision method has better intermediate visual acuity. Non-micro monovision methods will affect patients' near vision outcomes. Binocularly implanted EDOF IOL has better contrast sensitivity.

CLINICAL TRIAL REGISTRATION

Registration date:11/07/2023.

TRIAL REGISTRATION NUMBER

ChiCTR2300073433.

TRIAL REGISTRY

West China Hospital of Sichuan University retrospectively registered.

Visual performance and subjective experience 3 months and 12 months after combined implantation of 2 new complementary continuous phase multifocal intraocular lenses

PURPOSE

To assess the 3-month and 12-month postoperative visual performance and subjective quality of vision (QoV) after combined implantation of complementary continuous phase multifocal intraocular lenses (IOLs).

SETTING

Private practice, United Kingdom.

DESIGN

Case series.

METHODS

The study enrolled 44 patients undergoing phacoemulsification with implantation of an Artis Symbiose Mid in the dominant eye and an Artis Symbiose Plus in the nondominant eye. Refraction, uncorrected distance visual acuity (UDVA), corrected distance visual acuity, uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), electronic reading desk, and a QoV questionnaire were evaluated at 3 months and 12 months postoperatively.

RESULTS

The mean binocular UDVA was -0.06 ± 0.08 logMAR and -0.07 ± 0.06 logMAR at 3 months and 12 months ( P = .097), respectively. The mean binocular UIVA was 0.03 ± 0.13 logMAR and 0.03 ± 0.10 logMAR ( P = 1.0), respectively. The mean binocular UNVA was 0.07 ± 0.10 logMAR and 0.07 ± 0.08 logMAR ( P = .875), respectively. There was a significant improvement in QoV for both day and night between 3 and 12 months, with a significant reduction in halos at 12 months. Spectacle independence was reported in 93.2% of cases at 12 months.

CONCLUSIONS

The Artis Symbiose Mid and Plus IOL combined implantation provided an excellent range of uncorrected vision at 3 and 12 months. There was a significant improvement in QoV and less halos at 12 months. This IOL combination provided very high rates of complete spectacle independence.

Comparisons of visual outcomes between bilateral implantation and mix-and-match implantation of three types intraocular lenses

PURPOSE

To compare binocular static visual acuity (SVA), stereopsis, contrast sensitivity (CS) and dynamic visual acuity (DVA) of 5 combinations of bifocal intraocular lenses (IOLs), trifocal IOLs and extended-depth-of-focus (EDOF) IOLs in age-related cataract patients.

METHODS

Two hundred and ninety-two eyes of 146 patients who underwent cataract surgery in the ophthalmology department of the First Affiliated Hospital of Chongqing Medical University were involved. Subgroups included group MM (33patients, bilaterally bifocal IOL, ZMB00), group TT (31patients, bilaterally trifocal IOL, AT LISA tri839MP), group XX (34patients, bilaterally EDOF IOL, ZXR00), group MX (25patients, bifocal IOL, ZMB00 + EDOF IOL, ZXR00) and group TX (23patients, trifocal IOL, AT LISA tri839MP + EDOF IOL, ZXR00). The uncorrected SVAs (UDVA, UIVA and UNVA), uncorrected DVAs (UDDVA, UIDVA and UNDVA), near and distance stereopsis, and CS were assessed 3 months postoperatively.

RESULTS

Subgroups of TT, XX, MX and TX showed better UIVA than MM (bP = 0.039, 0.021, 0.035 and 0.037, respectively). MX showed better UNVA than MM and TX (bP = 0.031 and 0.013, respectively). MX group had the optimal outcomes of both near and distance stereopsis. In the UDDVA, XX group and MX group showed better outcomes than TX group at 24 fps (frames per second) (bP = 0.019 and 0.023, respectively). XX group and MX group showed optimal outcomes at all speeds of UIDVA (P = 0.001, 0.005, 0.003 and 0.005, respectively). As the speed increased, the XX group and the MX group showed better UNDVA than the MM group and the TT group (P = 0.019, 0.002 and 0.003, respectively).

CONCLUSIONS

Mix-and-match implantation of bifocal IOLs and EDOF IOLs provides excellent and stable binocular visual outcomes including SVA, stereopsis and DVA in distant and near distances.