Visual and refractive outcomes in hyperopic pseudophakic patients implanted with the Acri.LISA 366D multifocal intraocular lens

Three Patient-Reported Outcomes Questionnaires in Japanese Patients Undergoing Cataract Surgery with Trifocal IOL Implantation

Purpose

To analyze the patient-reported-outcomes obtained after trifocal intraocular lens (IOL) bilateral implantation in Japanese patients using three different validated questionnaires.

Methods

Fifty-three patients implanted with the FineVision HP IOLs (Beaver-Visitec International, Inc. USA) were enrolled in this prospective-study. At 3-months, refraction (spherical equivalent [SE] and cylinder), logMAR uncorrected distance visual acuity (UDVA), and corrected distance visual acuity (CDVA) were obtained. Specifically, patient-reported-outcomes were evaluated using the NEI VFQ-25, the Catquest-9SF, and the PRSIQ questionnaires.

Results

The mean SE and refractive cylinder were 0.00±0.22D and -0.07±0.23D, respectively. A 98.11% of eyes were within ±0.50D and 100% were within ±1.00D of the SE. A 93.40% of the eyes showed equal or less than 0.50D of astigmatism and 100% of eyes equal or less than 1.00D. The mean value for monocular UDVA was -0.05±0.07 logMAR and the mean value for monocular CDVA was -0.07±0.06 logMAR. 87.74% and 92.45% of the eyes showed 20/20 or better monocular UDVA and CDVA, respectively, with 97.17% and 98.11% showing 20/25 or better for UDVA and CDVA, respectively. The NEI VFQ-25 outcomes showed very high scores across all categories, with mean general vision, distance and near activities values of 86.70±6.35, 96.23±7.72 and 92.14±10.74, respectively. The outcomes for the Catquest-9SF questionnaire showed that 90.57% of patients did not report difficulty in their everyday-life with their sight, and 100% of them were "very or quite satisfied" with their sight at present. The PRSIQ outcomes revealed that 100%, 98.11% and 98.11% of patients did not need glasses or contacts for far, intermediate and near vision, respectively.

Conclusion

The results of the patient-reported-outcomes questionnaires indicated that patients implanted bilaterally with the FineVision HP IOL have high vision and health related quality-of-life scores, with a high spectacle independence rate and high patient satisfaction.

Refractive lens exchange: What are the red lines?

Practical advancements in phacoemulsification techniques and intraocular lenses and the wide availability of phacoemulsification machines have led refractive lens exchange (RLE) to increase in popularity. Ethical boundaries in RLE have subsequently been pushed to include patients at higher risk of complications. In this editorial, we consider RLE outcomes and complications per type of refractive error, together with preoperative, intraoperative and postoperative ethical obligations for refractive surgeons. In the conclusions section, we propose an algorithm for ethics-guided indications to RLE.

Recommendation for Presbyopia-Correcting Intraocular Lenses: A Delphi Consensus Statement by the ESASO Study Group

PURPOSE

To establish consensus among experts in lens and refractive surgery to guide general ophthalmologists on issues related to presbyopia-correcting intraocular lenses (IOLs).

DESIGN

A modified Delphi method to reach a consensus among experts.

METHODS

A steering committee formulated 105 relevant items grouped into four sections (preoperative considerations, IOL selection, intraoperative considerations, and postoperative considerations). The consensus was defined as ≥ 70% of experts agreeing with the evaluation of a statement.

RESULTS

Ten experts participated and completed all rounds of questionnaires (100% response rate). Of 68 items considered in the preoperative considerations, consensus was achieved in 48 (70.6%). There was a lack of consensus over IOL selection, the experts only agreed on the importance of the patient's habits for the optical IOL design selection. Of the 14 considerations related to intraoperative issues, the experts reached a consensus on 10 (71.4%). The postoperative considerations section reached the highest consensus in 10 items of 13 (76.9%).

CONCLUSIONS

Key recommendations for a diffractive multifocal IOL were a potential postoperative visual acuity > 0.5, a keratometry between 40-45 diopters, a pupil >2.8 mm under photopic conditions and <6.0 mm under scotopic conditions, a root mean square of higher order corneal aberrations <0.5 µm for 6-mm pupil size, while monofocal or non-diffractive IOLs should be considered for patients with coexisting eye disorders. A lack of agreement was found in the issues related to the IOL selection.

FS-LASIK for the treatment of moderate-to-high hyperopia

PURPOSE

To report modern outcomes of femtosecond laser-assisted cataract surgery (FS-LASIK) for the correction of moderate-to-high hyperopia (≥3.50 diopters [D] and ≤6.50 D), excluding low or very high hyperopia.

SETTING

Vissum, Alicante, Spain.

DESIGN

Monocentric retrospective case series study.

METHODS

Visumax-500 kHz femtosecond laser and Amaris-750 excimer-laser were used. Eyes with at least 6 months of follow-up were included. 36-month data was collected when available. Primary outcome measure was short term efficacy and safety. Secondary outcome measure was long term stability.

RESULTS

6-month data of 92 eyes was collected (68 eyes at 36 months). Mean age was 34.6 ± 10.4 years. Mean treated sphere was 4.69 ± 0.87. Efficacy index was 0.91 and 0.90 at 6 months and 36 months respectively. Safety index was 1.00. Uncorrected distance visual acuity was 20/20 or better in 72%, postoperative spherical equivalent within 0.5 D in 80% (93% within 1 D), and loss of 1 line of corrected distance visual acuity (CDVA) occurred in 13% (2 or more lines in 0%). Gain of 1 or more CDVA lines occurred in 17%. A slight but significant regression was observed at 36 months. Postoperatively, 21.73% required flap lift for laser enhancement, and 11.95% an orthoptic visual rehabilitation due to accommodative disorders.

CONCLUSIONS

Modern LASIK provides good efficacy and safety levels for the management of moderate to high hyperopia (up to +6.5 D), with levels close to those previously reported with refractive lens exchange for young hyperopia patients without presbyopia, where we defend the maintenance of LASIK as first line therapy. Risk of requiring a refractive enhancement or an orthoptic visual rehabilitation remains relevant and needs to be discussed with patients preoperatively.

Ten-year outcomes of pseudophakic mini-monovision correction of hyperopic presbyopia

PURPOSE

To evaluate long-term efficacy, safety, and spectacle independence after the treatment of hyperopic presbyopia with pseudophakic mini-monovision using standard monofocal intraocular lenses (IOLs) after bilateral cataract surgery.

SETTING

Private practice in Barcelona, Spain.

DESIGN

Retrospective, noncomparative case series.

METHODS

Patients with hyperopic presbyopia underwent bilateral cataract surgery with pseudophakic mini-monovision using standard monofocal IOLs between 2008 and 2018. Main outcomes analyzed were uncorrected distance visual acuity (UDVA), uncorrected near distance visual acuity (UNVA), and rates of spectacle independence at postoperative day 1 (POD1), months 1, 6 and 12, and at 5 and 10 years (Y10) postoperatively.

RESULTS

The study enrolled 463 patients. Both UDVA and UNVA significantly improved postoperatively ( P < .05). The mean binocular UDVA improved from 0.47 ± 0.3 logMAR preoperatively to 0.096 ± 0.14 at POD1 to 0.16 ± 0.2 at Y10 ( P = .0033). The binocular UNVA was 0.05 logMAR at Y10, whereas in preoperative visits, all patients needed spectacles. The mean UDVA for the dominant eye ≤0.20 logMAR was achieved in 84.29% at the Y10. Self-reported and measured complete spectacle independence for near vision was achieved in 79.61% of patients at POD1 and 71.92% at Y10 postoperatively. For distance, respectively, in 86.29% of patients at POD1 and 78.43% at Y10. The achieved results were stable. No serious events were reported, as well as no photic phenomena.

CONCLUSIONS

Pseudophakic mini-monovision in hyperopic presbyopes is a safe, effective, and low-cost approach for the long-term correction of presbyopia. It significantly reduces spectacle dependence and fulfils patients' expectations after bilateral cataract surgery.

Bilateral Refractive Lens Exchange With Trifocal Intraocular Lens for Hyperopia in Patients Younger Than 40 Years: A Case-Control Study

PURPOSE

To evaluate visual outcomes, satisfaction, and spectacle independence in non-presbyopic hyperopic patients who underwent bilateral refractive lens exchange with a trifocal intraocular lens (IOL) and to compare them with presbyopic hyperopic patients.

METHODS

In this retrospective study, patients younger than 40 years underwent bilateral refractive lens exchange with a diffractive trifocal IOL (FineVision Micro F; PhysIOL SA) for hyperopia with at least 3 months of follow-up. A control group of patients older than 50 years was matched by axial length, sex, and follow-up. Safety, efficacy, predictability, patient satisfaction, and spectacle independence were evaluated.

RESULTS

One hundred thirty-three patients (average age = 36.94 ± 2.91 years; range = 21.50 to 40 years) were included in this study. After a mean follow-up of 8.83 ± 5.69 months (range = 2.75 to 77.63 months), the safety and efficacy indexes and predictability within ±1.00 diopters (D) were 1.02%, 0.98%, and 99.62%, respectively, which was not different from the control group (P > .05). No intraoperative complications were recorded. The only postoperative complication was posterior capsule opacification in 21 eyes (7.89%), which was similar to the control group (P > .05). Ninety-seven percent of patients in each group expressed that they were satisfied and all of them in each group reported that they did not use spectacles for distance, intermediate, or near vision.

CONCLUSIONS

Refractive lens exchange and trifocal IOL implantation for hyperopia in patients without presbyopia provided the same good visual outcomes as in presbyopic patients with a high rate of patient satisfaction and spectacle independence. [J Refract Surg. 2021;37(8):524-531.].

Visual And Refractive Outcomes In Hyperopic Pseudophakic Patients Implanted With A Trifocal Intraocular Lens

Purpose

To assess visual and refractive results after bilateral implantation of a trifocal intraocular lens (IOL) in patients with hyperopia.

Methods

In a retrospective nonrandomized study, 196 eyes of 98 patients had bilateral implantation of a trifocal IOL. The Barrett Universal II formula was used for IOL power calculation. Eyes were divided into two groups for their analysis: low-moderate, with IOL power ranging from 22 to 26 D, and high, with IOL power ranging from 25 to 34 D. Refractive error was used to assess predictability, and corrected distance visual acuity (CDVA) and uncorrected distance visual acuity values were used to assess efficacy and safety of the surgery.

Results

Six months postoperatively, our results revealed a Snellen decimal CDVA of 0.97±0.05 and 0.94±0.09, for the low-moderate and high groups, respectively. The low-moderate hyperopia group showed a 75.23% of eyes with 20/20 of CDVA and 100% of eyes with 20/25 of CDVA, and the high hyperopia group showed 60.95% and 94.29% for these values of visual acuity, respectively. The mean postoperative spherical equivalent was -0.25±0.36D and -0.24±0.42D for low-moderate and high hyperopia groups, respectively. In the case of low-moderate hyperopia group, 81% of eyes were within ±0.50D and 99% within ±1.00D. These values were 78% and 95%, respectively, for the high hyperopic eyes.

Conclusion

Bilateral implantation of a trifocal IOL in hyperopic eyes provided good visual and refractive outcomes. The Barrett Universal II formula was accurate in predicting the IOL power in hyperopic eyes.

Light-distortion analysis as a possible indicator of visual quality after refractive lens exchange with diffractive multifocal intraocular lenses

PURPOSE

To study the perception of light distortion after refractive lens exchange (RLE) with diffractive multifocal intraocular lenses (IOLs).

SETTING

Clínica Oftalmológica das Antas, Porto, Portugal.

DESIGN

Retrospective comparative study.

METHODS

Refractive lens exchange was performed with implantation of an AT Lisa 839M (trifocal) or 909MP (bifocal toric) IOL, the latter if corneal astigmatism was more than 0.75 diopter (D). The postoperative visual and refractive outcomes were evaluated. A prototype light-distortion analyzer was used to quantify the postoperative light-distortion indices. A control group of eyes in which a Tecnis ZCB00 1-piece monofocal IOL was implanted had the same examinations.

RESULTS

A trifocal or bifocal toric IOL was implanted in 66 eyes. The control IOL was implanted in 18 eyes. All 3 groups obtained a significant improvement in uncorrected distance visual acuity (UDVA) (P < .001) and corrected distance visual acuity (CDVA) (P = .001). The mean uncorrected near visual acuity (UNVA) was 0.123 logMAR with the trifocal IOL and 0.130 logMAR with the bifocal toric IOL. The residual refractive cylinder was less than 1.00 D in 86.7% of cases with the toric IOL. The mean light-distortion index was significantly higher in the multifocal IOL groups than in the monofocal group (P < .001), although no correlation was found between the light-distortion index and CDVA.

CONCLUSIONS

The multifocal IOLs provided excellent UDVA and functional UNVA despite increased light-distortion indices. The light-distortion analyzer reliably quantified a subjective component of vision distinct from visual acuity; it may become a useful adjunct in the evaluation of visual quality obtained with multifocal IOLs.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Multifocal intraocular lens explantation: a case series of 50 eyes

OBJECTIVE

To assess the visual complaints, reasons, and patient satisfaction for multifocal intraocular lens (IOL) explantation.

DESIGN

Retrospective observational case series.

METHODS

This study evaluated 50 eyes of 37 patients who underwent multifocal IOL explantation followed by IOL implantation. Before and 3 months after IOL exchange surgery, we investigated the symptoms, reasons, patient demographics, clinical results, and patient satisfaction in eyes undergoing multifocal IOL explantation. Data collected included preoperative subjective and objective findings, reasons, IOL type, postoperative course, and patient satisfaction.

RESULTS

The most common complaints for IOL explantation were waxy vision, followed by glare and halos, blurred vision at far, dysphotopsia, blurred vision at near, and blurred vision at intermediate. The most common reasons for IOL explantation were decreased contrast sensitivity, followed by photic phenomenon, unknown origin including neuroadaptation failure, incorrect IOL power, preoperative excessive expectation, IOL dislocation/decentration, and anisometropia. The axial length was 25.13±1.83 mm. Of the explanted multifocal IOLs, 84% were diffractive and 16% were refractive. Monofocal IOLs accounted for 90% of the exchanged IOLs. Patient satisfaction was significantly improved from 1.22±0.55 preoperatively to 3.78±0.97 postoperatively, which was graded on a scale of 1 (very dissatisfied) to 5 (very satisfied) (Wilcoxon signed-rank test, P<.001).

CONCLUSIONS

Multifocal IOL explantation was required in some patients undergoing multifocal IOL implantation. IOL exchange surgery appears to be a feasible surgical option for dissatisfied patients with persistent visual symptoms after multifocal IOL implantation.

Visual performance of a multifocal toric soft contact lens

PURPOSE

To evaluate the visual performance of the Proclear multifocal toric contact lens (CL; CooperVision, US) for both presbyopia and astigmatism correction.

METHODS

In this crossover study design, 20 presbyopic subjects with astigmatism were fitted in a random order with either Proclear multifocal toric CL or Proclear toric single vision distance CL (DCL) combined with reading spectacles. After 1 month, high-contrast distance visual acuity, near high-contrast visual acuity, distance contrast sensitivity (CS) under photopic and mesopic conditions without and with glare, near CS, defocus curve, and stereopsis were measured. Subjects were then refitted with the alternative correction, and the procedure was repeated.

RESULTS

Repeated measures analysis of variance revealed differences in visual acuity and CS (p < 0.001) between groups. Mean binocular distance visual acuity and near visual acuity obtained with multifocal toric CL were -0.01 ± 0.03 logMAR and -0.04 ± 0.06 logMAR, respectively. The mean distance CS with the multifocal toric CL was within normal limits under photopic and mesopic conditions. Under photopic conditions, distant CS was better with distance CL than with multifocal toric CL only at 18 cycles/degree. Under mesopic conditions without and with glare, there were differences between both CLs in distant CS for all spatial frequencies. There were differences between the two CLs in near CS for all spatial frequencies. Mean values of stereopsis obtained with multifocal toric CLs and with the DCL combined with reading glasses were 62 ± 12 sec of arc and 59 ± 12 sec of arc, respectively (p = 0.06). Near range of clear vision with the multifocal toric CLs was 1.55 ± 0.33D.

CONCLUSIONS

The results of this study suggest that the multifocal toric CL studied is a good option to compensate both presbyopia and astigmatism, providing an optimal distance and near visual quality without compromising the stereopsis.

Effect of multizone refractive multifocal contact lenses on standard automated perimetry

PURPOSE

The aim of this study was to evaluate whether the creation of 2 foci (distance and near) provided by multizone refractive multifocal contact lenses (CLs) for presbyopia correction affects the measurements on Humphreys 24-2 Swedish interactive threshold algorithm (SITA) standard automated perimetry (SAP).

METHODS

In this crossover study, 30 subjects were fitted in random order with either a multifocal CL or a monofocal CL. After 1 month, a Humphrey 24-2 SITA standard strategy was performed. The visual field global indices (the mean deviation [MD] and pattern standard deviation [PSD]), reliability indices, test duration, and number of depressed points deviating at P<5%, P<2%, P<1%, and P<0.5% on pattern deviation probability plots were determined and compared between multifocal and monofocal CLs.

RESULTS

Thirty eyes of 30 subjects were included in this study. There were no statistically significant differences in reliability indices or test duration. There was a statistically significant reduction in the MD with the multifocal CL compared with monfocal CL (P=0.001). Differences were not found in PSD nor in the number of depressed points deviating at P<5%, P<2%, P<1%, and P<0.5% in the pattern deviation probability maps studied.

CONCLUSIONS

The results of this study suggest that the multizone refractive lens produces a generalized depression in threshold sensitivity as measured by the Humphreys 24-2 SITA SAP.

Visual and optical performance with hybrid multifocal intraocular lenses

During the past years, the wish to become independent of spectacles has been growing among cataract and presbyopic patients due to many factors, such as the increase in near visual demands, the aesthetic need for a spectacle-free image and ageing of refractive surgery patients, among others. This review assesses recently published studies that analyse visual and optical performance through different metrics of eyes implanted with multifocal intraocular lenses (IOLs), particularly hybrid IOL designs. The published evidence suggests that hybrid multifocal IOLs provide very good outcomes in a number of visual and optical performance parameters. Patients implanted with this type of IOL obtain a satisfactory full range of visual functions, including patients of particular characteristics such as highly ametropic or post-LASIK.