Unilateral Versus Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in Emmetropic Presbyopic Patients

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in 5,226 Patients With Presbyopia

PURPOSE

To assess visual and refractive outcomes and visual function after bilateral RayOne Trifocal toric and nontoric intraocular lens (IOL) (Rayner) implantation in patients with presbyopia.

METHODS

Charts of patients with presbyopia who underwent refractive lens exchange with bilateral implantation of the RayOne Trifocal IOL (toric and non-toric) were retrospectively reviewed. Visual and refractive outcomes were evaluated at 3 months. Patient satisfaction, spectacle independence, and visual disturbance profile were assessed by questionnaires.

RESULTS

A total of 5,226 patients were assigned to one of two groups: 1,010 patients had toric IOL implantation (toric group) and 4,216 patients received the non-toric model (non-toric group). Mean ± standard deviation visual acuity at 3 months for the toric group was binocular uncorrected distance visual acuity (UDVA) of 0.07 ± 0.11 logMAR, monocular corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR, binocular uncorrected near visual acuity (UNVA) at 40 cm of 0.10 ± 0.09 logMAR, binocular uncorrected intermediate visual acuity (UIVA) at 40 cm of 0.13 ± 0.12 logMAR, postoperative spherical equivalent (SE) of -0.21 ± 0.47 diopters (D), and cylinder of -0.34 ± 0.40 D. The non-toric group had binocular UDVA of 0.04 ± 0.08 logMAR, monocular CDVA of 0.05 ± 0.07 logMAR, binocular UNVA of 0.10 ± 0.08 logMAR, binocular UIVA of 0.13 ± 0.11 logMAR, SE of -0.08 ± 0.38 D, and cylinder of -0.28 ± 0.34 D. No statistically significant differences were found in achieving spectacle independence and there were high levels of satisfaction in both groups.

CONCLUSIONS

In this retrospective analysis with more than 5,000 patients, both the toric and non-toric RayOne Trifocal IOL models provided good visual performance at all distances, resulting in excellent levels of spectacle independence and patient satisfaction. [J Refract Surg. 2024;40(7):e468-e479.].

Phacoemulsification with implantation of a trifocal intraocular lens in eyes with asteroid hyalosis and synchysis scintillans

PURPOSE

To compare the visual outcomes in both eyes of patients who undergo phacoemulsification and trifocal intraocular lens (IOL) implantation and have asteroid hyalosis (AH) or synchysis scintillans (SS) in only one eye.

METHODS

A retrospective comparative case series was performed. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction after implantation of the same model of trifocal IOL in both eyes (PhysIOL FineVision Pod-F and Micro-F and Rayner RayOne Trifocal).

RESULTS

A total of 164 eyes of 82 patients (41 females, 50%) met the inclusion criteria. There were no statistically significant differences in sphere, cylinder, spherical equivalent, UDVA, UIVA, or UNVA between the groups. Postoperative CDVA was slightly better in the control group (logMAR 0.03) than in the AH/SS group (logMAR 0.04) (P: 0.014). There were no statistically significant differences in predictability, safety index, or efficacy index between the groups. Overall subjective satisfaction was good (98.2%).

CONCLUSIONS

Visual outcomes and satisfaction are good after implantation of trifocal IOLs in eyes with AH or SS. Therefore, trifocal IOLs should not be ruled out in these patients when no other vitreoretinal disorder is present.

Bilateral Femtosecond Laser-Assisted Clear Lens Extraction with Trifocal Intraocular Lens Implantation for Presbyopia Correction: A Short-Term Observational Study in Chinese Adults

Purpose

To observe the outcome of bilateral femtosecond laser-assisted clear lens extraction with trifocal intraocular lens (IOL) implantation for presbyopia correction and evaluate its feasibility in early presbyopic adults.

Methods

Prospective case series of eyes with clear crystalline lenses that underwent femtosecond laser-assisted lens extraction and trifocal IOL (Acrysof IQ PanOptix, Model TFNT00, Alcon) implantation between 2021 and 2023 were followed up for at least 3 months after surgery. Outcome measures included monocular uncorrected visual acuity at near (UNVA, 40 cm), intermediate (UIVA, 60 cm), and distance (UDVA, 5 m), monocular manifest refraction, corrected distance visual acuity (CDVA), defocus curve assessment, and spectacle independence at both near and distance.

Results

A total of 60 eyes from 30 consecutive patients were included, and their mean age was 50.4±6.5 years. After surgery, the mean UNVA (LogMAR) increased from 0.28±0.16 to 0.08±0.07, UIVA increased from 0.25±0.12 to 0.09±0.06, and UDVA increased from 0.27±0.21 to 0.01±0.08. The enhancements of UNVA, UIVA and UDVA were all significant (P < 0.05). The optometric results showed that the mean postoperative spherical equivalent (SE) was -0.21±0.24 D, and the mean postoperative CDVA (LogMAR) was -0.00±0.06. The preoperative spectacle independences at near and distance were 46.7% (14/30) and 56.7% (17/30), respectively, and both increased to 100% at 3 months after surgery.

Conclusion

Satisfactory visual outcomes and safe surgical procedures were observed in this study, which demonstrate that bilateral femtosecond laser-assisted clear lens extraction with PanOptix IOL implantation could be a feasible approach for presbyopia correction in working-age Chinese patients.

Comparison of Patients With Emmetropia and Presbyopia and Different Accommodation Who Undergo Unilateral or Bilateral Implantation of a Trifocal IOL

PURPOSE

To compare visual outcomes and satisfaction in patients with emmetropia, presbyopia, and greater or lesser residual accommodation who undergo unilateral or bilateral implantation of a trifocal diffractive intraocular lens (IOL).

METHODS

A multicenter, multisurgeon study was performed to evaluate outcomes in patients with emmetropia and presbyopia who underwent refractive lens exchange followed by implantation of a FineVision trifocal IOL (PhysIOL). The inclusion criteria were as follows: emmetropia, sphere -0.25 to +0.50 diopters (D), cylinder less than 0.75 D, and manifest refractive spherical equivalent (MRSE) of -0.25 to +0.25 D. All patients also had to have an uncorrected distance visual acuity (UDVA) of Snellen 0.9 or better in each eye. The sample was divided into different clusters based on two variables: eyes operated on (monocular or binocular) and age either younger than 55 years or 55 years or older. Thus, four possible groups were created. Visual and refractive performance, patient satisfaction, and spectacle independence were assessed.

RESULTS

A total of 690 eyes from 431 patients were evaluated. There was no difference in postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuity between the groups. Binocular uncorrected near vision (UNVA) was better in patients who underwent surgery on both eyes regardless of age (median [interquartile range]: 0.00 [0.00; 0.10] vs 0.10 [0.00; 0.10] logMAR; P < .001). Binocular uncorrected intermediate vision (UIVA) was better in patients who underwent surgery on both eyes aged younger than 55 years than in those who underwent surgery in one eye aged 55 years or older (median [interquartile range]: 0.18 [0.10; 0.18] vs 0.30 [0.18; 0.30] logMAR; P < .001). The efficacy and safety indexes were 0.98 ± 0.09 and 1.01 ± 0.06, respectively. A total of 93.3% of eyes were within the 0.50 D range in postoperative MRSE. Visual dysphotopsia was worse in patients with both eyes operated on, although the differences were not statistically significant.

CONCLUSIONS

The study shows that after refractive lens exchange, patients with emmetropia and presbyopia who received a trifocal IOL in one or both eyes achieved good UNVA, UIVA, and UDVA. Regarding near binocular visual acuity, results were better for patients who underwent surgery on both eyes than for those who underwent surgery on one eye. Regarding binocular intermediate visual acuity, patients aged younger than 55 years with both lenses replaced had better results than those 55 years or older with only one lens replaced. However, no significant differences were observed in UDVA or patient satisfaction. [J Refract Surg. 2023;39(12):817-824.].

Objective cataract grading methods and expected contrast sensitivity reestablishment with multifocal intraocular lenses

PURPOSE

To determine the cut-off points for age and metrics provided by cataract grading objective systems for which a reestablishment in contrast sensitivity (CS) is expected after multifocal intraocular lens (MIOL) implantation.

METHODS

One hundred seven subjects were included in this retrospective analysis carried out during the screening for presbyopia and cataract surgery. Monocular distance corrected contrast sensitivity defocus curve (CSDC) and visual acuity were measured, and crystalline lens sclerosis was graded with three objective metrics: Ocular Scatter Index (OSI), Dysfunctional Lens Index (DLI) and Pentacam Nucleus Staging (PNS). A CS value of 0.8 logCS at far distance, following published literature on this matter, was selected to compute the cut-off that maximized the detection of eyes exceeding this value at the preoperative screening, either for age or objective metrics.

RESULTS

The CDCS showed a stronger correlation than CDVA with objective grading methods, whereas all objective metrics were significantly correlated between them (p < 0.05). The cut-offs for age, OSI, DLI and PNS were ≤ 62, ≤ 1.25, ≥ 7.67 and ≤ 1, respectively. The OSI provided the highest area under the receiver operating characteristic curve (0.85) followed by the age (0.84), DLI (0.74) and PNS (0.63).

CONCLUSIONS

Surgeons conducting clear lens exchange should communicate the possible distance CS loss after surgery with MIOL implantation according to the previous described cut-offs points. Age in combination with any cataract grading objective system is recommended to detect possible inconsistencies.

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange with a Trifocal Intraocular Lens in Patients with Presbyopia

INTRODUCTION

Refractive lens exchange (RLE) patients represent a unique population with a different baseline and set of expectations compared to their cataract counterparts. Visual outcomes and patient satisfaction following RLE with bilateral implantation of a trifocal intraocular lens (IOL) were assessed in a cohort of patients with presbyopia and without cataract.

METHODS

Charts of patients with presbyopia who underwent femtosecond laser-assisted RLE with bilateral implantation of the PanOptix trifocal IOL (toric and non-toric) at a single-surgeon, private practice center from September 2019 to August 2020 were retrospectively reviewed. Eyes with prior keratorefractive surgery, amblyopia, or underlying pathology were excluded. Primary endpoints included corrected and uncorrected visual acuity at distance (CDVA and UDVA), intermediate (DCIVA and UIVA), and near (DCNVA and UNVA) at 6 months. Secondary endpoints included residual refractive error, patient-reported satisfaction, spectacle independence, and visual disturbance profile as assessed by a validated questionnaire at 6 months.

RESULTS

Seventy-eight eyes of 39 patients (mean age 56 ± 6 years; 79% female) were included. Most eyes were hyperopic (mean SE 2.35 ± 1.81). Postoperatively, 100% and 92% of eyes were within ± 1.00 D and ± 0.50 D of emmetropia, respectively. One hundred percent, 97%, and 97% of patients achieved UDVA, UNVA, and UIVA of logMAR 0.1 or better. Starbursts were the most frequent (67%) and bothersome (41%) visual disturbance cited, but nearly half (41%) of patients rated them as absent or "not bothersome at all." Overall, 77% of patients reported achieving complete spectacle independence with 87% and 90% of patients stating they were satisfied with their vision and would recommend the same procedure to others, respectively.

CONCLUSIONS

RLE with bilateral implantation of the PanOptix IOL is a safe and effective procedure with good patient satisfaction. Because of their relatively clear native lenses and visually demanding needs compared to their cataract counterparts, surgeons should take extra precautions to counsel RLE patients on the limitations of trifocal technology.

Visual performance, safety and patient satisfaction after bilateral implantation of a trifocal intraocular lens in presbyopic patients without cataract

Background

The aim was to evaluate the safety and efficacy of a trifocal intraocular lens (IOL) for the correction of presbyopia and to assess patient satisfaction.

Methods

Records from three centres were reviewed to select presbyopic patients having undergone bilateral refractive lens exchange and implantation of the AT LISA tri 839MP multifocal IOL. Postoperatively, monocular and binocular distance, intermediate and near visual acuities, corrected and uncorrected, and subjective refraction were measured. Patients also completed a quality of life questionnaire. Safety evaluation included IOL stability and postoperative complications.

Results

72 eyes (36 patients) were analysed. No clinically significant difference between pre- and postoperative corrected distance visual acuity (CDVA) was found for monocular or binocular measurements. Mean postoperative monocular CDVA was 0.02 ± 0.04 logMAR. Mean refractive values all improved statistically significantly compared with preoperative baseline (p ≤ 0.0064). Overall, 82.4% of eyes had spherical equivalent within ± 0.5 D and 97.1% within ± 1.0 D of emmetropia with a mean accuracy of -0.10 ± 0.41 D. Spectacle independence for distance, intermediate and near visual acuity was 87.5%, 84.4% and 78.1% respectively, and 78.1% of patients were satisfied with their postoperative, spectacle-free vision. Eight eyes received Nd:YAG laser treatment. No other IOL-related safety issues were reported.

Conclusion

AT LISA tri 839MP multifocal IOL bilaterally implanted in presbyopic patients provided excellent distance, intermediate and near visual outcomes with very accurate correction of refraction. These results were associated with a high level of spectacle independence and patient satisfaction.

Trial registration

Trial registered on https://clinicaltrials.gov/ under the identification NCT03790592 (31/12/2018).

SMILE for the Treatment of Residual Refractive Error After Cataract Surgery

INTRODUCTION

In the context of managing patients' expectations and satisfaction regarding visual acuity after cataract surgery, we aimed to investigate the improvement in visual acuity and patient satisfaction after small-incision lenticule extraction (SMILE) in pseudophakic (trifocal intraocular lens, IOL) patients with residual myopic refraction after cataract surgery.

METHODS

Seventy-six patients (82 eyes) who underwent cataract surgery with ZEISS AT LISA tri 839MP IOL implantation were included in this retrospective study. The included patients were 56-79 years old, wanted spectacle independence, and had preoperative myopic refraction between - 1.0 and - 2.25 diopters (D) and astigmatism between - 0.75 and - 1.75 D. The treatment status of these patients was defined as trifocal IOL (n = 82). SMILE was performed in patients who were dissatisfied after cataract surgery, and these patients were followed up for 1 year on average. We evaluated visual acuity and satisfaction and further examined laser vision correction and satisfaction levels in patients who were dissatisfied after trifocal IOL implantation.

RESULTS

The possible reasons for patient dissatisfaction were reading books, using a computer, and driving at night. After SMILE, the residual myopic refractive error (spherical) decreased significantly from - 2.08 ± 0.28 [- 2.25 to - 1.0] preoperatively to - 0.25 ± 0.20 - 0.5 to 0] 1 year postoperatively (p < 0.001). Additionally, the uncorrected distance visual acuity increased from 0.65 ± 0.08 [0.52-0.7] logMAR preoperatively to 0.09 ± 0.02 [0.05-0.1] logMAR at 1 month postoperatively (p < 0.001), 0.09 ± 0.02 [0.05-0.1] logMAR at 6 months postoperatively, and 0.06 ± 0.02 [0.05-0.1] logMAR at 12 months postoperatively (p < 0.001). Patient satisfaction measures after SMILE (reading, night driving, and using a computer) were significantly improved.

CONCLUSION

SMILE is a reliable method for treating residual refraction after cataract surgery, as it provides results in the shortest time without complications and increases patient satisfaction.

TRIAL REGISTRATION

The protocol was registered on clinicaltrials.gov (NCT04693663).

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.

Partial monovision achieved by unilateral implantation of a multifocal add-on lens with bilateral pseudophakia: evaluation and results

Purpose

To assess the results of partial monovision (PMV) in comparison to a bilateral monofocal implantation (MMV).

Methods

The PMV group was treated bilaterally with a monofocal intraocular lens (IOL) implantation, followed 3 months later by the implantation of a multifocal AddOn® lens (+ 3.00 D) into the non-dominant eye. The MMV group received a bilateral monofocal IOL implantation intending to achieve a slight anisometropia (0.0 D/ − 0.50 D). The near visual acuity (UNVA), intermediate visual acuity (UIVA), distance visual acuity (UDVA), defocus curve, and Lang-Stereotest II were conducted uncorrected, binocular, and minimum 3 months after the last operation. For the contrast sensitivity test, the patients were refractively corrected. The Quality of Vision Questionnaire (QoV), Visual Function Questionnaire (VF-14), spectacle independence, and general satisfaction were also assessed.

Results

A total of 27 PMV patients and 28 MMV patients without ocular diseases relevant to visual acuity were examined. The PMV group was significantly better at UNVA (0.11 ± 0.08 logMAR vs 0.56 ± 0.16 logMAR) and between − 2.00 and − 4.00 D in the defocus curve (p < 0.001). At the UIVA, the PMV group was slightly better (0.11 ± 0.10 logMAR vs 0.20 ± 0.18 logMAR) but not significant (p = 0.054). The UDVA (− 0.13 ± 0.09 logMAR vs − 0.09 ± 0.14 logMAR) (p = 0.315) and contrast sensitivity (p = 0.667) revealed no differences between the groups. The stereo vision was in favor of PMV (p = 0.008). Spectacle independence was statistically better for PMV at distance, intermediate, and near (distance p = 0.012; intermediate p < 0.001; near p < 0.001). In the VF-14 Questionnaire, the PMV was statistically superior (p < 0.001). The QoV Questionnaire showed no differences regarding frequency and severity of visual disturbances. Both groups were highly satisfied (p = 0.509).

Conclusion

Patients with PMV are more independent of glasses and are able to read without disadvantages in distance vision, due to halos and glare. The concept of PMV is well suited for the desire of eyeglass independence, without optical side effects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00417-022-05584-y.

Binocular visual function after unilateral versus bilateral implantation of segmented refractive multifocal intraocular lenses: a pilot study

PURPOSE

To evaluate binocular visual function after unilateral and bilateral implantation of segmented refractive multifocal intraocular lenses (MIOLs).

METHODS

This prospective comparative pilot study included patients who underwent SBL-3 (Lenstec; + 3.00 D) implantation at Peking University Third Hospital. Patients were divided into two groups (monocular or binocular surgery). Thirty-two patients with emmetropic presbyopic contralateral eyes and 49 patients with bilateral SBL-3 implantation within a week between eyes were included in the unilateral SBL-3 and bilateral groups, respectively. At 3-month follow-up, the main outcomes were binocular uncorrected distant, intermediate, and near visual acuity (UDVA, UIVA, and UNVA). Secondary outcomes included binocular best-corrected visual acuity at all distances, defocus curve, contrast sensitivity, photic phenomena, spectacle independence, patient satisfaction, and National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) score. The essential perceptual phenomena constituting binocular vision, simultaneous perception, fusion, and stereopsis were also evaluated.

RESULTS

Both groups showed similar binocular UDVA and UIVA, but UNVA was significantly better in the bilateral group (0.07 ± 0.07 versus 0.12 ± 0.07, P = 0.008). Better binocular defocus curve at intermediate to near focal points, higher percentage of spectacle independence at near distance, and NEI-VFQ-25 near activity scores were observed in the bilateral group. No significant differences in contrast sensitivity, photic phenomena, overall satisfaction, other NEI-VFQ-25 subscales, fusional amplitude, and stereoacuity were found between groups.

CONCLUSION

Unilateral implantation of segmented refractive MIOL provided desirable distant visual acuity and high patient satisfaction, but inferior intermediate and near visual outcomes compared with bilateral implantation.

Laser corneal enhancement after trifocal intraocular lens implantation in eyes that had previously undergone photoablative corneal refractive surgery

PURPOSE

To evaluate visual and refractive outcomes of laser corneal enhancement (LCE) after trifocal intraocular lens (IOL) implantation in eyes previously treated with myopic/ hyperopic laser corneal refractive surgery (LCRS).

SETTING

Clinica Baviera-AIER-Eye group, Spain.

DESIGN

Retrospective comparative case series.

METHODS

Patients were classified by primary LCRS (myopic/hyperopic). We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction after implantation of two trifocal IOL models (Physiol-FineVision and Zeiss-ATLisa 839) and subsequent laser enhancement.

RESULTS

We assessed 186 eyes from 146 patients (89 myopic, 97 hyperopic). At the last visit, refractive outcomes were better in myopic than in hyperopic eyes, with statistically significant differences for sphere (p<0.001), cylinder (p<0.001), MRSE (p=0.003), CDVA (p=0.005), UDVA (p=0.047) and UNVA (p=0.003) but not for UIVA (p=0.580), binocular UIVA (p=0.660), or binocular UNVA (p=0.836). Predictability differences were nonsignificant between groups for a final MRSE of ±0.5 D and ±1.0 D (p=0.167 and 0.502). Efficacy and safety were similar in both groups (p=0.235 and p=0.080). A greater myopic MRSE was present after trifocal implantation in myopic than hyperopic eyes (MRSE= -0.93D vs -0.69D, p=0.013) and the differences were maintained after enhancement between both groups (MRSE -0.00 D vs 0.00 D, p=0.003) respectively. Overall satisfaction was similar in both groups (p>0.05 all items).

CONCLUSION

Corneal laser enhancement after implantation of a trifocal IOL in eyes previously treated for myopia/hyperopia with LCRS is safe, effective, predictable, and highly satisfactory.