Optical quality of the eye after lens replacement with a pseudoaccommodating intraocular lens

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.

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery

PURPOSE

To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS).

METHODS

This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group.

RESULTS

The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group (p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and -1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos.

CONCLUSIONS

This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients' satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

Refractive surgery beyond 2020

Refractive surgery refers to any procedure that corrects or minimizes refractive errors. Today, refractive surgery has evolved beyond the traditional laser refractive surgery, embodied by the popular laser in situ keratomileusis or 'LASIK'. New keratorefractive techniques such as small incision lenticule extraction (SMILE) avoids corneal flap creation and uses a single laser device, while advances in surface ablation techniques have seen a resurgence in its popularity. Presbyopic treatment options have also expanded to include new ablation profiles, intracorneal implants, and phakic intraocular implants. With the improved safety and efficacy of refractive lens exchange, a wider variety of intraocular lens implants with advanced optics provide more options for refractive correction in carefully selected patients. In this review, we also discuss possible developments in refractive surgery beyond 2020, such as preoperative evaluation of refractive patients using machine learning and artificial intelligence, potential use of stromal lenticules harvested from SMILE for presbyopic treatments, and various advances in intraocular lens implants that may provide a closer to 'physiological correction' of refractive errors.

Bilateral Implantation of the Acri.LISA Bifocal Intraocular Lens in Myopic Eyes

Purpose

To asses visual quality after bilateral implantation of the Acri.LISA 366D intraocular lens (IOL) (Carl Zeiss Meditec) in patients with high and low–moderate myopia.

Methods

A total of 304 eyes of 152 patients had bilateral implantation of the Acri.LISA 366D IOL. The patients were divided into 2 groups: low–moderate myopia (IOL power from 15 to 20.5 D) and high myopia (IOL power from 0 to 14.5 D). Monocular and binocular best-corrected distance visual acuity (BCVA) and best distance-corrected near visual acuity (BCNVA), binocular best distance-corrected intermediate visual acuity (BCIVA), and distance contrast sensitivity (OS) under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were determined.

Results

At the 6-month postoperative visit, there were no statistically significant differences in monocular and binocular BCVA (p=0.13 and p=0.22, respectively). Monocular and binocular BCNVA was comparable between the groups (p=0.26 and p=0.09, respectively). The mean binocular BCIVA changed significantly as a function of the distance of the test (p<0.01) in both groups, and there were no statistically significant differences between groups at any distance. Monocular and binocular CS under photopic and mesopic conditions was similar between both groups (p>0.01).

Conclusions

Bilateral implantation of the Acri.LISA 366D in high myopic eyes provides a satisfactory full range of vision comparable to that obtained in low–moderate myopic eyes.

Comparison of visual outcomes, spectacles dependence and patient satisfaction of multifocal and accommodative intraocular lenses: innovative perspectives for maximal refractive-oriented cataract surgery

Background

The aim of this study was to evaluate visual outcomes for different working distances (far, 60 cm and 33 cm) and impact on vision quality of multifocal IOLs AcrySof ResTOR SN6AD1 and SN6AD3 (Alcon, Inc., Fort Worth, Texas, USA) as well as REVIEW FIL611PV multifocal and OPTOFLEX FIL618 accommodative IOLs (Soleko, Ltd., Rome, Italy) in patients undergoing bilateral phacoemulsification.

Methods

In this observational prospective study 63 patients undergoing binocular cataract surgery were divided into four groups for implantation of one of the IOLs under evaluation. Visual outcomes were evaluated at 1 day, 7 days, 1 month, 3 months and 6 months after surgery. Patients’ satisfaction and spectacle independence were evaluated with questionnaires administered at the 6-months follow-up.

Results

Improvements in visual acuity for the three working distances were statistically significant in all cases compared to the preoperative status, especially after binocular implantation. The AcrySof ReSTOR SN6AD1 multifocal IOL provided the best visual acuity results and tolerability for all working distances. While performing worse than SN6AD1, FIL611PV and FIL618 provided better uncorrected visual acuity and spectacles independence for intermediate/close-up and far distances respectively, in comparison with the SN6AD3 group.

Conclusions

SN6AD1 was confirmed the best choice for all working distances. However, FIL611PV IOL may represent a valid and more cost-effective alternative, especially if surgeons intend to prioritize spectacle independence and patient autonomy at intermediate and close-up distances, in accordance to specific needs and requests.

Trial registration

Trial retrospectively registered in ISRCTN Registry on 02/02/2017. TRN: ISRCTN14145737.

Long-term results of clear lens extraction combined with piggyback intraocular lens implantation to correct high hyperopia

AIM

To assess the refractive outcome of clear lensectomy combined with piggyback intraocular lens implantation in highly hyperopic patients.

METHODS

This case review included 19 eyes of 10 patients with high hyperopia and axial length less than 21mm. Intraocular lens power was calculated for emmetropia using the Holladay II formula in 17 eyes, and SRK/T formula in 2 eyes following clear lens extraction and piggyback intraocular lens implantation. Patients were examined periodically over 24 months for visual acuity and spherical equivalent (SE).

RESULTS

The mean postoperative SE at 24 months was 0.20±1.39D (range, -3.00 to 2.50D), better than preoperative 9.81±2.62D (range, +6.00 to +14.50D) (P<0.001). Five eyes had SE within ±0.5D of emmetropia and 11 eyes within ±1.00D at postoperative 24 months. The mean postoperative uncorrected visual acuity (UCVA) at 24 months was 0.60±0.36, significantly improved compared to preoperative 1.39±0.33 (P<0.001). The mean best-corrected visual acuity (BCVA) at 24 months was 0.49±0.35, not statistically different compared to preoperative 0.38±0.30 (P=0.34). Twelve eyes maintained and 1 gained 1 or more Snellen line of BCVA, 4 eyes lost 1 line, and 2 eyes lost 2 lines at 24 postoperative months. Twelve eyes best-corrected near visual acuity (BCNVA) achieved J1 at postoperative 24 months compared to preoperative 7 eyes and the other 7 eyes better than J3.

CONCLUSION

Clear lens extraction combined piggyback intraocular lens implantation appears to be an effective procedure to correct high hyperopia but mild overcorrection and intralenticular opacification may require secondary procedure.

Multifocal intraocular lenses for unilateral cataract in children

PURPOSE

To evaluate the implantation of apodized diffractive multifocal intraocular lenses (IOLs) in children with unilateral cataract.

SETTING

Ophthalmology Service, Hospital Clínico Lozano Blesa, Zaragoza, Spain.

DESIGN

Prospective clinical study.

METHODS

Five children between 4 and 6 years of age with unilateral cataract had cataract extraction and implantation of an apodized diffractive multifocal IOL (AcrySof Restor SN60D3). Phacoaspiration was accompanied by posterior capsulorhexis followed by an anterior vitrectomy. Uncorrected distance (UDVA), corrected distance (CDVA), and corrected near (CNVA) visual acuities; binocular function using the Worth 4-dot test and the TNO stereotest; and subjective symptoms such as glare and halos were evaluated over 21 months of follow-up.

RESULTS

At the final follow-up visit, the mean UDVA was 0.45 ± 0.149 logMAR and the mean CDVA was 0.30 ± 0.06 logMAR with 20/32 in 3 eyes, 20/50 in 1 eye, and 20/63 in 1 eye. The mean CNVA was 0.10 ± 0.05 logMAR (about 20/25) with J1 in 2 eyes, J2 in 1 eye, J3 in 1 eye, and J4 in 1 eye. The stereoacuity was 120 seconds of arc (arcsec) in 2 patients, 240 arcsec in 1 patient, 1980 arcsec in 1 patient, and nonexistent in 1 patient. The Worth 4-dot test showed that 4 patients had fusion. None of the 5 patients complained about halos or glare. No IOL decentration was observed in any patient.

CONCLUSION

Implantation of an apodized multifocal IOL seems to be a satisfactory alternative to monofocal pseudophakia in children with unilateral cataract.

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.

Collagen copolymer toric posterior chamber phakic intraocular lens in eyes with keratoconus

PURPOSE

To assess the safety, efficacy, stability, and predictability of collagen copolymer toric phakic intraocular lens (pIOL) implantation to correct myopia and astigmatism in eyes with keratoconus.

SETTING

Fernández-Vega Ophthalmological Institute, Oviedo, Spain.

METHODS

This prospective study comprised keratoconic eyes that had implantation of a toric Intraocular Collamer Lens. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refraction, and postoperative complications were evaluated 1, 3, 6, and 12 months postoperatively.

RESULTS

Preoperatively, the mean spherical equivalent in the 30 eyes (21 patients) was -5.38 diopters (D) +/- 3.26 (SD) (range -13.50 to -0.63 D) and the mean cylinder, -3.48 +/- 1.24 D (range -1.75 to -6.00 D). At 12 months, 86.7% of the eyes were within +/-0.50 D of the attempted refraction and all eyes were within +/-1.00 D. For the astigmatic components J0 and J45, 83.3% of eyes and 86.7% of eyes, respectively, were within +/-0.50 D. The mean Snellen UDVA was 0.81 +/- 0.20 and the mean CDVA, 0.83 +/- 0.18; CDVA was 20/40 or better in 29 eyes 96.7% of eyes and 20/25 or better in 22 eyes (73.3%). No eyes lost more than 2 lines of CDVA; 29 eyes (96.7%) maintained or gained 1 or more lines. The efficacy index was 1.07 and the safety index, 1.16. There were no complications or adverse events.

CONCLUSIONS

The results confirm that toric ICL implantation is a predictable, effective procedure to correct ametropia in eyes with keratoconus. Predictability and stability were achieved early and remained fairly stable up to 12 months.

Pupil size, white-to-white corneal diameter, and anterior chamber depth in patients with myopia

PURPOSE

To evaluate anatomical parameters in a population of patients with myopia.

METHODS

Nine hundred sixty-four myopic eyes (-3.00 to -20.00 diopters [D] spherical equivalent refraction) were evaluated to measure mesopic and photopic pupil size with an infrared pupillometer; anterior chamber depth and white-to-white corneal diameter were obtained with Orbscan II (Bausch & Lomb). Correlation analysis was performed to evaluate the relationships among anatomical parameters of the anterior segment of the eye.

RESULTS

Average change in pupil size between mesopic and photopic conditions shows a uniform gap of 1.5 mm in patients aged 18 to 62 years with a slight insignificant trend to decrease with age. Photopic and mesopic pupil size were highly correlated (r=0.694, P<.001) and the difference between both measures was positively correlated with mesopic pupil size (r=0.207, P<.001) and inversely correlated with photopic pupil size (r=0.561, P<.001). Anterior chamber depth and white-to-white corneal diameter were positively correlated (r=0.389, P<.001). White-to-white corneal diameter and anterior chamber depth were not correlated with age (r=-0.096, P<.001) or anterior chamber depth (r=-0.183, P<.001-0.183) as a function of age.

CONCLUSIONS

Average difference between photopic and mesopic pupil size remained constant across the range of ages included in this cohort. A positive correlation was noted between anterior segment dimensions, and anterior chamber depth decreased with age.

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

PURPOSE

To assess the visual quality after bilateral implantation of the Acri.LISA 366D intraocular lens (IOL; Carl Zeiss Meditec, Jena, Germany) in patients with hyperopia.

DESIGN

Prospective, nonrandomized study.

METHODS

One hundred and seventy eyes of 85 patients had bilateral implantation of the Acri.LISA 366D IOL. The patients were divided into 2 groups: low to moderate hyperopia (IOL power, 21 to 24.5 diopters [D]) and high hyperopia (IOL power, 25 to 36 D). Monocular and binocular best spectacle-corrected visual acuity (BSCVA), best distance-corrected near visual acuity (BCNVA), binocular best distance-corrected intermediate visual acuity (VA), and distance contrast sensitivity (CSF) under photopic (85 cd/m(2)) and mesopic (5 cd/m2) conditions were determined.

RESULTS

At the 6-month postoperative visit, there were no statistically significant differences in monocular and binocular BSCVA (P = .06 and P = .09, respectively). Monocular and binocular BCNVA were comparable between both groups (P = .24 and P = .42, respectively). The mean binocular best distance-corrected intermediate VA changed significantly as a function of the distance of the test (P < .01) in both groups, and there were no statistically significant differences between groups at any distance. Differences were not found between groups in binocular CSF under mesopic and photopic conditions.

CONCLUSIONS

Bilateral implantation of the Acri.LISA 366D in patients with high hyperopia provided a satisfactory full-range of vision comparable with that obtained in patients with low to moderate hyperopia.

Refractive lens exchange with foldable toric intraocular lens

PURPOSE

To assess visual and refractive outcomes, and rotational stability after refractive lens exchange (RLE) with toric intraocular lens (IOL) implantation to correct ametropia and preexisting astigmatism.

DESIGN

Prospective, nonrandomized, observational case series (self-controlled).

METHODS

This prospective, nonrandomized, and self-controlled study included 32 eyes of 19 consecutive patients with more than 1.00 diopter (D) of preexisting corneal astigmatism having RLE with AcrySof Toric IOL implantation (Alcon Laboratories Inc, Fort Worth, Texas, USA). Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), refractive sphere, and keratometric and refractive cylinder were recorded preoperatively and 6 months after surgery. Toric IOL axis shift was also measured. A patient satisfaction, visual phenomena, and spectacle dependency questionnaire was also carried out.

RESULTS

At 6 months postoperatively, UCVA was 20/32 or better in 100% of the eyes, with 84.3% achieving 20/25 or better. One hundred percent of eyes achieved 20/25 or better BCVA. No eye lost >or=2 lines, 1 eye lost 1 line, 16 eyes did not change, 4 eyes gained 1 line, and 11 eyes gained >or=2 lines of BCVA after the surgery. Mean refractive cylinder was reduced significantly after surgery from -2.46 +/- 0.99 D to -0.53 +/- 0.30 D (P < .001). Vector analysis to compare attempted vs achieved correction showed that 100% of eyes were within +/- 1.00 D for the spherical equivalent, and 100% of eyes were within +/-0.50 D for the astigmatic components (J(0) and J(45)). Mean toric IOL axis rotation was 0.90 +/- 1.76 degrees, being <or= 5 degrees in 96.8% of eyes evaluated. Patients were satisfied with their vision without reporting severe visual phenomena (from none to moderate).

CONCLUSIONS

RLE with toric IOL implantation showed good visual and refractive outcomes for correcting spherical and cylindrical refractive errors.

[The basics of refractive lens exchange]

Removal of the crystalline lens and its replacement by an intraocular lens (IOL) is known as refractive lens exchange (RLE). RLE is performed to correct high ametropia or aniseikonia. Crystalline lens removal always leads to a complete loss of accommodation; therefore, RLE should mainly be used for patients with beginning or existing presbyopia. RLE patients usually have a good best-corrected visual acuity, which is the default value for the postoperative uncorrected visual acuity. To reach this goal, microincisional and astigmatism-neutral implantation techniques as well as special IOL optic designs are available. These optic designs offer each patient individualized best visual performance. In spite of the high requirements for postoperative optical quality, RLE can lead to an effective, safe, predictable, and stable outcome with a low risk of complications.

Maximizing satisfaction with presbyopia-correcting intraocular lenses: the missing links

PURPOSE

To critically analyze recent studies of presbyopia-correcting intraocular lenses (IOLs) and to examine opportunities to enhance patient satisfaction further.

DESIGN

Perspective.

METHODS

Literature review and commentary.

RESULTS

Although overall patient satisfaction with the currently available presbyopia-correcting IOLs remains high, it is not uniform. Current accommodating or multifocal IOL designs are hampered by limited accommodative ability or reduced contrast sensitivity and photic phenomenon, respectively. Toric IOLs and IOLs inserted through smaller incisions minimize postoperative wound healing changes. Better assessment of total ocular characteristics, including corneal wavefront and pupil size and dynamics, will allow further IOL customization to each patient.

CONCLUSIONS

Postoperative modification of IOLs may offset variations in postoperative healing that cannot be predicted before surgery. Further methods to assess and modify neural adaptive capability are needed. Newer IOL designs may enhance functional depth of field further without compromising contrast sensitivity or inducing photic phenomena.

Femtosecond laser for residual refractive error correction after refractive lens exchange with multifocal intraocular lens implantation

PURPOSE

To assess visual and refractive outcomes of femtosecond laser for residual refractive error correction after refractive lens exchange (RLE) with multifocal intraocular lens (IOL) implantation.

DESIGN

Prospective, nonrandomized, masked observational case series (self-controlled).

METHODS

Fifty-three eyes of 31 consecutive patients were submitted to femtosecond laser surgery after RLE with multifocal IOL implantation. Patients showed an average manifest refractive error (D) of M, 0.200 +/- 0.490; J(0), -0.051 +/- 0.532; and J45, -0.007 +/- 0.371. Visual acuity (VA) was measured at distance and near vision before and six months after the surgery.

RESULTS

At six months after surgery, mean uncorrected VA was 0.83 +/- 0.20 and improved in 100% of the eyes. No eye lost two or more lines of best-corrected distance VA; five eyes lost one line, 31 eyes did not change after the surgery, 13 eyes gained one line, and four eyes gained two lines. All eyes were within +/- 1.00 diopters (D) and 96.2% were within +/- 0.50 D of the desired refraction. The average manifest refractive error (D) after surgery was M, 0.014 +/- 0.170; J0, 0.029 +/- 0.118; and J45, 0.007 +/- 0.061. No eye lost two or more line of best distance-corrected near VA; two eyes lost one line, 40 eyes did not change, and 11 eyes gained one line. Mean uncorrected distance near VA was 0.88 +/- 0.12 at six months. Best distance-corrected near VA changed from 0.89 +/- 0.14 before surgery to 0.90 +/- 0.13 at six months.

CONCLUSIONS

Femtosecond laser after RLE with multifocal IOL implantation is an effective procedure for correcting residual ametropia and resulted in better distance visual outcomes.