Influence of different acrylic intraocular lens materials on optical quality of vision in pseudophakic eyes

Three-year multinational clinical study on an aspheric hydrophobic acrylic intraocular lens

PURPOSE

To present the results of a study investigating the 3-year effectiveness and safety of the Clareon single-piece intraocular lens (IOL).

SETTING

19 multinational sites.

DESIGN

Prospective multicenter single-arm study.

METHODS

Patients were bilaterally implanted with Clareon IOLs. Assessments included uncorrected distance visual acuity, corrected distance visual acuity (CDVA), manifest refraction, tilt, decentration, applanation tonometry, and fundus examination, including glistenings and posterior capsule opacification (PCO) evaluation. The primary outcomes for effectiveness and safety were evaluated at 1 year and compared with ISO historical safety and performance endpoint (SPE) rates. Patients were followed for up to 3 years after implantation.

RESULTS

424 eyes of 215 patients were implanted (n = 215 first eye, n = 209 second eye), and 183 patients completed the trial at 3 years (with 364 binocular and 1 monocular patient). At 1 year, the cumulative and persistent adverse event rates were below SPE targets, and 99.5% of eyes achieved a monocular CDVA of ≤0.3 logMAR (vs the SPE target of 92.5%). At 3 years, the mean monocular CDVA was -0.032, with 93.4% (341/365) of eyes achieving a CDVA of 0.1 logMAR or better, 100% of eyes presented with grade 0 glistenings ≤25 MV/mm 2 , and 92.9% of eyes (394/424) had either no PCO or clinically nonsignificant PCO.

CONCLUSIONS

This study supports the long-term safety and effectiveness of the Clareon IOL. The visual outcomes were excellent and stable over the 3-year study period, PCO rates were very low, and 100% of IOLs had grade 0 glistenings.

Visual Acuity, Wavefront Aberrations, and Defocus Curves With an Enhanced Monofocal and a Monofocal Intraocular Lens: A Prospective, Randomized Study

PURPOSE

To compare uniocular and binocular visual acuity, wavefront aberrations, and defocus curves using the TECNIS Eyhance (Johnson & Johnson) and RayOne (Rayner) intraocular lenses (IOLs).

METHODS

In this prospective, randomized, comparative study, 50 patients (100 eyes) were randomized to receive the same IOL bilaterally (ClinicalTrials.gov Identifier: NCT04175951). Follow-up visits were at 1 and 3 to 9 months postoperatively. Primary outcome measures were uncorrected distance (UDVA) and uncorrected intermediate (UIVA) visual acuity (logMAR) at 66 cm. Secondary outcome measures were corrected distance (CDVA) and distance-corrected intermediate (DCIVA) visual acuity at 66 cm, manifest refraction, spherical (Z₄⁰) and vertical coma (Z₃^-1) aberrations (total, internal eye, and corneal) at normal pupil size, defocus curves, and Catquest 9SF and Glare and Halos questionnaire on Likert scale (1 = no glare and halos and 4 = continuous).

RESULTS

Uniocular UDVA (P = .02), UIVA (P = .02), and binocular UIVA (P < .01) and uniocular (P = .01) and binocular (P < .01) DCIVA were better with the TECNIS Eyhance IOL at 3 to 9 months. At 3 to 9 months, both uniocular and binocular defocus curves were significantly broader with the TECNIS Eyhance IOL between -0.50 and -3.00 diopters (D). For total and internal eye, there was a statistically but clinically insignificant difference in Z₄⁰ with the TECNIS Eyhance IOL. Rasch scores improved (TECNIS Eyhance: 2.04 ± 1.34 to 2.91 ± 0.81 and RayOne:1.61 ± 1.35 to 2.97 ± 0.16) at 3 to 9 months. Refraction, Z₃^-1, glare, and halos were not different.

CONCLUSIONS

The TECNIS Eyhance IOL provided better DCIVA and broader defocus curves than the RayOne IOL. There was no difference in CDVA or patient-reported outcomes. Although there were some differences in aberrations when measured with normal pupil size, they were not clinically significant. [J Refract Surg. 2022;38(1):10-20.].

Visual outcome, optical quality, and patient satisfaction with a new monofocal IOL, enhanced for intermediate vision: preliminary results

PURPOSE

To compare visual outcomes, contrast sensitivity, optical quality, spectacle independence, and visual disturbances in patients implanted with 2 models of monofocal intraocular lenses (IOLs).

SETTING

Eye Clinic, Department of NEUROFARBA, University of Florence, Italy.

DESIGN

Prospective case series METHODS:: Patients without ocular comorbidities and corneal astigmatism less than 0.75 diopters (D) had cataract surgery with bilateral implantation of either of 2 monofocal IOLs, the Tecnis ZCB00 or the Tecnis Eyhance ICB00 (Johnson & Johnson Vision Care, Inc.). Six months postoperatively, monocular and binocular uncorrected and corrected (at 4 m) distance visual acuities, as well as uncorrected (UIVA), distance corrected, and corrected intermediate (at 66 cm) and near (at 40 cm) visual acuities were measured. Photopic contrast sensitivity, binocular defocus curve, objective scatter index (OSI), Strehl ratio, modulation transfer function (MTF) cutoff, halo and glare perception, and spectacle independence were also evaluated.

RESULTS

A total of 80 eyes of 40 patients were evaluated in this study. Although monocular and binocular uncorrected and corrected distance and near visual acuities were similar between groups, monocular and binocular UIVA were significantly higher in the Eyhance group. There were no statistically significant differences between the 2 groups in terms of photopic contrast sensitivity, OSI, MTF cutoff, Strehl ratio, and glare and halo perception. The ICB00 IOL provided better spectacle independence than the ZCB00 IOL for intermediate distance.

CONCLUSIONS

In patients without ocular comorbidities, the Eyhance ICB00 IOL provided better UIVA and higher intermediate spectacle independence without impairment of far vision and visual quality, compared with the ZCB00 IOL.

A comparison of mesopic visual acuity and objective visual quality following cataract surgery with hydrophobic acrylic intraocular lenses

PURPOSE

To evaluate mesopic visual acuity and visual quality as measured by objective scatter index (OSI) in pseudophakic eyes with long-term follow-up after implantation of hydrophobic acrylic lenses made from two different lens materials.

SETTING

This study was carried out in a private clinic.

DESIGN

This study was an observational cohort study.

METHODS

This pilot study included 181 eyes of 136 patients who had undergone cataract surgery with implantation of monofocal hydrophobic acrylic intraocular lenses (IOLs), either Alcon AcrySof (82 eyes) or Abbott Medical Optics' Tecnis (99 eyes). The monocular corrected distance visual acuity (CDVA) of the subjects was recorded under mesopic room illumination and OSI was measured by an optical quality analysis system using double-pass wavefront method.

RESULTS

Mean follow-up duration was 60.07±18.82 months. Eyes implanted with Tecnis IOLs had statistically significantly better mesopic CDVA (0.08±0.08) compared to those implanted with AcrySof IOLs (0.11±0.07) (P=0.020). Mesopic CDVA of 20/25 or better was found in 79.8% of eyes in the Tecnis group compared to 62.2% of eyes in AcrySof group. Similarly, OSI was also found to be statistically significantly better for Tecnis IOLs compared to AcrySof IOL group (mean OSI, Tecnis: 1.65±0.92, AcrySof: 2.01±1.36; P=0.033). When glaucomatous eyes were excluded, OSI was still significantly better (P=0.028) in the Tecnis IOL group.

CONCLUSION

The eyes implanted with Tecnis IOLs showed better long-term optical performance in terms of both OSI and mesopic visual acuity in comparison to those with AcrySof IOLs.

Fellow-eye comparison of posterior capsule opacification between 2 aspheric microincision intraocular lenses

PURPOSE

To compare posterior capsule opacification (PCO) between 2 microincision hydrophilic intraocular lenses (IOLs) and with a conventional spherical hydrophobic IOL.

SETTING

St. Thomas' Hospital, London, United Kingdom.

DESIGN

Prospective randomized comparative study.

METHODS

A microincision Acri.Smart 36A (negatively aspheric) or Akreos MI-60 (aspherically neutral) IOL was randomized to the first eye of patients with the alternative IOL implanted in the fellow eye within 3 weeks. Postoperatively, 100% and 9% logMAR corrected distance visual acuity (CDVA) were assessed. Retroillumination photographs were analyzed using the posterior capsule opacity software system. The data on PCO scores were compared with those of a conventional spherical hydrophobic IOL (Acrysof SN60AT).

RESULTS

One hundred percent CDVA was significantly better at 12 months and 9% CDVA was better at 6, 12, and 24 months (P<.05) with the negatively aspheric IOL. One eye in each group with microincision IOLs developed capsule phimosis at 1 month. Neodymium:YAG capsulotomies were required by 2 years in 2 eyes with a negatively aspheric IOL and 8 eyes with an aspherically neutral IOL. At 24 months, the mean PCO score remained less than 10% with the conventional spherical IOL, whereas it increased with time in the negatively aspheric IOL (up to 16%) and the aspherically neutral IOL (up to 23%).

CONCLUSIONS

The negatively aspheric IOL had a better PCO profile than the aspherically neutral IOL. This may be attributed to the difference in the edge design between the IOLs. The microincision IOLs had more PCO than the conventional 1-piece hydrophobic IOL.

Fellow-eye comparison of 2 aspheric microincision intraocular lenses and effect of asphericity on visual performance

PURPOSE

To evaluate visual performance and aberrations with aspheric and spherically neutral microincision intraocular lenses (IOLs) and assess the influence of asphericity on visual performance, wavefront aberration, and depth of focus.

SETTING

St. Thomas' Hospital, London, United Kingdom.

DESIGN

Clinical trial and cohort study.

METHODS

In the first study, patients with bilateral cataract were randomized to receive an aspheric Acri.Smart 36A IOL or a spherically neutral Akreos MI60 IOL in the first eye. The other IOL was implanted in the second eye within 3 weeks. Assessments at 3 months were 100% and 9% corrected distance visual acuity (CDVA) and distance-corrected near visual acuity (DCNVA). Aberrations and depth of focus were computed using iTrace software. In the second study, data from the other published study was combined to assess the visual performance, aberration, and depth of focus in groups of spherical, spherically neutral, and negatively aspheric (asphericity -0.17 μm) IOLs.

RESULTS

In part 1, there was no difference in 100% or 9% CDVA, DCNVA, or depth of focus between the 2 microincision IOLs. Total spherical aberration was lower with the aspheric IOL. In part 2, the CDVA and DCNVA were not different between the spherical (n = 44), spherically neutral (n = 32), or aspheric (n = 76) IOLs. Total spherical (P<.01) and vertical coma aberrations decreased with increasing IOL asphericity (P<.01). Depth of focus (4.0 mm pupil) also decreased with increasing asphericity and was significant between the spherical IOL and aspheric IOLs. The DCNVA did not differ between groups.

CONCLUSION

Asphericity of IOLs did not affect distance visual acuity. The difference in depth of focus was significant only between negatively aspheric and spherical IOLs. Asphericity differences up to 20 μm did not influence depth of focus.