Comparison of the visual performance and quality of vision with combined symmetrical inferonasal near addition versus inferonasal and superotemporal placement of rotationally asymmetric refractive multifocal intraocular lenses

Visual and patient reported outcomes provided by a refractive multifocal intraocular lens based on continuous transitional focus

PURPOSE

To analyze the quality of vision of patients implanted bilaterally with the multifocal Precizon Presbyopic intraocular lens (IOL), as well as to evaluate the visual performance provided by the lens.

SETTING

Vissum Miranza Alicante.

DESIGN

Prospective multicenter study.

METHODS

56 patients (mean age 65.0 ± 8.7 years old) underwent bilateral implantation with multifocal Precizon Presbyopic IOL. The quality of vision was assessed by a quality of vision questionnaire at 6 months after the implantation procedure, a complete eye examination was also performed including visual and refractive measurements, defocus curve and contrast sensitivity assessment. Visual and refractive variables were compared in preoperative, 3-month postoperative and 6-month postoperative visits by Wilcoxon test.

RESULTS

The quality of vision analysis showed the absence of severe glare and severe haloes in all evaluated patients. Likewise, non-symptoms of glare, haloes and starbursts were seen in 75%, 68%, and 55% of subjects, respectively. Efficacy and safety index was 1.26 and 1.42, respectively. The 6-month postoperative binocular uncorrected distance visual acuity and near uncorrected visual acuity were 0.00 ± 0.09 and 0.20 ± 0.13 logMAR, respectively. Mean spherical equivalent was 0.29 ± 0.45 D.

CONCLUSIONS

The Precizon Presbyopic NVA IOL (OPHTEC BV) provides a suitable quality of vision with a low rate of disturbance photic phenomena induction, as well as an excellent visual performance at main distances of sight accomplishing the visual demands of the majority of patients.

Refractive Lens Exchange: A Review

In recent decades, technical advancements in lens surgery have considerably improved safety and refractive outcomes. This has led to a much broader range of indications for refractive lens exchange (RLE). Effective restoration of uncorrected distance and near visual acuity is possible with modern presbyopia correcting intraocular lenses (IOLs). Hyperopic patients who are fully presbyopic were identified as ideal candidates for RLE. For myopic patients, an increased risk of retinal detachment has been reported, which leads to a higher threshold to perform RLE in this patient group. The most frequent postoperative complications include posterior capsular opacification, deviation from the target refraction and cystoid macular edema. Thus, adequate planning of surgery, careful patient selection, as well as comprehensive counseling are crucial for successful RLE.

Comparative Analysis of the Visual, Refractive and Aberrometric Outcome with the Use of 2 Intraocular Refractive Segment Multifocal Lenses

To demonstrate the results of ray tracing higher- and lower-order aberrations in pseudophakic eyes with rotationally asymmetrical segment multifocal lenses, total high- and low-order aberrations, measured by root mean square value (RMS), refraction, uncorrected distance and uncorrected near visual acuity (UCDVA and UCNVA), and tear break-up time, were measured at scotopic size in 42 eyes of patients implanted with bifocal refractive Mplus15/Mplus30 IOL with +1.5 dpt near addition (42 eyes of patients implanted with Mplus15)/+3.0 dpt near addition (91 eyes of patients implanted with Mplus30), and 107 eyes of control group. No significant differences were noticed between the examined groups concerning UCDVA, UCNVA, and tear break-up time (p < 0.001). Coma and total high-order aberrations were significantly higher for the Mplus30 lens in comparison to the Mplus15 lens and the control group (Coma, Trefoil p < 0.001, Secondary Astigmatism p = 0.002). The spherical aberrations were significantly higher in the lower-addition lens (p = 0.016) in comparison to the control group and to the higher-addition lens group (p < 0.001). Both intraocular lens models were successful at reaching refractive aim, good distance, and near function with the lower higher-order aberrations for the low-addition lens.

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.

Influence of ocular biometric parameters such as effective lens position, keratometry, and axial length on near add power of multifocal intraocular lens

Visual quality after multifocal intraocular lens (mIOL) implantation has received increased attention. Postoperative residual ametropia, posterior capsule opacification, dry eye, IOL decentration, pupil size, and other factors can affect patient visual acuity. In addition, patient dissatisfaction after mIOL implantation has a relationship with the near add power of mIOLs, which is correlated with vision habits of different patients. Indeed, the actual spectacle plane add power of mIOLs is incompletely consistent with the near add power given by the manufacturers. Ocular biometric parameters such as effective lens position, keratometry, and axial length have effect on the near add power of mIOLs in the lens plane. In this article, the influence of ocular biometric eye parameters on the actual near add power of mIOLs in the lens plane was reviewed.

Outcomes of a Refractive Segmented Bifocal Intraocular Lens with a Lower Near Addition

Purpose

To evaluate clinical and subjective outcomes of a segmented bifocal IOL with a 2.0 D near addition.

Patients and Methods

Retrospective analyses of patients who had undergone refractive lens exchange with bilateral implantation of the SBL-2 IOL (Lenstec, Inc., Christ Church, Barbados) were performed. The number of patients included in the study was 389 (778 eyes). Refractive, visual and patient-reported outcomes were presented for the last available visit (mean follow-up 2.05 ± 1.33 months).

Results

The percentage of eyes within ±0.50D and ±1.00D of emmetropia was 82.5% (642/778) and 97.8% (761/778), respectively. The mean uncorrected intermediate visual acuity (66 cm) of the last available visit was 0.08 ± 0.15 logMAR monocularly and 0.04 ± 0.14 logMAR binocularly. The mean monocular and binocular uncorrected near visual acuity (40 cm) were 0.30 ± 0.15 logMAR and 0.24 ± 0.14 logMAR, respectively. Of all patients, 97.2% (378/389) claimed never to use any correction for distance vision, while 93.1% (362/389) of patients did not require any correction for near vision. The mean scores for visual phenomena (on the scale from 1 – no difficulty to 7 – severe difficulty) were 1.8 ± 1.3, 1.7 ± 1.2, 1.7 ± 1.2 and 1.6 ± 1.2 for glare, halo, starburst, and ghosting/double vision, respectively.

Conclusion

Despite the lower near addition of SBL-2 segmented bifocal IOL, patients achieved reasonable rates of spectacle independence and a low incidence of visual phenomena.

Secondary positioning of rotationally asymmetric refractive multifocal intraocular lens in a patient with glaucoma: A case report

BACKGROUND

Asymmetric multifocal intraocular lenses (IOLs) are now widely used in the modern cataract surgery, providing a good level of visual performance over a range of distances and high postoperative patient satisfaction. We report a case of improved visual quality after shifting the near segment of an asymmetrical multifocal IOL to the superotemporal placement in the dominant eye of a glaucoma patient.

CASE SUMMARY

A 72-year-old woman with bilateral glaucoma underwent phacoemulsification in the dominant eye (left eye) with implantation of an asymmetrical multifocal IOL. Postoperative uncorrected distance visual acuity (UDVA) was 0.0 logMAR (20/20 Snellen) and uncorrected near visual acuity (UNVA) was 0.1 logMAR (20/25 Snellen). Two weeks later, the patient presented to our clinic with decreased vision due to migration of lens epithelial cells to IOL anterior surface and edema of corneal endothelial cells. Anterior capsule polishing and superotemporal placement of near segment [+3.00 diopter (D) addition (add)] of IOL were performed. As a result, UDVA at the first week and first year after reposition was 0.0 logMAR (20/20 Snellen), and compared with 0.3 logMAR (20/40 Snellen) in the first week, the UNVA was improved to 0.0 logMAR (20/20 Snellen) one year after surgery.

CONCLUSION

The postoperative inflammatory reaction and lens epithelial cells proliferation were obvious in this glaucoma patient. Capsule polishing and rotation of the lens were beneficial to the patient, which not only enhanced the patient's vision, but also improved the patient's satisfaction. Therefore, glaucoma patients need to be cautious of implanting multifocal IOLs. Placement of a near segment of an asymmetrical multifocal IOL in the dominant eye should be performed on an individual basis.

The effects of premium intraocular lenses on presbyopia treatments

Background

Presbyopia has become a global disease affecting the world's aging population. Among various treatments, cataract extraction and intraocular lens (IOL) implantation have become the most popular and common methods of presbyopia correction. During the twentieth century, IOLs have underwent significant innovation and advancements to meet the patients' high demands for functional vision at all distances.

Main Text

To meet the increasing needs for excellent near and intermediate vision for daily activities, some premium IOLs with more than one focus have been developed, for example, the refractive MfIOLs, diffractive MfIOLs, extended depth of field (EDOF) IOLs, and accommodating IOLs (AIOLs) were introduced to meet this need. In addition, the add-on MfIOLs have been explored as promising supplementary IOLs for pseudophakic presbyopia. When selecting the MfIOLs, the IOLs' features, patients' characteristics, preoperative eye conditions, and treatment expectations should be considered.

Conclusions

In this review, we focus on the multifocal IOLs (MfIOLs) commonly used for presbyopia correction and systematically summarized their optical designs and clinical outcomes. More evidence-based studies are required to provide guidelines for MfIOL selection, provide maximum visual benefits, and develop personalized visual solutions in the future.

New method to improve the quality of vision in cataractous keratoconus eyes

To analyze using optical simulations if the proper use of a segmented intraocular lens (IOL) can improve the visual outcomes compared to the implantation of a spherical monofocal IOL. The wavefront profile of the Mplus (Oculentis) and a monofocal IOLs with the phase transformation introduced by each IOL were calculated using a Hartmann-Shack wavefront sensor. In addition, the wavefront profile of schematic eye models of various keratoconus conditions was obtained and was propagated to the IOLs. The optical performance of such combination was obtained after combining ray tracing and Fourier optics. A pre-clinical validation was also evaluated incorporating clinical data from three different keratoconus eyes of three patients. The implantation of the Mplus IOL can compensate or reduce the overall coma of the eye with keratoconus improving the quality of vision compared with a spherical monofocal IOL due to lower displacements of the retinal image or tilting in keratoconus. All theoretical simulations were confirmed afterwards by mean of a preclinical validation. The use of a standard toric segmented IOL with a proper orientation and selection of the addition can improve the optical quality of the keratoconus eye compared to the use of a monofocal spherical IOL.

Influence of angle kappa-customized implantation of rotationally asymmetric multifocal intraocular lens on visual quality and patient satisfaction

PURPOSE

To evaluate the visual outcomes and patient satisfaction with angle kappa-customized implantation of SBL-3 (Lenstec, Inc.; +3 D), a rotationally asymmetric multifocal intraocular lens (MIOL).

METHODS

This was a prospective randomized control study. Data from consecutive patients, who underwent bilateral implantation of SBL-3 MIOL from June 2017 to August 2018, were enrolled in the study. One eye of each patient was randomly chosen to receive a horizontal IOL placement (control group), while the other eye received angle kappa-customized placement (design group). The outcomes include uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), defocus curve, contrast sensitivity, quality of vision and patient satisfaction. The follow-up was 3 months.

RESULTS

The study enrolled 80 eyes of 40 patients. There was no significant difference in mean UDVA, UIVA and UNVA between the two groups. The design group showed significantly better visual acuity at -1.50 D of defocus, based on the defocus curve (p = 0.022), and less vertical coma (p = 0.002) than the control group. No significant differences in contrast sensitivity, modulation transfer function, Strehl ratio and patient satisfaction were found between the two groups.

CONCLUSION

Angle kappa-customized implantation of SBL-3 had little impact on visual outcomes and patient satisfaction, except for a moderate impact on intermediate visual acuity.

[Current Review: Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses]

Presbyopia and cataract patients' wish to be increasingly independent of spectacles after surgery and this is one of the main drivers for the development of multifocal intraocular lenses (MIOL) and extended depth of focus (EDOF) intraocular lenses (IOL). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract refractive surgeons to help address this need. There is not one single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOL and EDOF IOL, their optics, and their impact on our patients' quality of vision have to be fully understood if we have to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOL/EDOF IOL, in order to help surgeons find an appropriate solution for each of their individual patients.

Visual Outcomes and Subjective Experience After Combined Implantation of Extended Depth of Focus and Trifocal IOLs

PURPOSE

To evaluate postoperative visual performance and patient-reported outcomes following combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a trifocal IOL.

METHODS

The study enrolled consecutive patients undergoing refractive lens extraction or cataract surgery with combined implantation of an EDOF IOL (dominant eye) and a trifocal IOL in the nondominant eye. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, defocus curves, and subjective questionnaires were evaluated 1 month postoperatively.

RESULTS

The study enrolled 100 consecutive patients (200 eyes). The postoperative mean binocular UDVA, UIVA, and UNVA were -0.08 ± 0.07, 0.13 ± 0.12, and 0.17 ± 0.11 logMAR, respectively. The percentage of eyes within ±0.50 and ±1.00 diopters of the refractive target was 65% and 96% with EDOF IOLs, and 76% and 99% with trifocal IOLs, respectively. Of all patients, 91% were satisfied or more than satisfied with the procedure, and 87% of patients were spectacle free for near vision. On a scale from 0 (not at all) to 3 (very), mean scores of 0.52 ± 0.83, 0.71 ± 0.83, and 0.34 ± 0.73 were reported for glare, halos, and starbursts. The mean daytime and nighttime Quality of Vision scores were 9.13 ± 0.91 and 7.96 ± 1.57, respectively.

CONCLUSIONS

The combination of an EDOF IOL and a trifocal IOL provides good unaided visual acuity for distance and near. This IOL combination provides high postoperative satisfaction and functional vision, but some early visual side effects were reported. [J Refract Surg. 2020;36(5):326-333.].

Visual quality and performance comparison between 2 refractive rotationally asymmetric multifocal intraocular lenses

PURPOSE

To compare the 12-month postoperative quality of vision and visual performance of 2 different refractive rotationally asymmetric multifocal intraocular lenses (IOLs).

SETTING

Cathedral Eye Clinic, Belfast, Northern Ireland, United Kingdom.

DESIGN

Retrospective case series.

METHODS

Refractive lens exchange (RLE) patients were divided into 2 groups. Group A comprised eyes receiving a Lentis Mplus LS-312 MF30 IOL and Group B, eyes receiving a Lenstec SBL-3 IOL. Refraction, uncorrected (UDVA) and corrected distance visual acuities, uncorrected intermediate (UIVA) and near (UNVA) visual acuities, distance-corrected intermediate and near (DCNVA) visual acuities, and quality of vision were evaluated preoperatively and up to 12 months postoperatively.

RESULTS

Each group comprised 90 eyes. Both groups had a high level of quality of vision 12 months postoperatively with no significant difference between the 2 groups (P = .919). There was no significant between-group difference in mean monocular and binocular UDVA, monocular UIVA, or monocular UNVA. Group B had statistically significantly better mean monocular DCNVA (P = .049), binocular UNVA (P = .011), and binocular DCNVA (P = .035). Group B had a higher percentage of complete spectacle independence.

CONCLUSIONS

Both refractive rotationally asymmetric multifocal IOLs provided an excellent level of quality of vision 12 months postoperatively. Both IOL models restored distance, intermediate, and near visual function; however the IOLs in Group B provided better near visual performance.

Visual Outcomes After Implantation of a Segmental Refractive Multifocal Intraocular Lens Following Cataract Surgery

PURPOSE

To evaluate visual outcomes, with particular attention to intermediate visual acuity (VA), of a segmental refractive multifocal intraocular lens (IOL) with optimized depth of focus (DoF).

DESIGN

Prospective, nonrandomized, noncomparative case series.

METHODS

Setting: Department of Ophthalmology, Goethe University, Frankfurt/Germany. Patient or Study Population: Fifty eyes (25 patients) were included. Inclusion criteria were bilateral cataract, age > 45 years, corneal astigmatism ≤ 0.75 diopter (D) postoperatively, pupil size 3-6 mm (mesopic), and center shift < 1 mm (Pentacam). Exclusion criteria were ocular surgeries, amblyopia, or potential postoperative distance-corrected VA (DCVA) > 0.3 logMAR. Intervention or Observation: Uncorrected (UCVA) and DCVA in 4 m, 80 cm, 40 cm; contrast sensitivity (CS); reading skills; defocus curve; and questionnaire on optical quality (OQ) and spectacle independence were assessed after 3 months.

MAIN OUTCOME MEASURES

UCVA and DCVA in 4 m, 80 cm, 40 cm; defocus curve.

RESULTS

UCVA was 0.05 ± 0.122 logMAR at 4 m, 0.18 ± 0.164 logMAR at 80 cm, and 0.16 ± 0.140 logMAR at 40 cm. Defocus curve testing showed, respectively, a flat monocular and binocular VA range from 0.00 to -2.00 D (-0.03 to 0.11 logMAR, -0.05 to 0.05 logMAR). Median CS under photopic and mesopic conditions without and with glare was 1.81 logCS, 1.65 logCS, 1.52 logCS, and 1.14 logCS, respectively. Reading speed at 40 cm showed a reading acuity of 0.100 logRAD with 94 words/minute.

CONCLUSION

This segmental multifocal IOL provides good VA at all distances (<0.20 logMAR), particularly providing good intermediate visual acuity and DoF. It showed good reading skills, OQ, and CS and high spectacle independence.

Correction of presbyopia: An integrated update for the practical surgeon

Presbyopia results from loss or insufficiency of the eye's accommodative ability, and clinically manifests as the inability to focus near objects on the retina. It is one of the most common causes of visual impairment worldwide especially in adults of productive or working age. Various means of compensating for the loss of accommodative ability have been devised from optical tools such as spectacles and contact lenses, to topical medications and to surgical procedures. A comprehensive search on journal articles about topical and surgical correction of presbyopia was undertaken. The various techniques for presbyopia correction, as enumerated in these articles, are discussed in this paper with the addition of our personal experience and perspective on the future of these techniques.

Validity of automated refraction after segmented refractive multifocal intraocular lens implantation

AIM

To evaluate the clinical utility of automated refraction (AR) and keratometry (KR) compared with subjective or manifest refraction (MR) after cataract or refractive lens exchange surgery with implantation of Lentis Mplus X (Oculentis GmbH) refractive multifocal intraocular lens (IOL).

METHODS

Eighty-six eyes implanted with the Lentis Mplus X multifocal IOL were included. MR was performed in all patients followed by three consecutive AR measurements using the Topcon KR-8000 autorefractor. Assessment of repeatability of consecutive AR before and after dilation with phenylephrine 10%, and comparison of the AR and KR with MR using vector analysis were performed at 3mo follow-up.

RESULTS

Analysis showed excellent repeatability of the AR measurements. Linear regression of AR versus MR showed good correlation for sphere and spherical equivalent, whereas the correlation for astigmatism was low. The mean difference AR-MR was -1.28±0.29 diopters (D) for sphere. Astigmatism showed better correlation between KR and MR.

CONCLUSION

We suggest AR sphere plus 1.25 D and the KR cylinder as the starting point for MR in eyes with a Lentis Mplus X multifocal IOL. If AR measurements are equal to MR, decentration of the IOL should be suspected.

Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses

Presbyopia and cataract patients' desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal intraocular lenses (MIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract-refractive surgeons to help address this need. There is not 1 single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOLs and EDOF IOLs, their optics, and their respective impact on our patients' quality of vision have to be fully understood to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOLs/EDOF IOLs to help surgeons find an appropriate solution for each of their individual patients.