Depth of field measures in pseudophakic eyes implanted with different type of presbyopia-correcting IOLS

Objective Versus Subjective Depth of Focus Correlation in Pseudophakic Eyes

PURPOSE

To develop a method for quantifying objective depth of focus (DOF) from the visual Strehl ratio based on the optical transfer function (VSOTF), measured on a ray-tracing aberrometer (iTrace; Tracey Technologies) and to compare it to the subjective clinical DOF in two groups of pseudophakic eyes with varying asphericity of the intraocular lenses (IOLs).

METHODS

In this cross-sectional study, two groups with negatively aspheric (Eyhance; Johnson & Johnson) and aspherically neutral (RayOne; Rayner) IOLs were assessed 3 to 9 months postoperatively. The patient assessments included: logarithm of the minimum angle of resolution visual acuity, refraction, defocus curves, and iTrace assessments. The primary outcome was to determine the threshold of VSOTF (%) corresponding to subjective DOF. Secondary outcomes were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction, keratometry, and wavefront aberrometry. The specific threshold of VSOTF matching the subjective DOF was determined.

RESULTS

Forty-two eyes (21 patients in each IOL group) were analyzed. For the primary outcome, in the Eyhance versus the RayOne IOL group and all eyes together there was no significant difference between 25% (P = .10 vs .28; P = .07) and 30% (P = .55 vs .73; P = .58) VSOTF and subjective DOF, respectively. For secondary outcomes, UDVA was better in the Eyhance group (P = .02). There was no difference in CDVA, manifest refraction, and keratometry. There was a significant difference in total and internal spherical aberration between the two groups, although it was not clinically significant.

CONCLUSIONS

This study showed that a 25% to 30% threshold of VSOTF values on iTrace measurements (Nanavaty Threshold) gives an objective DOF estimate, equivalent to clinical DOF derived from the defocus curve irrespective of the IOL's optical profiles. [J Refract Surg. 2025;41(4):e310-e317.].

Improvements in visual function early after cataract surgery in eyes implanted with multifocal intraocular lenses

PURPOSE

To compare the improvements in all-distance visual acuity (VA) and contrast sensitivity early after cataract surgery among eyes implanted with multifocal and monofocal intraocular lenses (IOLs).

STUDY DESIGN

Nonrandomized comparative study.

METHODS

Forty-two eyes with a trifocal IOL (Alcon, PanOptix®), 42 eyes with a combined bifocal and extended-depth-of-focus (EDF) IOL (Johnson & Johnson, Synergy®), and 84 eyes with a monofocal IOL were recruited. Uncorrected or corrected VA at various distances, and photopia and mesopic contrast VA were examined at 1 day and 3 months postoperatively. Improvements in these VAs were compared between time points and among groups.

RESULTS

Mean uncorrected as well as corrected VA improved significantly between 1 day and 3 months postoperatively at almost all distances in the trifocal and combined bifocal + EDF groups (P ≤ 0.018), and at the intermediate distance of 1.0 m and far distances in the monofocal group (P ≤ 0.031). Mean improvements in near uncorrected VA at 0.3 m, intermediate VA at 0.5 m, and far VA at 2.0, 3.0, and 5.0 m were significantly greater in the multifocal groups than in the monofocal group (P ≤ 0.032). Improvements in photopic and mesopic contrast VA at most contrasts were significantly better in the multifocal groups (P ≤ 0.021).

CONCLUSION

Mean uncorrected or corrected VA at almost all distances and contrast sensitivity at most contrasts improved significantly early after surgery in eyes implanted with multifocal IOLs, and the improvements in VA at most distances and in contrast sensitivity were better with multifocal IOLs than with monofocal IOLs.

Clinical outcomes of a toric continuous range of vision presbyopia-correcting intraocular lens

PURPOSE

To evaluate the clinical outcomes of the toric version of a presbyopia-correcting intraocular lens (IOL) based on the combination of a diffractive-based extended depth-of-focus (EDOF) pattern and a diffractive multifocal platform.

SETTING

Miranza COI Bilbao, Bilbao, Spain.

DESIGN

Prospective case series.

METHODS

35 patients (51 to 84 years) with corneal astigmatism ranging from 0.75 to 2.19 diopters (D) undergoing bilateral cataract surgery with implantation of the Synergy Toric II IOL were evaluated during a 3-month follow-up. Visual acuity, refraction, defocus curve, and patient-reported outcomes with the Catquest-9SF questionnaire were analyzed. A vectorial analysis was used to analyze the accuracy of astigmatic correction.

RESULTS

Mean 3-month monocular postoperative uncorrected distance, intermediate (80 cm) and near (40 cm) visual acuities were 0.06 ± 0.11 logMAR, 0.13 ± 0.12 logMAR, and 0.13 ± 0.09 logMAR, respectively. Mean monocular distance-corrected intermediate (80 cm) and near visual acuity (40 cm) were 0.11 ± 0.12 logMAR and 0.10 ± 0.10 logMAR, respectively. Mean binocular defocus curve showed visual acuities of 0.10 logMAR or better for defocus levels from +0.50 to -2.50 D. Residual cylinder was within ±0.50 D in 97.0% of eyes. The surgically induced astigmatism prediction error ranged between -0.49 D and 0.50 D, with a mean value of 0.04 ± 0.16 D. Mean absolute IOL rotation was 3.79 ± 2.94 degrees. Significant improvements were found in all Rasch-calibrated scores obtained with Catquest-9SF ( P < .001).

CONCLUSIONS

The implantation of the toric presbyopia-correcting IOL evaluated provides an efficacious astigmatic correction while providing a fully restoration of the visual function across different distances.

Visual results and subjective satisfaction after implantation of two different trifocal diffractive intraocular lenses models (AcrySof IQ PanOptix and AT LISA tri 839 MP)

BACKGROUND

This study aimed to compare visual results following the implantation of two distinct diffractive trifocal IOLs utilizing various vision evaluation techniques and subjective satisfaction.

METHODS

The study included 32 eyes receiving AcrySof IQ PanOptix implantation and 32 receiving AT LISA tri 839 MP. Post-operative examination at one year included uncorrected visual acuity (UCVA), distance-corrected visual acuity (DCVA) at 4 m, 80 cm, 60 cm, and 40 cm, Contrast sensitivity under photopic and mesopic conditions, and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence.

RESULTS

The two groups were similar in baseline demographics, pre-operative visual, biometric data (except for axial length), and surgical paraments. The PanOptix outperformed the AT LISA tri in the intermediate range when using the standard visual acuity testing (UCVA: 0.23 ± 0.14 logMAR vs. 0.31 ± 0.17 logMAR, p = 0.04; BCVA: 0.21 ± 0.12 vs. 0.28 ± 0.14, p = 0.03) and in the intermediate and far range when using the interactive computer program (intermediate: UNVA "E" optotype test: 0.05 ± 0.12 vs. 0.12 ± 0.13, p = 0.03; Far: UNVA "E" optotype: 0.07 ± 0.12 vs. 0.13 ± 0.10, p = 0.05). In addition, the PanOptix group had higher contrast sensitivity under photopic and mesopic conditions with and without glare at all spatial frequencies. There was no difference in subjective outcomes between the groups.

CONCLUSIONS

Patients who received PanOptix IOL had better visual outcomes for intermediate and far with higher contrast sensitivity under various conditions. Based on patients ' needs and demands, these results could support discussion when tailoring the optimal multifocal IOl.

Comparison of visual outcomes of bilateral dual-technology diffractive intraocular lens vs blended enhanced monofocal with dual-technology intraocular lens

PURPOSE

To compare clinical outcomes after implantation of TECNIS Synergy (ZFR00V) intraocular lenses (IOLs) in both eyes and implantation of the TECNIS Synergy and TECNIS Eyhance (ICB00) combination in patients undergoing cataract surgery.

SETTING

Department of Cataract, Hospital Oftalmológico de Brasilia (HOB), Brasília, Brazil.

DESIGN

Prospective, interventional, randomized, parallel-group study.

METHODS

Patients were categorized into 2 groups: Group 1: ZFR00V IOL was implanted in both eyes. Group 2: An ICB00 IOL was implanted in the dominant eye, and a ZFR00V IOL was implanted in the nondominant eye.

RESULTS

Visual acuity was similar between the 2 groups (95% CI <0.1 logMAR). A superior visual acuity of ≥ 20/25 (at -2.00 to -2.50 diopters [D]) was achieved in Group 1 (bilateral ZFR00V) than in Group 2 (combination of ZFR00V/ICB00). The binocular defocus curve demonstrated better visual acuity at 40 cm (-2.00 D) and 50 cm (-2.50 D) in Group 1 than in Group 2 ( P < .05). Similar contrast sensitivity values were observed between the 2 groups. Patients in Group 1 reported higher satisfaction (completely satisfied) than those in Group 2 ( P < .05). However, halos and glare were more pronounced in Group 1 than in Group 2 ( P < .05).

CONCLUSIONS

Both presbyopia-correcting IOL combinations showed similar binocular visual acuity results. Group 1 demonstrated enhanced visual acuity in the defocus curve at 40 cm (-2.00 D) and 50 cm (-2.50 D). Comparable contrast sensitivity outcomes were observed in both groups. Patients were more completely satisfied in Group 1 than in Group 2, despite the higher frequency of postoperative nighttime halos and glare.

Increasing depth of focus with allogeneic presbyopic inlays: 3-year results

PURPOSE

To demonstrate the safety and efficacy of allogenic corneal inlays designed to increase the depth of focus (DoF) in treated eyes.

SETTINGS

Medipol University Hospital, Istanbul, Turkey.

DESIGN

Prospective case series.

METHODS

This study includes 50 eyes of 25 patients with a follow-up of 3 years. Emmetropic patients with presbyopia had implantation of allogenic corneal inlays in the nondominant eye. The uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and uncorrected near visual acuity (UNVA) were evaluated in all eyes. A subjective visual acuity test system (Multifocal Lens Analyzer 3.0 application) was used to analyze the DoF by measuring the defocus curves.

RESULTS

No significant difference between the treated and fellow eyes in UDVA and CDVA was found, whereas UNVA was significantly better in the treated eyes ( P = .20, P = .07, P < .01, respectively). Comparing to the preoperative CDVA, there was a 1-line decrease in CDVA in 6 (%24) patients. The mean defocus curves reveal a DoF of 1.1 diopters (D) for the untreated eye at the logMAR = 0.2 threshold. By contrast, the mean DoF of the treated eye and binocularly was 2.8 D. The areas under the curve were significantly better in the near, intermediate, and total distances in the treated eyes, whereas it was better for the far distances in the untreated eyes. All values were significant ( P = .023 total, P < .01 others).

CONCLUSIONS

Allogenic presbyopic inlay implantation may be safe and provided a clinically and statistically significant increase in the DoF leading to good far, intermediate, and near-visual acuity in emmetropic presbyopic patients.

Functional outcomes after bilateral refractive lens exchange with a continuous-range-of-vision intraocular lens

PURPOSE

To clinically evaluate a diffractive continuous-range-of-vision intraocular lens (IOL) that combines bifocal and extended depth-of-focus technologies in refractive lens exchange (RLE) patients.

SETTING

University eye clinic.

DESIGN

Prospective interventional clinical study.

METHODS

Bilateral implantation of the TECNIS Synergy IOL was performed during a RLE procedure in 28 patients. At 3 months postoperatively, uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuities at 80 cm, and uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuities at 40 cm were assessed. Defocus curve testing and contrast sensitivity testing were also performed.

RESULTS

Binocular UDVA and CDVA of 56 eyes (28 patients) were -0.06 ± 0.07 logMAR and -0.13 ± 0.05 logMAR, respectively. UIVA and DCIVA were -0.06 ± 0.05 logMAR and -0.08 ± 0.06 logMAR, and UNVA and DCNVA were -0.01 ± 0.07 logMAR and -0.04 ± 0.07 logMAR. The defocus curve revealed a visual acuity of 0.10 logMAR or better from +0.50 to -3.00 diopters (D). Photopic contrast sensitivity at spatial frequencies 3.0, 6.0, 12.0, and 18.0 was 1.68 ± 0.20, 1.77 ± 0.19, 1.45 ± 0.18, and 1.02 ± 0.19 log units, respectively. Mesopic contrast sensitivity at the same frequencies was 1.56 ± 0.20, 1.44 ± 0.25, 0.92 ± 0.38, and 0.44 ± 0.37, respectively.

CONCLUSIONS

The Synergy IOL provided very good distance, intermediate, and near visual outcomes. A visual acuity of 0.10 logMAR or better was achieved from +0.50 to -3.0 D. Contrast sensitivity was within the normal range.

Clinical Outcomes with Extended Depth of Focus Intraocular Lenses in Cases in Which Multifocal Lenses Are Not Primarily Recommended

Purpose

The purpose of the study is to evaluate the visual and patient-reported outcomes of patients undergoing cataract surgery with implantation of an extended depth of focus (EDOF) intraocular lens (IOL) who were not primarily good candidates for multifocal IOL implantation.

Methods

Retrospective analysis of data from 30 eyes (23 patients) undergoing cataract surgery with implantation of one of two EDOF IOLs (follow-up: 37.9 ± 16.2 months) and prospective observational study including 106 eyes (78 patients) implanted with one of 6 different EDOF models (follow-up: 8.0 ± 7.7 months). Patients recruited had one of the following conditions: monofocal IOL implanted in the fellow eye, previous corneal refractive surgery, mild and nonprogressive maculopathy or glaucoma, age > 75 years, amblyopia, or previous vitrectomy.

Results

In the retrospective phase, significant improvements were found in uncorrected distance (UDVA), corrected distance (CDVA), and corrected near visual acuity (CNVA) (p ≤ 0.013), with a nonsignificant trend to improvement in uncorrected near visual acuity (UNVA). A total of 90% of patients were completely to moderately satisfied with the outcome achieved. In the prospective phase, significant improvements were found in UDVA, CDVA, UNVA, and CNVA (p ≤ 0.032), with a total of 85.5% of patients being completely to moderately satisfied (dissatisfaction 3.3%). In both phases, extreme difficulties were only reported by a limited percentage of patients for performing some near vision activities.

Conclusions

EDOF IOLs seem to be a viable option for providing an efficient visual rehabilitation with good levels of patient satisfaction and spectacle independence associated in patients that are not primarily good candidates for multifocal IOL implantation.

Trifocal intraocular lenses versus bifocal intraocular lenses after cataract extraction among participants with presbyopia

BACKGROUND

Presbyopia occurs when the lens of the eyes loses its elasticity leading to loss of accommodation. The lens may also progress to develop cataract, affecting visual acuity and contrast sensitivity. One option of care for individuals with presbyopia and cataract is the use of multifocal or extended depth of focus intraocular lens (IOL) after cataract surgery. Although trifocal and bifocal IOLs are designed to restore three and two focal points respectively, trifocal lens may be preferable because it restores near, intermediate, and far vision, and may also provide a greater range of useful vision and allow for greater spectacle independence in individuals with presbyopia.

OBJECTIVES

To assess the effectiveness and safety of implantation with trifocal versus bifocal IOLs during cataract surgery among people with presbyopia.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 3); Ovid MEDLINE; Embase.com; PubMed; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 31 March 2022.  SELECTION CRITERIA: We included randomized controlled trials that compared trifocal and bifocal IOLs among participants 30 years of age or older with presbyopia undergoing cataract surgery.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology and graded the certainty of the body of evidence according to the GRADE classification.

MAIN RESULTS

We identified seven studies conducted in Europe and Turkey with a total of 331 participants. All included studies assessed visual acuity using a logarithm of the minimum angle of resolution (LogMAR chart). Of them, six (86%) studies assessed uncorrected distance visual acuity (the primary outcome of this review). Some studies also examined our secondary outcomes including uncorrected near, intermediate, and best-corrected distance visual acuity, as well as contrast sensitivity. Study characteristics All participants had bilateral cataracts with no pre-existing ocular pathologies or ocular surgery. Participants' mean age ranged from 55 to 74 years. Three studies reported on gender of participants, and they were mostly women. We assessed all of the included studies as being at unclear risk of bias for most domains. Two studies received financial support from manufacturers of lenses evaluated in this review, and at least one author of another study reported receiving payments for delivering lectures with lens manufacturers. Findings All studies compared trifocal versus bifocal IOL implantation on visual acuity outcomes measured on a LogMAR scale. At one year, trifocal IOL showed no evidence of effect on uncorrected distance visual acuity (mean difference (MD) 0.00, 95% confidence interval (CI) -0.04 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence) and uncorrected near visual acuity (MD 0.01, 95% CI -0.04 to 0.06; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). Trifocal IOL implantation may improve uncorrected intermediate visual acuity at one year (MD -0.16, 95% CI -0.22 to -0.10; I2 = 0%; 2 studies, 107 participants; low-certainty evidence), but showed no evidence of effect on best-corrected distance visual acuity at one year (MD 0.00, 95% CI -0.03 to 0.04; I2 = 0%; 2 studies, 107 participants; low-certainty evidence). No study reported on contrast sensitivity or quality of life at one-year follow-up. Data from one study at three months suggest that contrast sensitivity did not differ between groups under photopic conditions, but may be worse in the trifocal group in one of the four frequencies under mesopic conditions (MD -0.19, 95% CI -0.33 to -0.05; 1 study; I2 = 0%, 25 participants; low-certainty evidence). One study examined vision-related quality of life using the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) at six months, and suggested no evidence of a difference between trifocal and bifocal IOLs (MD 1.41, 95% CI -1.78 to 4.60; 1 study, 40 participants; low-certainty evidence). Adverse events Adverse events reporting varied among studies. Of five studies reporting information on adverse events, two studies observed no intraoperative and postoperative complications or no posterior capsular opacification at six months. One study reported that glare and halos were similar to the preoperative measurements. One study reported that 4 (20%) and 10 (50%) participants had glare complaints at 6 months in trifocal and bifocal group, respectively (risk ratio 0.40, 95% CI 0.15 to 1.07; 40 participants). One study reported that four eyes (11.4%) in the bifocal group and three eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy at one year. The certainty of the evidence for adverse events was low.

AUTHORS' CONCLUSIONS

We found low-certainty of evidence that compared with bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate visual acuity at one year. However, there was no evidence of a difference between trifocal and bifocal IOL for uncorrected distance visual acuity, uncorrected near visual acuity, and best-corrected visual acuity at one year. Future research should include the comparison of both trifocal IOL and specific bifocal IOLs that correct intermediate visual acuity to evaluate important outcomes such as contrast sensitivity, quality of life, and vision-related adverse effects.

Evaluation of extended depth-of-focus hydrophobic intraocular lens with an optic concept based on combination of high-order aberrations

Background

Extended depth-of-focus (EDOF) intraocular lenses (IOLs) provide a continuous range of uncorrected vision at different distances.

Objective

To assess visual acuity, refractive outcomes, and patient satisfaction after cataract surgery using the LuxSmart EDOF IOL (Bausch+Lomb).

Design

A two-center, prospective observational clinical study.

Methods

This study includes patients who have undergone bilateral phacoemulsification with bilateral implantation of the LuxSmart EDOF IOL, with the aim of achieving emmetropia. Visual acuity (VA) and subjective refraction were obtained in all patients preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Subjective measures were obtained using the Catquest-9SF questionnaire and the Patient-Reported Spectacle Independence Questionnaire (PRSIQ). Contrast sensitivity and a glare assessment were undertaken postoperatively. Safety outcomes were additionally assessed.

Results

Sixty eyes from thirty patients were recruited for this study. The mean spherical equivalent was 1.04 ± 1.67 D preoperatively and -0.30 ± 0.46 D at 6 months. Monocular uncorrected distance VA was 0.57 ± 0.32 (logMAR) preoperatively and 0.09 ± 0.12 (logMAR) at 6 months. Mean 6-month monocular uncorrected VA was 0.11 ± 0.13, 0.12 ± 0.15, and 0.31 ± 0.15 (logMAR) at 80, 66, and 40 cm, respectively. More than 90% of patients were either fairly or very satisfied with their vision. There was one case of suspected vitreomacular traction postoperatively.

Conclusion

The LuxSmart EDOF IOL offers good refractive, VA, and safety outcomes. The single elongated focal point designed to enhance the DOF shows good results for VA and patient satisfaction.

Complementary system vs conventional trifocal intraocular lens: comparison of optical quality metrics and unwanted light distribution

PURPOSE

To evaluate the ARTIS Symbiose complementary intraocular lens (IOL) system, consisting of the MID and PLUS models, in comparison with a conventional trifocal IOL (AcrySof IQ PanOptix).

SETTING

The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.

DESIGN

Laboratory investigation.

METHODS

Modulation and phase transfer functions were obtained in polychromatic light using an optical bench setup. Simulated visual acuity (VA) values were derived from optical quality metrics weighted by neural contrast sensitivity. United States Air Force (USAF) chart images were acquired and processed. Furthermore, the light distribution beyond the center of a polychromatic point spread function was assessed.

RESULTS

The peak simulated VA values of ARTIS Symbiose MID were at 0 diopters (D) of defocus (-0.02 logMAR) and at -1.5 D (0.00 logMAR); of ARTIS Symbiose PLUS, they were at 0 D of defocus (-0.01 logMAR) and at -2.5 D (0.01 logMAR). AcrySof IQ PanOptix demonstrated 3 peaks: at 0 D of defocus (-0.02 logMAR), at -1.75 D (0.03 logMAR), and at -2.5 D (0.02 logMAR). The summation of USAF chart images in the simulated binocular IOL system produced a slightly better image quality at -1.0 D and -1.5 D than AcrySof IQ PanOptix. The IOLs yielded comparable light spread across the studied range except for a localized intensity spike of the ARTIS Symbiose IOLs.

CONCLUSIONS

The complementary IOL system may yield better monocular intermediate VA compared with the conventional trifocal IOL. However, the effect of binocular summation in terms of VA and the perception of photic phenomena still needs to be investigated.

Comparative Visual Outcome Analysis of a Diffractive Multifocal Intraocular Lens and a New Diffractive Multifocal Lens with Extended Depth of Focus

This study compares the visual and refractive performance of the TECNIS Synergy (DFR00V-DFW150-225-300-375) multifocal intraocular lens (IOL) and the AcrySof IQ PanOptix (TFAT00-30-40-50-60) multifocal IOL. Patients who underwent phacoemulsification and cataract extraction and received either a multifocal Synergy or PanOptix IOL were included. Monocular uncorrected distance (UDVA), intermediate (UIVA), near (UNVA), and corrected distance (CDVA) visual acuities were assessed at three and six months postoperatively. Secondary outcome measures of photic phenomena were also assessed. A total of 140 patients (224 eyes) were included in this study, with 69 patients (105 eyes) in the Synergy group and 71 patients (119 eyes) in the PanOptix group. There were no statistically significant differences in UIVA or CDVA measurements across all time points. When assessing UDVA, at three months postoperatively, there were more eyes in the PanOptix group with vision better than 20/40 (p = 0.04). At three and six months postoperatively, the average UNVA was superior in the Synergy group (p = 0.01, 0.002). While the Synergy group reported more night vision disturbances at one and three months (p = 0.01, 0.03), the PanOptix group had more night vision disturbances at six months (p = 0.02). Although not statistically significant, the AcrySof IQ PanOptix multifocal IOL demonstrated better UDVA and UIVA sooner postoperatively than the TECNIS Synergy multifocal IOL. The Synergy IOL provided statistically better UNVA compared to the PanOptix IOL at three and six months postoperatively. Synergy patients reported more early photic phenomena than PanOptix patients, which later diminished.

Comparative analysis of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and bifocal profiles with a standard monofocal intraocular lens

Background

Recently, a new presbyopia-correcting intraocular lens (IOL) that combines extended depth-of-focus and bifocal profiles (ZFR00: Tecnis® Synergy®, Johnson & Johnson Vision, Santa Ana, CA, USA) has been established and several studies have been reported. We attempted to compare the performance with a standard IOL (ZCB00: Tecnis® monofocal, Johnson & Johnson Vision, Santa Ana, CA, USA) manufactured using the same material from the same company, which has been extensively used worldwide.

Methods

The medical records of patients undergoing cataract surgery with ZCB00 or ZFR00 implantation between March 2021 and September 2021 and with available 3-month visit data were reviewed. Uncorrected near, intermediate, and distance visual acuity (VA), corrected distance VA, and optical quality were the main outcome measures.

Results

This study included forty-six patients (64 eyes), with twenty-one patients (32 eyes) implanted with ZCB00 and twenty-five patients (32 eyes) implanted with ZFR00. The average age of the patients was 66.0 ± 10.1 (range: 40 to 82) and 65.1 ± 4.7 (range: 59 to 77) years in the ZCB00 and ZFR00 groups, respectively. The preoperative characteristics did not differ significantly between the two groups. Compared to the ZCB00 group, the ZFR00 group demonstrated significantly superior intermediate and near VA (p < 0.001) at 3 months postoperatively. The ZFR00 group showed significantly lower objective measured optical quality than that in the ZCB00 group.

Conclusions

The ZFR00 exhibited a continuous range of vision and a smooth defocus curve, while the ZCB00 provided superior objective optical quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02516-6.

Depth of field and visual performance after implantation of a new hydrophobic trifocal intraocular lens

Purpose

To assess the depth of field (DOF) by means of defocus curve analysis applying different visual acuity criteria in patients following cataract surgery and bilateral implantation of a new trifocal diffractive intraocular lens (IOL).

Methods

Fifty eyes of 25 consecutive patients who underwent implantation of the Asqelio™ trifocal IOL (AST Products Inc., USA) were enrolled in this observational prospective study. Monocular subjective DOF was obtained from defocus curves with absolute and relative criteria of tolerance for different visual acuities values. Patient’s visual satisfaction, postoperative refraction and visual acuity at far, intermediate (67 cm) and near (40 cm) distances were also measured at 1 and 3-months post-surgery. Analysis of variance was used to assess differences in refractive error after the surgical procedure, and paired t-tests were used to assess differences in VA. Patient satisfaction results were reported as percentages.

Results

Spherical equivalent was 0.05 ± 0.23 D and residual cylinder 0.01 ± 0.23 D 3-months after the surgery. Absolute DOF obtained was 3.29 ± 0.91 D considering 0.1 LogMAR as cut-off value, and 4.82 ± 0.69 D when 0.3 logMAR as cutoff value. Relative DOF considering a drop of 0.1 logMAR from maximum visual acuity was 2.57 ± 0.82 D, and 1.27 ± 0.70 D when a drop of 0.04 logMAR was considered. Visual acuities obtained 3-months after the surgery were 0.03 ± 0.13, − 0.05 ± 0.06, 0.03 ± 0.08 and 0.04 ± 0.08 logMAR for uncorrected and best-corrected for distance, and best distance-corrected for intermediate and near distances, respectively. Average response to visual satisfaction queries was 8.24/10 at distance, 8.04/10 at intermediate, and 7.88/10 at near.

Conclusions

Patients implanted with this trifocal IOL showed a significant improvement in visual acuity at different distances providing wide absolute and relative DOF values. The outcomes demonstrate that this lens is predictable yielding good patient satisfaction rates.

The relationship between patient satisfaction and visual and optical outcome after bilateral implantation of an extended depth of focus multifocal intraocular lens

Purpose

To evaluate patient satisfaction after implantation of the Tecnis Symfony multifocal intraocular lens (MIOL).

Methods

120 eyes of 60 subjects with senile cataract were bilaterally implanted with the Tecnis Symfony IOL. Follow-up examination was performed 6 months postoperatively. Main outcome measures included uncorrected and corrected distance and near visual acuity, manifest refraction, and visual quality metrics. According to their subjective symptoms patient were divided in two groups: satisfied and unsatisfied.

Results

Uncorrected intermediate (0.15 ​± ​0.11 vs 0.18 ​± ​0.01, P ​= ​0.04) and near (0.26 ​± ​0.12 vs 0.31 ​± ​0.11, P ​= ​0.04) (UIVA, UNVA) log MAR visual acuity was significantly better, cylindrical error less (0.31 ​± ​0.36 vs 0.67 ​± ​0.29, P ​= ​0.05), axial length (AL) smaller (23.68 ​± ​1.3 vs 24.22 ​± ​1.6, P ​= ​0.05), Strehl ratio higher (0.08 ​± ​0.08 vs 0.05 ​± ​0.04, P ​= ​0.03) and mesopic pupil larger (4.3 ​± ​1.1 vs 3.7 ​± ​1.05, P ​= ​0.01) among satisfied patients.Residual cylinder, Strehl ratio, halos, mesopic pupil diameter and UNVA were significant predictors of patient satisfaction. Uncorrected distance visual acuity, higher order Strehl ratio and pupil diameter were significant predictors of halos. Near visual acuity significantly correlated (P ​= ​0.018, R ​= ​0.22) with axial length.

Conclusions

Uncorrected cylindrical error, poor reading quality, larger pupil and halos seem to be the most disturbing factors for patients implanted with the Tecnis Symfony IOL.

Comparison of visual results and optical quality of two presbyopia-correcting intraocular lenses: TECNIS symfony versus TECNIS synergy

PURPOSE

This study compared the extended depth of focus (EDOF) intraocular lens (IOL) (ZXR00; Tecnis® Symfony^®, Johnson & Johnson Vision, Santa Ana, CA, USA) and a new presbyopia-correcting IOL that combines EDOF and multifocal profiles (ZFR00; Tecnis^® Synergy^®, Johnson & Johnson Vision, Santa Ana, CA, USA) with the same material.

METHODS

The medical records of patients undergoing cataract surgery with ZXR00 or ZFR00 implantation between March 2021 and July 2021 and with the data available for the 3-month visit were reviewed. The uncorrected near, intermediate, and distance visual acuity (VA), corrected distance VA, defocus curves, refractive errors (RE), optical quality parameters, and patient-reported visual performance parameters were the main outcome measures.

RESULTS

Among the twenty-three enrolled patients, twelve patients (21 eyes) received ZXR00 and nine patients (17 eyes) received ZFR00. The mean age of the patients was 59.6 ± 10.6 (range: 49 to 70) and 65.2 ± 8.2 (range: 45 to 82) years in ZXR00 and ZFR00 groups, respectively, without significant difference. There was not a significant difference between the two groups in terms of baseline parameters and postoperative RE. The ZFR00 group showed markedly superior intermediate and near VA (p < 0.001 for all) at 3 months postoperatively. In terms of optical quality, ZXR00 was significantly better than ZFR00 (p < 0.001).

CONCLUSIONS

Both IOLs had comparable distance VA. ZFR00 IOL was superior for intermediate and near visual acuity, but ZXR00 IOL was better for optical quality. Research with more participants is needed to support this finding.

Vision through Healthy Aging Eyes

As life expectancy grows, so too will the number of people adversely affected by age. Although it is acknowledged that many conditions and diseases are associated with age, this mini-review will present a current update of the various visual changes that generally occur in healthy individuals disregarding the possible effects of illness. These alterations influence how the world is perceived and in turn can affect efficiency or the ability to perform ordinary daily tasks such as driving or reading. The most common physical developments include a decreased pupil size and retinal luminance as well as changes both in intercellular and intracellular connections within the retina along the pathway to the visual cortex and within the visual cortex. The quantity and the physical location of retinal cells including photoreceptors, ganglion and bipolar retinal cells are modified. The clarity of intraocular organs, such as the intraocular lens, decreases. These all result in common visual manifestations that include reduced visual acuity, dry eyes, motility changes, a contraction of the visual field, presbyopia, reduced contrast sensitivity, slow dark adaptation, recovery from glare, variation in color vision and a decreased visual processing speed. Highlighting these prevalent issues as well as current and possible future innovations will assist providers to formulate treatments and thereby conserve maximum independence and mobility in the modern mature population.

Preliminary Evaluation of the Clinical Benefit of a Novel Visual Rehabilitation Program in Patients Implanted with Trifocal Diffractive Intraocular Lenses: A Blinded Randomized Placebo-Controlled Clinical Trial

The authors of this study evaluated the potential benefit on visual performance of a novel 3 week visual rehabilitation program based on the use of Gabor patches in patients undergoing bilateral cataract surgery with the implantation of two models of trifocal diffractive intraocular lens (IOL). A total of 30 patients were randomly assigned to two groups: a study group (15 patients) that used a videogame based on Gabor patches and a placebo group (15 patients) that used a videogame without specific stimuli for improving visual performance. No statistically significant differences between groups were found in distance, intermediate, and near post-training visual acuity (p ≥ 0.15). Significantly better distance contrast sensitivity (CS) was found for the spatial frequencies of 6 (p = 0.02) and 12 cpd (p = 0.01) in the study group. Likewise, significantly better values of near CS were found in the study group compared to the placebo group for the spatial frequency of 1.5 cpd (p = 0.02). In conclusion, a 3 week visual rehabilitation program based on the use of Gabor patches in the immediate postoperative period after the bilateral implantation of trifocal diffractive IOLs seems to be beneficial for improving both distance and near visual performance achieved with the implant.