Comparative visual performance of diffractive bifocal and rotationally asymmetric refractive intraocular lenses

Comparison of visual performance between diffractive bifocal and diffractive trifocal intraocular lenses

To evaluate the visual performance of a diffractive bifocal intraocular lens (IOL) with + 4.0 D near addition (ZMB00) and a diffractive trifocal IOL with + 2.17 D and + 3.25 D near addition (AcrySof IQ PanOptix TFNT00), we investigated the 10-week postoperative parameters after cataract surgery in which ZMB00 or TFNT00 lenses were implanted bilaterally from 2011 to 2020 (with a 3-month interval between implantation of the right and left lenses). The study included 1448 eyes of 724 patients. The diffractive bifocal group comprised 1326 eyes of 663 patients (aged 67.0 ± 7.8 years; females/males, 518/145), and the diffractive trifocal group comprised 122 eyes of 61 patients (aged 66.6 ± 7.3 years; females/males, 35/26). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Uncorrected near visual acuity and higher-order aberrations (ocular/internal, scaled to a pupil size of 4 mm) (Wavefront_4mm_postoperative_Ocular/Internal_Spherical) were significantly better in the bifocal group (p < 0.00068, Wald test). Uncorrected intermediate visual acuity, contrast sensitivity (6.3/4.0/2.5/1.6/1.0/0.7 degrees), and contrast sensitivity with glare (4.0/1.6/1.0/0.7 degrees) were significantly better in the trifocal group (p < 0.00068, Wald test).

Comparison of cataract patients with regular corneal astigmatism after implantation of extended range-of-vision and bifocal toric intraocular lenses

Purpose

To compare the postoperative visual acuity and visual quality between extended range-of-vision and multifocal toric intraocular lens (IOLs) after implantation in cataract patients with regular corneal astigmatism.

Setting

Department of Ophthalmology, the Second Hospital of Jilin University, Changchun, Jilin Province, China.

Design

Retrospective and single-center study.

Methods

The study involved implanting the Tecnis Symphony (ZXR00IOL) or the bifocal toric (ZMTIOL) in patients undergoing cataract surgery. Three months after surgery, lens performance was evaluated using distance, intermediate, and near visual acuity tests, defocus curves, the modulation transfer function (MTF), a visual function index questionnaire (VF-14), and the adverse optical interference phenomena.

Results

The 3-month postoperative follow-up found that both groups had good corrected distance vision. The ZMT group had better-uncorrected distance visual acuity and near visual acuity (p < 0.05). However, the ZXR group showed better uncorrected intermediate visual acuity (p < 0.05) and visual continuity. Overall astigmatism in the postoperative ZMT group was significantly lower than that in the pre-operative group (p < 0.05). The ZMT group had lower total high-order aberrations (tHOs), higher MTF values, and higher VF-14 scores (p < 0.05). Finally, the ZXR group exhibited reduced halo and glare phenomena (p < 0.05).

Conclusion

We found that ZMT can effectively correct a corneal astigmatism of 1.0-1.5 D and ZXR can improve patient outcomes regarding subjective optical quality and range of vision. These findings have the potential to improve future astigmatism treatment options.

Comparison of visual performance between bifocal and extended-depth-of-focus intraocular lenses

We compared the visual performance of a bifocal intraocular lens (IOL) (ZMB00) and an extended-depth-of-focus (EDOF) IOL (ZXR00V) by evaluating postoperative parameters at 10 weeks after the last surgery in cataract patients who underwent bilateral ZMB00 or ZXR00V implantation between 2011 and 2020. The right and left lenses were implanted within 3 months of each other. The study enrolled 1536 eyes of 768 patients; the ZMB00 group comprised 1326 eyes of 663 patients (age: 67.0 ± 7.8 years; female/male, 518/145), and the ZXR00V group comprised 210 eyes of 105 patients (age: 67.8 ± 6.9 years; female/male, 39/66). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations and pupil diameter, ensured statistical validity. Uncorrected near visual acuity, corrected near visual acuity, and near spectacle independence were significantly better in the ZMB00 group (p<0.00068, Wald test) than in the ZXR00V group. Contrast sensitivity (visual angle of the test target: 4.0°/2.5°/1.6°/1.0°/0.7°) and contrast sensitivity with glare (4.0°/2.5°/1.6°/1.0°/0.7°) were significantly better in the ZXR00V group (p<0.00068, Wald test) than in the ZMB00 group. Uncorrected intermediate visual acuity, contrast sensitivity with glare (6.3°), and 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) scores for General Vision were slightly but significantly better in the ZXR00V group than in the ZMB00 group (p<0.05, Wald test). At high-performance levels, the two IOL groups had different characteristics regarding various visual performance parameters.