Comparison of clinical outcomes of 3 trifocal IOLs

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in 5,226 Patients With Presbyopia

PURPOSE

To assess visual and refractive outcomes and visual function after bilateral RayOne Trifocal toric and nontoric intraocular lens (IOL) (Rayner) implantation in patients with presbyopia.

METHODS

Charts of patients with presbyopia who underwent refractive lens exchange with bilateral implantation of the RayOne Trifocal IOL (toric and non-toric) were retrospectively reviewed. Visual and refractive outcomes were evaluated at 3 months. Patient satisfaction, spectacle independence, and visual disturbance profile were assessed by questionnaires.

RESULTS

A total of 5,226 patients were assigned to one of two groups: 1,010 patients had toric IOL implantation (toric group) and 4,216 patients received the non-toric model (non-toric group). Mean ± standard deviation visual acuity at 3 months for the toric group was binocular uncorrected distance visual acuity (UDVA) of 0.07 ± 0.11 logMAR, monocular corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR, binocular uncorrected near visual acuity (UNVA) at 40 cm of 0.10 ± 0.09 logMAR, binocular uncorrected intermediate visual acuity (UIVA) at 40 cm of 0.13 ± 0.12 logMAR, postoperative spherical equivalent (SE) of -0.21 ± 0.47 diopters (D), and cylinder of -0.34 ± 0.40 D. The non-toric group had binocular UDVA of 0.04 ± 0.08 logMAR, monocular CDVA of 0.05 ± 0.07 logMAR, binocular UNVA of 0.10 ± 0.08 logMAR, binocular UIVA of 0.13 ± 0.11 logMAR, SE of -0.08 ± 0.38 D, and cylinder of -0.28 ± 0.34 D. No statistically significant differences were found in achieving spectacle independence and there were high levels of satisfaction in both groups.

CONCLUSIONS

In this retrospective analysis with more than 5,000 patients, both the toric and non-toric RayOne Trifocal IOL models provided good visual performance at all distances, resulting in excellent levels of spectacle independence and patient satisfaction. [J Refract Surg. 2024;40(7):e468-e479.].

Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis

PURPOSE

To assess the efficacy and safety of various intraocular lenses (IOLs), including standard monofocal, bifocal, trifocal, extended depth of focus (EDOF), and enhanced monofocal IOLs, post-cataract surgery through a network meta-analysis.

METHODS

A systematic search of PubMed, Cochrane Library, and Web of Science was conducted to identify relevant studies from the past 5 years. Parameters such as binocular visual acuities, spectacle independence, contrast sensitivity (CS), and optical quality were used to evaluate efficacy and safety. Data from the selected studies were analyzed using Review Manager 5.4 and STATA 17.0 software.

RESULTS

Twenty-eight Randomized Controlled Trials (RCTs) comprising 2465 subjects were included. Trifocal IOLs exhibited superior uncorrected near visual acuity (UNVA) compared to monofocal IOLs (MD: -0.35; 95% CI: -0.48, -0.22). Both trifocal (AcrySof IQ PanOptix IOLs group MD: -0.13; 95% CI: -0.21, -0.06) and EDOF IOLs (MD: -0.13; 95% CI: -0.17, -0.09) showed better uncorrected intermediate visual acuity (UIVA) than monofocal IOLs. Trifocal IOLs ranked highest in spectacle independence at various distances (AT LISAtri 839MP group: SUCRA 97.5% for distance, 80.7% for intermediate; AcrySof IQ PanOptix group: SUCRA 83.0% for near).

CONCLUSIONS

For cataract patients who want to treat presbyopia, trifocal IOLs demonstrated better visual acuity and spectacle independence at near distances. Different types of trifocal IOL characteristics differ. EDOF and enhanced monofocal IOLs have improved visual quality at intermediate distances.Therefore, It is very important to select the appropriate IOLs based on the lens characteristics and patient needs.

Customizing Clinical Outcomes with Implantation of Two Diffractive Trifocal IOLs of Identical Design but Differing Light Distributions to the Far, Intermediate and Near Foci

Purpose

To evaluate clinical outcomes after bilateral or contralateral implantation of the Gemetric™ (G) and Gemetric™ Plus (GPlus) diffractive trifocal intraocular lenses (IOLs).

Methods

This was a prospective, randomized, multi-center open-label study comparing clinical results and subjective patient responses around 6 months after implantation of the study lenses (toric and non-toric) in three different groups (bilateral G, bilateral GPlus and contralateral G/GPlus implantation). Results included the manifest refraction, uncorrected and distance corrected monocular and binocular visual acuity (VA) at distance, intermediate and near; the defocus curve; contrast sensitivity; and patient reported outcomes regarding spectacle independence, satisfaction and visual disturbances.

Results

There was no statistically significant difference in the mean refraction spherical equivalent between the two lens models (p = 0.33) or between the toric and non-toric lenses (p = 0.06). Monocular VA was better at distance with the G lens and better at near with the GPlus lens (p < 0.01). Mean binocular VA was better than 0.1 logMAR at all distances for all groups, both uncorrected and distance corrected. The mean binocular distance corrected VA was better than 0.15 logMAR from 0.0 D to -3.50 D for all groups. All VA data for the contralateral group was as good or better than for the bilateral GPlus group. Questionnaire results showed no difference between groups for the frequency, severity, or degree of bother of visual disturbances (p > 0.24).

Conclusion

The two diffractive trifocal IOLs studied here may be used either bilaterally or contralaterally for the correction of presbyopia in cataract patients, providing excellent visual acuity with low levels of visual disturbances and high rates of overall spectacle independence. Bilateral Gemetric implantation resulted in slightly better distance and intermediate vision while contralateral implantation provided slightly better near vision. There was no apparent advantage to implanting the GPlus IOL bilaterally.

The accuracy of the trifocal IOL calculation using equivalent K-readings and total corneal power in different zones

PURPOSE

To identify the equivalent K-readings and total keratometry zones that is optimally suitable for calculating the IOL spheroequivalent according to 7 formulas.

METHODS

The study included 40 patients (40 eyes) who underwent uneventful femtosecond laser-assisted cataract surgery and refractive lens exchange (RLE) with implantation of a trifocal diffractive IOL (PanOptix, Alcon inc.). Targeted emmetropia was achieved in all patients, no distance and near correction was needed. Retrospective IOL calculations were performed utilizing 7 formulas (SRK/T, Holladay 1 and 2, Haigis, Hoffer Q, Barrett Universal 2, Olsen) and Pentacam keratometry data: Holladay equivalent K-readings, total optical power by ray tracing (TCRP) centered on the apex and pupil in 10 zones (from 0.5 to 5 mm in 0.5 mm increments). For each formula/zone/map combination: postoperative predicted refraction (PPRs), mean absolute errors (MAEs), and median absolute errors (MedAEs) were analyzed.

RESULTS

According to EKR, the Haigis formula showed the lowest error in the central zones up to 3.5 mm, the TCRP zone for Holladay I and II formulas 4.0-4.5 mm, for HofferQ and SRK/T formulas 4.5-5.0 mm, and for Olsen and Barrett II Universal-5 mm.

CONCLUSION

The use of keratometry data (EKR, TCRP) in the formulas adapted to SimK, with the correct choice of the evaluation zone of keratometric data, will increase the chance of hitting the refractive target.

Clinical Outcomes of a Bi-Aspheric Trifocal Diffractive Intraocular Lens

Purpose

To assess refractive and visual outcomes post-cataract surgery with bilateral implantation of a bi-aspheric diffractive trifocal intraocular lens (IOL).

Methods

A total of 24 patients who underwent bilateral implantation with the Asqelio Trifocal IOL TFLIO130C were evaluated at the 6 months postoperative mark. Key outcome measures included refractive error, photopic monocular and binocular uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and corrected intermediate visual acuity (UIVA, CDIVA) at 60 cm, and uncorrected and corrected near visual acuity (UNVA, CDNVA) at 40 cm. Additionally, monocular and binocular CDNVA were assessed under mesopic conditions. Monocular and binocular defocus curves, and binocular contrast sensitivity under photopic and mesopic conditions, with and without glare, were measured. Catquest-9SF and visual symptoms questionnaires were also administered.

Results

Postoperative average values of binocular logMAR photopic CDVA, photopic CDIVA, photopic CDNVA and mesopic CDNVA were -0.01±0.06, 0.03±0.09, 0.02±0.05 and 0.19±0.13, respectively. About 100% of patients showed cumulative CDVA and CDNVA ≥20/25, and CDIVA ≥20/32. The average absolute depth-of-focus was about 4.50D. The average postoperative spherical equivalent was 0.05±0.30D and 100% and 93.75% eyes were within ±1.00D and ±0.50D, respectively. Contrast sensitivity was either within or above normal levels under both photopic and mesopic conditions, both with and without glare, except for 12 cpd under mesopic conditions with glare where the mean falls just below the normal range. Questionnaires revealed that 87.5% of patients were either satisfied or very satisfied with their vision after the surgery, and higher percentages for no difficulty in performing different activities, ranging from 70.83% to 95.83%, were reported.

Conclusion

This study demonstrates that the bi-aspheric diffractive trifocal IOL yields very good visual performance across distances, fostering high satisfaction levels and minimal difficulties in daily activities.

Randomised placebo-controlled clinical trial evaluating the impact of a new visual rehabilitation program on neuroadaptation in patients implanted with trifocal intraocular lenses

PURPOSE

To evaluate the efficacy of a new visual training program for improving the visual function in patients implanted with trifocal intraocular lenses (IOLs).

METHODS

Randomised placebo-controlled clinical trial enrolling 60 subjects (age, 47-75 years) undergoing cataract surgery with implantation of trifocal diffractive IOL. Home-based active visual training was prescribed immediately after surgery to all of them (20 sessions, 30 min): 31 subjects using a serious game based on Gabor patches (study group) and 29 using a placebo software (placebo group). Visual acuity, contrast sensitivity (CS), and perception of visual disturbances (QoV questionnaire) were evaluated before and after training. Likewise, in a small subgroup, resting-state functional magnetic resonance imaging (rs-fMRI) analysis was performed.

RESULTS

No significant differences were found between groups in compliance time (p = 0.70). After training, only significant improvements in monocular uncorrected intermediate visual acuity were found in the study group (p ≤ 0.01), although differences between groups did not reach statistical significance (p ≥ 0.11). Likewise, significantly better binocular far CS values were found in the study group for the spatial frequencies of 6 (p = 0.01) and 12 cpd (p = 0.03). More visual symptoms of the QoV questionnaire experienced a significant change in the level of bothersomeness in the study group. Rs-fMRI revealed the presence significant changes reflecting higher functional connectivity after the training with the serious game.

CONCLUSIONS

A 3-week visual training program based on the use of Gabor patches after bilateral implantation of trifocal diffractive IOLs may be beneficial for optimising the visual function, with neural changes associated suggesting an acceleration of neuroadaptation. Trial registration ClinicalTrials.gov, NCT04985097. Registered 02 August 2021, https://clinicaltrials.gov/(NCT04985097 ).

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.

Comparison of Visual Outcomes of Two Trifocal IOLs

PURPOSE

To compare the visual outcomes of bilateral implantation of two commercially available trifocal intraocular lenses (IOLs) (AcrySof IQ PanOptix IOL; Alcon Laboratories, Inc and AcrivaUD Trinova IOL; VSY Biotechnology).

METHODS

This comparative, investigator-initiated, single-center randomized trial was conducted by the Department of Ophthalmology of the Medipol Mega University Hospital in Istanbul, Turkey. Adult patients were randomized in a 1:1 ratio using a block randomization program to undergo cataract surgery and receive the implantation of either the PanOptix or Trinova IOL in both eyes. Outcome measures including binocular uncorrected and corrected visual acuities at distance, intermediate (66 cm), and near (40 cm), defocus curve, refractive outcomes, contrast sensitivity, glare and halos, and patient satisfaction were assessed at a minimum of 3 months following bilateral IOL implantation.

RESULTS

A total of 71 patients (142 eyes) were included, with 35 patients (70 eyes) in the PanOptix IOL group and 36 patients (72 eyes) in the Trinova IOL group. At the 3-month follow-up examination, mean distance-corrected intermediate visual acuity (primary endpoint) was significantly better for the PanOptix IOL group (0.0 ± 0.09 logMAR) compared with the Trinova IOL group (0.01 ± 0.10 logMAR) (P = .0304). Mean logMAR uncorrected intermediate acuity (UIVA) and near (UNVA) visual acuity were also significantly better for the PanOptix IOL group (UIVA = 0.1 ± 0.10 logMAR; UNVA= 0.0 ± 0.09 logMAR) compared with the Trinova IOL group (UIVA = 0.2 ± 0.10 logMAR; UNVA = 0.2 ± 0.11 logMAR) (both P < .001). There were no statistically significant differences in all other outcomes between groups. No adverse events were reported in both groups.

CONCLUSIONS

These results suggest that the PanOptix IOL provides better intermediate and near visual outcomes compared to the Trinova IOL and represents a good choice for patients seeking to achieve spectacle independence. [ J Refract Surg. 2023;39(8):524-530.].

Analysis of Daily Visual Habits in a Presbyopic Population

Purpose

To evaluate and report the visual habits and requirements of a sample of presbyopic patients using an advanced sensor.

Methods

Transversal study collecting clinical data from 40 presbyopes candidates for presbyopia-correction intraocular lens (IOL) implantation with mean age of 61.0 years (43-80 years). A complete ophthalmological examination was performed in all patients including visual, refractive, an ocular biometric analysis. Furthermore, patients were instructed about the use of the Vivior Monitor system (Vivior AG, Zürich, Switzerland), which consists of a series of sensors attached to the rim of the patient's glasses that capture information about the visual behavior of the patient. This device was worn for a period of 36 hours or more. The data collected were transferred to a database and analyzed.

Results

Mean percentages of time dedicated to distance, intermediate, and near vision were 27.25 ± 11.93% (5-65%), 30.23 ± 9.36% (12-50%), and 42.53 ± 14.96% (13-78%), respectively. Mean percentages of time performing activities under photopic, mesopic, and scotopic conditions were 37.08 ± 23.20% (5-87%), 33.65 ± 13.84% (6-67%), and 29.28 ± 17.03% (4-65%). The percentage of time with digital screens ranged from 2% to 48%. Age was significantly correlated with the percentage of time dedicated to distance vision (r = 0.317, p=0.047) and to activities performed under photopic conditions (r = -0.344, p=0.030).

Conclusions

Distance and illumination conditions used to perform different daily life visual activities vary significantly among presbyopes, with a trend to the dedication of more time to intermediate and near visual activities performed under photopic and mesopic conditions. Data interpretation should be done with care until a proper validation of the device used.

Visual performance and impact of residual refractive errors with trifocal intraocular lenses of different aspheric design

BACKGROUND

To assess the visual quality and the tolerance to low refractive errors of two trifocal intraocular lenses (IOL) with different amounts of spherical aberration (SA).

METHODS

The study included patients having bilateral implantation of the AcrySof® IQ PanOptixTM (aberration-correcting) or the RayOneTM (aberration-free) Trifocal IOL. Three months after the surgery patients underwent: monocular/binocular and uncorrected/corrected distance visual acuity (VA) and binocular defocus curves. Binocular contrast sensitivity (CSF) and subjective halo perception were assessed with the best distance correction (CDVA), with a positive defocus of + 0.50D and with a negative defocus of -0.50D. Patient's satisfaction was evaluated with the Catquest9-SF questionnaire.

RESULTS

This study included 54 eyes (28 with PanOptix and 26 with RayOne) of 27 patients. Both groups achieved corrected/uncorrected and monocular/binocular distance VA values better than 0.0 logMAR (1.0 decimal) with no statistically significant differences between them (p > 0.05 for all cases). Defocus curves showed a VA of 0.1 logMAR or better between -2.5 and + 1.0D with no differences between groups (p > 0.05 at all distances). Overall CSF values remained stable under the induced residual refractions for both groups. The halo effect remained stable for the PanOptix group but increased with myopization in the RayOne group (p = 0.02). The questionnaire showed high rates of patient's satisfaction with no differences between groups.

CONCLUSION

Both lenses showed overall good visual outcomes and offered high rates of patient's satisfaction. Moreover, in normal patients with trifocal IOLs, the combination of residual refractive errors and certain amounts of SA may increase some visual disturbances.

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.

Early patient-reported outcomes of cataract surgery with implantation of the trifocal liberty 677MY intraocular lens: A pilot study

PURPOSE

To report our first clinical and patient-reported outcomes in the early postoperative period with a new model of trifocal diffractive intraocular lens (IOL).

METHODS

Pilot prospective analysis of the results of 26 eyes of 13 patients (age, 44-79 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL Liberty 677MY (Medicontur Medical Engineering Ltd., Zsámbék, Hungary). The following clinical outcomes were evaluated during the first postoperative month: measurement of distance, intermediate and near visual acuity, binocular defocus curve, and level of spectacle independence, patient satisfaction, perception of photic phenomena, and difficulty in performing several vision-related daily tasks by means of a questionnaire.

RESULTS

Mean binocular LogMAR uncorrected distance, intermediate and near visual acuities were -0.03 ± 0.13, 0.21 ± 0.16, and 0.16 ± 0.09, respectively. Furthermore, 100.0%, 84.6% and 92.3% of patients achieved a binocular corrected distance, distance-corrected intermediate and distance-corrected near visual acuity of 20/32 or better, respectively. In the defocus curve, visual acuities were better than 0.2 logMAR for defocus levels between +1.00 and -3.00 D. Spectacle independence was referred by all patients, with any of them reporting dissatisfaction with the outcome of the surgery. The postoperative vision did not lead to difficulties in the daily life in 92.3% of patients. Bothersome halos, glare or starbursts were only reported by only 7.7% of patients.

CONCLUSIONS

The trifocal IOL evaluated provides a successful visual rehabilitation with minimal photic phenomena associated, leading to high levels of spectacle independence and patient satisfaction.

Efficacy of a Secondary Trifocal Sulcus IOL in Providing Near and Intermediate Vision in Patients with Prior Myopic Laser Vision Correction and Cataract Surgery

Purpose

To evaluate the visual function of patients with a history of prior laser vision correction and cataract surgery with implantation of a monofocal primary IOL after subsequent implantation of a secondary sulcus trifocal intraocular lens (IOL).

Setting

One clinical practice in Haugesund, Norway.

Design

Prospective, single arm, non-interventional unmasked study.

Methods

Eligible subjects who had previous laser vision correction and cataract surgery involving implantation of a monofocal IOL in the capsular bag of one or both eyes were subsequently implanted with a secondary IOL in the sulcus. Postoperative uncorrected and best distance-corrected visual acuities (VAs) were measured at distance (4 m), intermediate (60 cm), and near (40 cm), along with low contrast visual acuity and the monocular distance corrected defocus curve.

Results

Twenty-five eyes were evaluated from 7 to 24 months after trifocal implantation. The mean monocular uncorrected VAs were 0.06, 0.21 and 0.10 logMAR at distance, intermediate and near, respectively. Uncorrected near VA was 0.2 logMAR or better in 80% of eyes (20/25). VA of 0.2 logMAR or better at all test distances was achieved in 15/25 eyes (60%) in the uncorrected state and 17/25 eyes (68%) when corrected for distance vision. Binocular uncorrected distance visual acuity was 0.1 logMAR or better in all subjects while binocular uncorrected near visual acuity was 0.1 logMAR or better in all but one subject. The defocus curve showed a range of functional vision from distance to 30 cm. No adverse events were identified.

Conclusion

The trifocal sulcus IOL provided excellent distance and near vision and a good range of functional vision, similar to results obtained when a primary trifocal IOL is implanted. It is a viable option to provide better intermediate and near vision to patients with a prior history of refractive surgery and a monofocal IOL implanted.

Comparison of visual outcomes after two types of mix-and-match implanted trifocal extended-depth-of-focus and trifocal intraocular lenses

PURPOSE

To compare visual outcomes between two types of mix-and-match implanted trifocal extended-depth-of-focus (EDoF) and trifocal intraocular lenses (IOLs).

METHODS

A total of 212 eyes of 106 subjects with mix-and-match implanted FineVision Triumf and FineVision HP IOLs (Triumf-HP group) and 212 eyes of 106 subjects with mix-and-match implanted Zeiss AT LARA and AT LISA IOLs (AT LARA-LISA group) were enrolled in this retrospective case-control study. Uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and binocular distance-corrected defocus curves were measured between 6 and 10 weeks after cataract surgery.

RESULTS

There was no significant difference in UDVA among the four IOLs. UNVA was the best in eyes with the FineVision HP IOL (0.04 ± 0.06 logMAR), followed by eyes with the AT LISA IOL (0.07 ± 0.07 logMAR), the FineVision Triumf IOL (0.09 ± 0.09 logMAR), and the AT LARA IOL (0.11 ± 0.08 logMAR), respectively. The AT LARA-LISA group had better visual acuity than the Triumf-HP group between - 1.00 D and - 1.50 D of defocus, and the Triumf-HP group had better visual acuity than the AT LARA-LISA group between - 3.00 D and - 4.00 D of defocus.

CONCLUSION

Mix-and-match implantation of trifocal EDoF and trifocal IOLs provided good visual outcomes in far, intermediate, and near distances. The mix-and-match implantation of Triumf-HP IOLs led to better visual outcomes in near vision, while that of the AT LARA-LISA IOLs led to better visual outcomes in intermediate vision.

Refractive Outcomes after Cataract Surgery

A post-operative manifest refractive error as close as possible to target is key when performing cataract surgery with intraocular lens (IOL) implantation, given that residual astigmatism and refractive errors negatively impact patients’ vision and satisfaction. This review explores refractive outcomes prior to modern biometry; advances in biometry and its impact on patients’ vision and refractive outcomes after cataract surgery; key factors that affect prediction accuracy; and residual refractive errors and the impact on visual outcomes. There are numerous pre-, intra-, and post-operative factors that can influence refractive outcomes after cataract surgery, leaving surgeons with a small “error budget” (i.e., the source and sum of all influencing factors). To mitigate these factors, precise measurement and correct application of ocular biometric data are required. With advances in optical biometry, prediction of patient post-operative refractory status has become more accurate, leading to an increased proportion of patients achieving their target refraction. Alongside improvements in biometry, advancements in microsurgical techniques, new IOL technologies, and enhancements to IOL power calculations have also positively impacted patients’ refractory status after cataract surgery.

Long-term performance of a diffractive-refractive trifocal IOL with centralized diffractive rings: 5-year prospective clinical trial

PURPOSE

To report the 5-year visual, refractive, and patient-reported outcomes following implantation of a trifocal intraocular lens (IOL) during cataract surgery.

SETTING

Csolnoky Ferenc University Hospital, Veszprém, Hungary.

DESIGN

Prospective, longitudinal, single-center, interventional study.

METHODS

100 eyes of 50 patients underwent bilateral implantation of a trifocal IOL during cataract surgery. Preoperative corrected distance (CDVA) and postoperative uncorrected distance visual acuity (UDVA), CDVA, uncorrected (UIVA) and corrected (CIVA) intermediate and uncorrected (UNVA) and corrected (CNVA) near visual acuity were collected. All subjects were seen at day 1, 1 month, 3 months, 6 months, 12 months, and 24 months, and at year 5. Contrast sensitivity, slitlamp photography, and quality of vision questionnaire were performed at months 3, 6, 12, and 24 and at year 5. Of these 50 patients, 41 completed their 5-year follow-up.

RESULTS

At year 5, 74 eyes of 37 patients were analyzed. The mean postoperative UDVA was 0.02 ± 0.10 (logMAR). The mean CDVA was -0.04 ± 0.07. The mean UIVA was 0.04 ± 0.09. The mean CIVA was 0.00 ± 0.08. The mean UNVA was 0.09 ± 0.09. The mean CNVA was 0.05 ± 0.07. Mesopic and photopic contrast sensitivity values were in the upper third range of the age-matched normal values.

CONCLUSIONS

5-year prospective study data showed that bilateral implantation of a diffractive-refractive trifocal IOL with centralized diffractive rings provided good functional vision at all distances. There was high level of spectacle independence and patient satisfaction with minimal levels of dysphotopsia.

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.

Clinical Outcomes and Patient Satisfaction with a New Diffractive-Refractive Trifocal Intraocular Lens - A 12 Month Prospective Study

Purpose

To evaluate the clinical outcomes and patient satisfaction after implantation of Optiflex Trio, a new trifocal intraocular lens (IOL) following cataract surgery.

Methods

Patients undergoing phacoemulsification for age-related cataracts and who satisfy the eligibility criteria underwent bilateral implantation with Optiflex Trio trifocal IOL. At follow -up visits of 1, 3, 6, and 12 months, binocular uncorrected and corrected distance, intermediate and near visual acuity, reading performance, contrast sensitivity (CS) and patient satisfaction for dysphotopsia and spectacle independence were evaluated using questionnaires.

Results

A total of 54 eyes from 27 patients with mean age of 66.30±7.48 years were included in the study. At 12 months, 78% (n = 21) patients had binocular cumulative UDVA of 20/20 or better. Post-op SE refraction accuracy was within ±0.50 D for 93% (n = 50) eyes, and refractive cylinder accuracy was within ≤0.50 D in 94% (n = 51) eyes. The mean binocular UNVA was 0.01±0.05 LogMAR, and the mean UIVA at 60 and 80 cm was 0.07±0.06 and 0.03±0.05 LogMAR, respectively, at 12 months. Reading speeds at 40, 60 and 80 cm showed improvement overtime. No patient had complained of severe dysphotopsia, and none of the patients required glasses for any activity. No eye underwent YAG-laser capsulotomy for significant PCO at the end of mean follow-up.

Conclusion

After 12 months, Optiflex Trio trifocal IOL provided a complete visual restoration with good visual quality outcomes in terms of uncorrected distance, intermediate and near visual acuity. The incidence of dysphotopsia was low, and spectacle independence was high, resulting in good patient satisfaction.

Trial Registry

CTRI/2019/10/021647 (www.ctri.nic.in).

COMPARISON OF REFRACTIVE AND VISUAL OUTCOMES OF THREE PRESBYOPIA-CORRECTING INTRAOCULAR LENSES

PURPOSE

To evaluate and compare the clinical outcomes after cataract surgery with implantation of three different types of trifocal diffractive intraocular lenses (IOLs).

SETTING

Hospital da Luz, Lisbon, Portugal.

DESIGN

Prospective comparative case series.

METHODS

180 eyes of 90 patients undergoing phacoemulsification cataract surgery with implantation of one of these trifocal IOLs were enrolled: Tecnis Synergy (J&J Vision) (Synergy group, 30 patients), Acrysof PanOptix (Alcon) (PanOptix group, 30 patients), and POD F (PhysIOL) (Finevision group, 30 patients). The outcomes in terms of distance, intermediate and near visual acuity (VA), refraction, defocus curve, photic phenomena and spectacle independence were evaluated at 3-months follow-up.

RESULTS

No significant differences were found between groups in monocular distance-corrected intermediate (Synergy 0.04±0.11, PanOptix 0.05±0.09, Finevision 0.08±0.10; p=0.107) and near VA (0.01±0.08, 0.01±0.06, 0.04±0.10; p=0.186). Likewise, no significant differences among groups were found in binocular uncorrected distance (p=0.572), near (p=0.929) and intermediate VA (p=0.327). In contrast, significant differences between groups were found in the visual acuity for the vergence demands of -0.50, -1.00, -2.00, -3.50 and -4.00 D (p≤0.045). No significant differences among groups were found either in the frequency, severity and bothersomeness of different disturbing visual symptoms, including glare and haloes (p≥0.129). More than 96% of patients in all groups did not require the use of spectacles at any distance after surgery.

CONCLUSIONS

The three trifocal IOLs evaluated provide an effective visual rehabilitation with minimal incidence of photic phenomena. A trend to obtain a wider range of functional focus was observed with the Tecnis Synergy IOL.

Clinical Outcomes With a New Continuous Range of Vision Presbyopia-Correcting Intraocular Lens

PURPOSE

To evaluate the clinical outcomes including patient-reported outcome measures in a sample of eyes undergoing bilateral cataract surgery with implantation of a new model of presbyopia-correcting intraocular lens (IOL).

METHODS

This non-randomized prospective case series enrolled 206 eyes of 103 patients undergoing phacoemulsification cataract surgery with bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Vision). High and low contrast visual acuity, refractive, defocus curve, and patient-reported visual performance (Catquest-9SF questionnaire) outcomes were evaluated during a 3-month follow-up.

RESULTS

A total of 96.1% (99 of 103) and 91.3% (94 of 103) of patients achieved binocular postoperative uncorrected distance (UDVA) and near visual acuity (UNVA) of 0.00 logMAR (20/20), respectively. Mean postoperative mesopic UNVA for both eyes was 0.14 ± 0.03 logMAR. Likewise, mean binocular UDVA and UNVA were 0.00 ± 0.03 and 0.04 ± 0.02 logMAR. An almost flat mean defocus curve was obtained, with visual acuities between 0.00 and 0.10 logMAR for most defocus levels in both eyes. A reduction of contrast led to a limited but statistically significant change in UNVA in both eyes (P < .001). The Rasch calibrated scoring of item 2 and the Rasch calibrated mean score of the Catquest-9SF questionnaire increased significantly with surgery (P < .001).

CONCLUSIONS

This new presbyopia-correcting IOL provides a continuous range of functional focus, with a limited deterioration under mesopic conditions, which is perceived as a satisfactory outcome by the patient if proper patient selection is performed. [J Refract Surg. 2021;37(4):256-262.].

Multifocal and Accommodating Intraocular Lenses for the Treatment of Presbyopia: A Report by the American Academy of Ophthalmology

PURPOSE

To review the published literature assessing the efficacy and safety of presbyopia-correcting intraocular lenses (IOLs) for the treatment of presbyopia after cataract removal.

METHODS

Literature searches were undertaken in January 2018 and September 2020 in the PubMed, Medline, and Cochrane Library databases. This yielded 761 articles, of which 34 met the criteria for inclusion in this assessment and were assigned a level of evidence rating by the panel methodologist. Thirteen studies were rated level I and 21 studies were rated level II.

RESULTS

Presbyopia-correcting lenses were effective at improving distance and near visual acuity after cataract surgery. Near acuity at different focal lengths was related directly to the effective add power of multifocal and extended depth-of-focus (EDOF) IOLs. Most multifocal and EDOF lenses that were compared with a control monofocal lens demonstrated that patient-reported spectacle independence was superior to the monofocal lens. All patients who had multifocal and EDOF lenses implanted showed decreased contrast sensitivity and reported more visual phenomena as compared with control participants who received monofocal lenses.

CONCLUSIONS

Presbyopia-correcting lenses improve uncorrected near and distance visual acuity and decrease spectacle dependence after cataract surgery. Mesopic contrast sensitivity is decreased compared with monofocal lenses, and patient-reported visual phenomena are more likely in patients receiving multifocal or EDOF lenses.

Clinical Outcomes After Bilateral Implantation of a Trifocal Presbyopia-Correcting Intraocular Lens in an Indian Population

Purpose

To evaluate the effectiveness and safety of a presbyopia-correcting trifocal intraocular lens (IOL), AcrySof^® IQ PanOptix^® (TFNT00), in an Indian population.

Patients and Methods

This prospective, multicenter, observational, single-arm, post-marketing study included 67 patients undergoing cataract surgery with bilateral implantation of TFNT00 across five Indian sites. Postoperative outcomes were assessed at 3 months after second eye surgery. Effectiveness outcomes included: mean binocular and monocular visual acuity (VA) at distance (4 m), intermediate (60 cm), and near (40 cm); binocular defocus curve; manifest refraction; and subjective symptom questionnaire evaluation. Safety outcomes included the rate of ocular adverse events and mesopic contrast sensitivity.

Results

Mean binocular and monocular distance-corrected and uncorrected VAs of 0.1 logMAR or better (approximately 20/25 Snellen) were achieved at distance, intermediate, and near. Overall, ≥70% of patients achieved binocular 0.1 logMAR vision or better across all distances. TFNT00 maintained a mean VA of 0.1 logMAR or better at the defocus range of +0.5 diopters (D) to –2.5 D (200 cm to 40 cm). The subjective symptom questionnaire-assessed frequency of halo visual disturbances was low at Month 3; halos were reported “none of the time” to “only some of the time” in 86.6% of patients. The large majority of patients (98.5%) were “satisfied” or “very satisfied” with their near, intermediate, and distance vision at Month 3, and ≥94.0% of patients reported spectacle independence for tasks at all distances. The adverse event rate was low; no patients discontinued due to an adverse event.

Conclusion

TFNT00 provided a continuous range of vision of 20/25 or better for distance to near and performed effectively at an intermediate functional distance of 60 cm, resulting in high levels of spectacle independence and patient satisfaction. TFNT00 demonstrated a good safety profile and a low post-operative frequency of halo visual disturbances.