Innovative trifocal (quadrifocal) presbyopia-correcting IOLs: 1-year outcomes from an international multicenter study

Visual Function After Implantation of Trifocal and Trifocal Toric Intraocular Lenses Using Intraoperative Aberrometry

Purpose

To evaluate patient outcomes and visual function following trifocal and trifocal toric intraocular lens (IOL) implantation using intraoperative aberrometry at a single site in the US.

Methods

This prospective, single arm study included 21 subjects that completed 3 month follow-up. Inclusion criteria were visually significant cataract and potential post-operative visual acuity of 20/25 or better. Endpoints included postoperative prediction error, refractive outcomes, uncorrected visual acuities at distance (UDVA), intermediate (UIVA), and near (UNVA), contrast sensitivity, and subject responses on the modified Visual Function Quality of Life Questionnaire (VF-14 QOL).

Results

Binocular UDVA, UIVA, and UNVA were 20/25 or better in 100% (21/21), 100% (21/21), 90% (19/21) of subjects. The absolute prediction error was 0.50 D or less in 79% (33/42) of eyes, and 81% (34/42) and 86% (36/42) of eyes achieved ≤0.5 D of residual astigmatism and manifest refraction spherical equivalent, respectively. On the modified VF-14 QOL, driving at night, reading small print, and reading a newspaper or book were the tasks that had the lowest percentages of subjects reporting no difficulty or a little difficulty.

Conclusion

Implantation with trifocal and trifocal toric IOLs using intraoperative aberrometry can provide high refractive precision, leading to excellent visual performance and low visual task difficulty at all ranges (distance, intermediate, and near).

Visual Outcomes and Patient Satisfaction of Trifocal or Trifocal Toric IOLs in Chinese Cataract Patients: Focus on Near Vision at 33 cm

Purpose

To examine the visual outcomes, particularly at 33 cm, and assess patient satisfaction following the implantation of a diffractive trifocal intraocular lens (IOL) and its toric variant.

Patients and Methods

This prospective single-arm observational study involved 45 Chinese patients (90 eyes) underwent bilateral cataract surgery and PanOptix or PanOptix toric intraocular lenses (IOLs) implantation. Postoperatively, visual acuity was evaluated at various distances, including 40 cm and 33 cm, for both monocular and binocular outcomes. Patient satisfaction was evaluated using the VF-14 questionnaire.

Results

72 eyes underwent PanOptix IOLs implantation, and 18 eyes received PanOptix toric IOLs. At 3-month postoperative mark, the mean monocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.02±0.09, 0.00±0.07, 0.02±0.07, and 0.07±0.14 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 96.7%, 96.7%, 94.4%, and 74.4%, respectively. The mean binocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.05±0.06, -0.03±0.05, 0.00±0.05, and 0.04±0.07 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 97.8%, 100.0%, 100.0%, and 91.1%, respectively. When the near point shifted from 40cm to 33cm, some patients showed a decline for UDVA, but the average reduction was less than one line. The overall VF-14 questionnaire score was 4.02±4.19.

Conclusion

PanOptix can provide Chinese patients with a full range of satisfying visual acuity, near to 33cm. Though the visual acuity of some patients at 33 cm did not match the level at 40 cm, the gap of one line may not carry clinical significant.

Refractive outcomes following bilateral implantation of a diffractive toric intraocular lens in a multisurgeon hospital setting

OBJECTIVE

To assess residual postoperative refractive astigmatism following bilateral implantation of a trifocal toric intraocular lens (IOL) in a real-world multisurgeon setting.

DESIGN

Prospective multisurgeon study (6 surgeons at 2 sites).

METHODS

Bilateral implantation of a trifocal toric IOL (AcrySof PanOptix IOL; Alcon Vision LLC, Fort Worth, TX, USA) was performed in 140 eyes of 70 patients. Patients were assessed on day 1 and 3 months postoperatively. The primary outcome measure was residual astigmatism. Secondary endpoints included absolute prediction error, IOL rotation, binocular uncorrected and distance-corrected visual acuities at near (40 cm), intermediate (60 cm), and distance (6 m) and spectacle independence evaluated with the validated Intraocular Lens Satisfaction questionnaire.

RESULTS

Mean preoperative cylinder was 1.25 ± 0.72 D and was 0.39 ± 0.28 D at 3 months postoperatively. At 3 months postoperatively, mean residual astigmatism was 0.39 ± 0.28 D (range, 0-1.25 D), and 118 eyes (84.3%) had postoperative astigmatism of 0.5 D or less. Mean absolute prediction error was 0.25 ± 0.21 D (range, 0-1.13 D), and 124 eyes (88.6%) had absolute prediction error of 0.5 D or less. At 3 months postoperatively, mean absolute rotation was 2.0 ± 2.7 degrees compared with baseline (range, 0-15 degrees), and 133 IOLs (95.0%) were within 5 degrees of the implanted axis. Additionally, 55 patients (79%) reported never or rarely using spectacles at near, 66 (94%) at intermediate, and 67 (96%) at distance.

CONCLUSIONS

The results of this study demonstrate that implantation with the PanOptix toric IOL can provide excellent refractive and visual outcomes with minimal residual astigmatism.

Binocular Visual Outcomes Comparison of Two Trifocal Intraocular Lenses in High-Myopic Cataract Patients: A 1-Year Multicenter Study

PURPOSE

To compare the postoperative visual outcomes and quality of vision obtained with 2 types of diffractive trifocal intraocular lenses (IOLs) in patients with highly myopic cataracts.

DESIGN

Prospective, multicenter, randomized controlled trial.

METHODS

Patients with high-myopic cataracts were randomized to binocular implantation of either the TFNT00 (n = 27) or the 839 MP (n = 28) trifocal IOLs at 3 surgery centers in China and were followed up for 1 year. Postoperative uncorrected distance, uncorrected intermediate, and uncorrected near visual acuity, and best-corrected distance visual acuity were measured. The defocus curve, high-order aberrations, modulation transfer function curve, Strehl ratio, and reading ability were compared between both groups. The functional vision and incidence of photic phenomena were surveyed using questionnaires.

RESULTS

Visual acuity at all ranges of vision was significantly improved in both groups. The TFNT00 group showed superior uncorrected intermediate visual acuity to that in the 839 MP group (P = .013). Reading ability at 40 and 60 cm was similar in both groups (P ≥ .05), whereas the preferred reading distances for near and intermediate were significantly different. The TFNT00 group had a significantly higher mean Visual Function Index 14 score, lower incidence of photic phenomena, and less posterior capsular opacity than the 839 MP group.

CONCLUSION

Bilateral implantation of both types of trifocal IOLs in patients with high-myopic cataracts provided good whole-course visual restoration, although recognition of fine Chinese characters remained impeded. As compared with 839 MP IOL, TFNT00 IOL resulted in greater patient satisfaction in intermediate activities, with a lower photic phenomena incidence.

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.].

Outcomes after bilateral implantation of AcrySof IQ PanOptix trifocal intraocular lens: a prospective interventional study

Background

Implantation of multifocal intraocular lenses (IOLs) is becoming increasingly popular for the treatment of visual demands at various distances in patients undergoing phacoemulsification cataract surgery. We aimed to assess the visual performance and rates of photic phenomena, posterior capsule opacification (PCO), and spectacle independence in patients with bilateral implantation of the AcrySof® IQ PanOptix® multifocal IOL model TFNT00 at one and six months postoperatively.

Methods

This prospective interventional cohort study included adult patients who underwent uneventful phacoemulsification cataract surgery with bilateral implantation of AcrySof® IQ PanOptix® IOL. Uncorrected and corrected visual acuities at far, intermediate, and near distances were measured preoperatively and at the one- and six-month postoperative follow-up examinations. The rates of photic phenomena, postoperative need for near and distance spectacles, and PCO were also recorded.

Results

We included 164 eyes of 82 patients with a male-to-female ratio of 38 (46.3%) to 44 (53.7%) and a mean (standard deviation [SD]) age of 52.37 (7.62) years. There were statistically significant improvements in the visual acuities of both eyes across all distances at the one- and six-month follow-up examinations compared to the preoperative values (all P < 0.001), except for corrected near visual acuity in the right eye (P > 0.05) at six-month. We also detected significant postoperative improvements in visual acuities of both eyes across all distances at the six-month follow-up compared to values at the one-month follow-up (all P < 0.05), except for corrected near visual acuity in the right eye (P > 0.05). The photic phenomenon was reported by 12 (14.6%) of the 82 patients at the six-month postoperative follow-up. Five (6.1%) and eight (9.8%) of the 82 patients reported using spectacles for distance and near, respectively. Additionally, PCO developed in 19 (11.6%) of the 164 included eyes, although it was not clinically significant at six months.

Conclusions

The AcrySof® IQ PanOptix® IOL model TFNT00 is recommended for use, given its excellent performance in all ranges of vision, a high rate of spectacle independence, and a good safety profile. Future comparative studies with longer follow-up periods are warranted to verify superiority of its performance over that of other available multifocal IOLs.

Comparison of visual performance and quality of life with a new nondiffractive EDOF intraocular lens and a trifocal intraocular lens

PURPOSE

To compare visual performance and quality of life (QoL) following bilateral implantation of a new nondiffractive extended depth-of-focus (EDOF) intraocular lens (IOL) and a trifocal IOL.

SETTING

Department of Ophthalmology, Baskent University Faculty of Medicine, Ankara, Turkey.

DESIGN

Prospective comparative interventional case series.

METHODS

104 eyes of 52 patients with cataract, bilaterally implanted with a nondiffractive EDOF IOL or a trifocal IOL, were included. Outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity and distance corrected near visual acuity, defocus curves, QoL (Visual Function Index 14), quality of vision (Quality of Vision [QoV] index), contrast sensitivity (Pelli-Robson chart), and binocular reading speed.

RESULTS

Twenty-six patients were included in each group. The UDVA and CDVA were better in the EDOF group (0.05 ± 0.04 and 0.01 ± 0.04) than the trifocal group (0.13 ± 0.06 and 0.11 ± 0.07) ( P = .02 and .01). Defocus curves showed that visual acuity was better with the EDOF IOL for vergences at 0.00, -0.50, and -1.00 and better with the trifocal IOL for vergences at -2.50, -3.00, -3.50, and -4.00. Contrast sensitivity scores were similar with both IOLs ( P = .12). The overall mean QoL scores were lower in the EDOF group, indicating a better QoL ( P = .04). The QoV was better in the EDOF group with significantly less glare, halos, and blurry vision ( P < .01).

CONCLUSIONS

The EDOF IOL performed better at distance, and the trifocal IOL performed better at near. Overall QoL and quality of vision were better with the EDOF IOL.

Randomized and double-blind comparison of clinical visual outcomes of 2 EDOF intraocular lenses

PURPOSE

To assess and compare the visual disturbance profiles of 2 extended depth-of-focus (EDOF) intraocular lenses (IOLs).

SETTING

Private practice (West Kootenays, British Columbia, Canada).

DESIGN

Prospective, randomized, single-surgeon study.

METHODS

This was a double-blind prospective study of 138 eyes (69 patients) that underwent bilateral implantation of 1 of 2 EDOF IOLs. Participants were randomized to either the Symfony group or the Vivity group. Outcome measures included Questionnaire for Visual Disturbances; binocular corrected distance visual acuities at distance (6 m), intermediate (66 cm), and near (40 cm); and refractive outcomes.

RESULTS

At 3 months postoperatively, 21 patients (60%) reported not experiencing glare in the Symfony group compared with 30 (88%) in the Vivity group, a difference of 28% (P = .008). Reports of experiencing starbursts were also significantly different between the Symfony and Vivity groups (23 participants [66%] Symfony and 30 participants [88%] Vivity; P = .027). In addition, 12 participants (34%) reported "moderate" or "severe" starbursts in the Symfony group compared with 3 (9%) in the Vivity group, a difference of 25% (P = .019). Visual acuities and refractive outcomes were similar between groups.

CONCLUSIONS

Both EDOF lenses provide good visual outcomes at distance and intermediate with acceptable near vision. The Symfony group had increased reports of some visual disturbances, notably the frequency, severity, and bothersomeness of starbursts and glare.

Clinical Outcomes After Bilateral Implantation of a Diffractive Trifocal Intraocular Lens: A Worldwide Pooled Analysis of Prospective Clinical Investigations

Purpose

To investigate visual and safety outcomes of AcrySof^® IQ PanOptix^® (model TFNT00), a trifocal, presbyopia-correcting intraocular lens (IOL), in patients of different ethnicities across multiple countries, based on a pooled analysis of six prospective multicenter studies.

Patients and Methods

This pooled analysis included adult patients from six prospective clinical studies performed across 56 centers worldwide. After cataract removal by phacoemulsification, all patients were implanted with TFNT00; follow-up duration varied from 3 to 12 months according to the studies' design. Binocular defocus curve; absolute manifest refraction spherical equivalent (MRSE); and binocular photopic uncorrected and corrected visual acuities at distance (UCDVA, BCDVA; 4-5 m), intermediate (UCIVA, DCIVA; 60-66 cm), and near (UCNVA, DCNVA; 40 cm) were measured.

Results

The study included 557 patients, 547 of whom were implanted bilaterally with the TFNT00 IOL (n = 1094 eyes). Binocular visual data at 1 month and 3-6 months after implantation were available for up to 546 and 542 bilaterally implanted patients, respectively. A continuous range of 0.1 logarithm of the minimum angle of resolution (logMAR) or better vision from distance (0.00 diopter [D], 4-5 m) to near (-3.00 D; optically equivalent to 33 cm) was observed 3-6 months after TFNT00 implantation. At 3-6 months, 88.2% of first eyes achieved an MRSE ≤0.50 D and 88.7% of second eyes achieved an MRSE ≤0.50 D. Overall, 99.3%, 92.3%, and 94.6% of patients bilaterally implanted with TFNT00 achieved binocular photopic BCDVA, DCIVA, and DCNVA of 0.14 logMAR or better, respectively. Ocular adverse device effects and secondary surgical interventions (SSIs) were infrequent.

Conclusion

This global pooled analysis showed that TFNT00 provided a continuous range of 0.1 logMAR (~20/25 Snellen) or better vision from distance to 33 cm, with a low incidence of ocular adverse device effects and SSIs.

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.

Comparative Study Between Non-Diffractive Extended Depth of Focus and Monofocal Intraocular Lenses

Purpose

To evaluate the visual acuity and quality of vision in bilaterally implanted ZCBOO/ZCTx monofocal (Johnson & Johnson Vision) intraocular lens (IOL) and bilaterally implanted DATx15 extended depth of focus (EDOF) IOL (Alcon Vision, LLC).

Methods

A single site, non-interventional study comparing ZCBOO/ZCTx monofocal IOL patients implanted with DATx15 IOL toric or non-toric versions in both eyes. A total of 30 patients (60 eyes) completed the study in the monofocal group, 32 (64 eyes) in the EDOF group, and all were targeted for emmetropia. Binocular uncorrected distance, intermediate (66cm), and near (40cm) visual acuities and distance corrected distance, intermediate (66cm) and near (40cm) visual acuities were assessed. Binocular distance corrected defocus curve testing was from -3.5 D to +3 D. Patient reported visual disturbances (QUVID) and IOL satisfaction (IOLSAT) questionnaires were administered.

Results

The DATx15 group mean uncorrected visual acuity was 0.15 ± 0.10 logMAR at 66cm and 0.36 ± 0.14 logMAR at 40cm, compared to 0.24 ± 0.15 logMAR and 0.59 ± 0.17 logMAR respectively for the ZCBOO/ZCTx group. The DATx15 group (23 respondents, 74%) also reported significantly more spectacle independence at near with the IOLSAT (p < 0.01), compared to the ZCBOO/ZCTx group (13 respondents, 43%). Glare, halos, starbursts, and blur reported on the QUVID questionnaire were similar in the two groups.

Conclusion

The DATx15 group had improved near and intermediate vision and increased spectacle independence compared to the ZCBOO/ZCTx group.

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.

Analysis of perioperative problems related to intraocular Implantable Collamer Lens (ICL) implantation

PURPOSE

To introduce a modified procedure of ICL implantation, to summarize the perioperative problems and their corresponding treatment after myopia correction with Implantable Collamer Lens (ICL), and to compare the difference of complications between the no-hole ICL and hole ICL.

METHODS

We searched all articles on ICL-related perioperative problems and their corresponding treatment in Scopus, Embase, PubMed and Web of Science databases for the last 22 years.

RESULTS

ICL implantation is safe, effective, stable and predictable in the correction of myopia, hyperopia and astigmatism, but can also cause a series of perioperative problems, including intraoperative and postoperative complications.

CONCLUSION

There are many kinds of complications related to ICL, but the common intraoperative and postoperative complications mainly include abnormality of arch height, abnormal position of ICL, loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma, cataract and night vision symptoms. Compared with ICL without central pore, the incidence of complications such as loss of corneal endothelial cells and corneal decompensation, high intraocular pressure and secondary glaucoma and cataract was relatively lower in central hole ICL, while postoperative complications such as night vision symptoms were obvious.

Clinical outcomes in a U.S. registration study of a new EDOF intraocular lens with a nondiffractive design

PURPOSE

To evaluate the effectiveness and safety of the DFT015 intraocular lens (IOL) (AcrySof IQ Vivity Extended Vision) compared with an aspheric monofocal control IOL (AcrySof IQ model SN60WF).

SETTING

11 investigation sites in the U.S.

DESIGN

Prospective randomized controlled clinical study.

METHODS

Patients aged 22 years or older with bilateral cataracts were randomized to receive bilateral implantation of DFT015 or SN60WF. The 4 coprimary effectiveness outcomes (6 months postoperatively) were monocular photopic distance-corrected intermediate visual acuity (DCIVA), monocular photopic corrected distance visual acuity (CDVA), monocular depth of focus (DoF), and the percentage of patients achieving a DCIVA of 0.2 logMAR or better. The mean monocular photopic distance-corrected near visual acuity (DCNVA) was a secondary effectiveness outcome. Safety and patient-reported visual disturbances were evaluated through questionnaires.

RESULTS

218 patients (435 eyes) completed the study. Compared with SN60WF, DFT015 demonstrated superior mean monocular photopic DCIVA ( P &amp;lt; .001), noninferior mean monocular photopic CDVA, and superior mean monocular photopic DCNVA ( P &amp;lt; .001) and provided an extended monocular DoF (increase of 0.54 diopters at 0.2 logMAR). With DFT015, 78 first eyes (72.9%) achieved a DCIVA of 0.2 logMAR or better at 6 months. Incidences of ocular serious adverse events and patient-reported most bothersome visual disturbances were low and consistent between groups.

CONCLUSIONS

DFT015 is safe and effective for the visual correction of aphakia, exceeding American National Standards Institute criteria for an extended depth-of-focus IOL by providing superior DCIVA and DCNVA, with comparable CDVA and visual disturbances to the SN60WF monofocal IOL.

Comparison of Visual Performance and Patient Satisfaction After Multifocal Intraocular Lens Implantation and During Multifocal Contact Lens Wear After Monofocal Intraocular Lens Implantation: A Pilot Study

Purpose

To compare the visual performance and patient satisfaction in multifocal intraocular lens (IOL)-implanted eyes and multifocal contact lens (CL)-wearing eyes undergoing monofocal IOL implantation.

Methods

We retrospectively assessed visual acuity at all distances (0.3, 0.5, 0.7, 1, and 5 m), contrast sensitivity function, patient satisfaction score, and the rate of spectacle independence in the multifocal IOL and multifocal CL groups.

Results

Binocular visual acuity at 0.3, 0.5, 0.7, 1, and 5 m was 0.05 ± 0.11, − 0.02 ± 0.09, − 0.02 ± 0.09, − 0.02 ± 0.09, and − 0.04 ± 0.07, respectively, in the multifocal IOL group and 0.25 ± 0.13, 0.04 ± 0.10, 0.01 ± 0.09, − 0.01 ± 0.07, and 0.00 ± 0.08, respectively, in the multifocal CL group. We found significant differences in visual acuity at all distances. The area under the log contrast sensitivity function was 1.32 ± 0.14 and 1.33 ± 0.16 in the multifocal IOL and CL groups, respectively (p = 0.444). The patient satisfaction score for overall vision was 80.2 ± 20.6 and 82.9 ± 10.5 (p = 0.889), and the rate of spectacle independence was 23.4% and 41.7% in the multifocal IOL and CL groups, respectively (p = 0.277).

Conclusions

According to our experience, both multifocal IOLs and CLs provided good near-to-distance binocular vision and subsequent high patient satisfaction in daily activities with acceptable contrast sensitivity, suggesting their viability for presbyopic correction in elderly subjects.

New methodology for measuring intraocular lens performance using acuity reserve

PURPOSE

To validate a new methodology of intraocular lens (IOL) assessment using acuity reserve analysis via area under the curve (AUC) to assess intermediate vision.

SETTING

Study 1 was conducted at 17 sites in Australia, Chile, and Europe. Study 2 was conducted at 15 sites in Australia, Brazil, and Europe.

DESIGN

Post hoc analyses of defocus curve results from 2 clinical trials (study 1: single-arm investigation of the AcrySof IQ PanOptix Trifocal IOL [model TFNT00; Alcon Research LLC]; study 2: comparative investigation of AcrySof PanOptix Trifocal IOL vs the AT LISA Trifocal IOL [model 839MP; Carl Zeiss Meditec AG]).

METHODS

Acuity reserve was calculated using AUC compared with visual demand (logMAR) at various distances. Study 1 validated the model; study 2 compared acuity reserve, for a range of defocus levels, for the 2 IOLs.

RESULTS

The defocus curve (study 1 [149 patients; 298 eyes]) showed good visual acuity (ie, >20/25) at all defocus levels; the AUC estimate showed 2 lines or more of reserve at -2.50 diopters. Comparative post hoc analysis (study 2 [182 patients]) demonstrated significantly improved acuity reserve with PanOptix IOL vs AT LISA IOL at 20 to 40 days postoperatively (P < .001) and 120 to 180 days postoperatively (P < .001).

CONCLUSIONS

Acuity reserve analysis using AUC represents a new methodology for comparative IOL assessment, providing additional detail beyond defocus curve analysis. This method demonstrated that the PanOptix Trifocal IOL was superior to the AT LISA Trifocal IOL (model 839MP) for visual acuity at near to intermediate distances with visual acuity reserve analysis.

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.