Quality of life related variables measured for three multifocal diffractive intraocular lenses: a prospective randomised clinical trial

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.

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.

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.

Clinical Evaluation of Reading Performance in Refractive Lens Exchange With a Diffractive Continuous-Range-of-Vision Intraocular Lens

PURPOSE

Evaluation of reading performance with a novel presbyopia correcting intraocular lens (IOL) in refractive lens exchange using an electronic reading desk.

DESIGN

Prospective interventional before-and-after clinical study.

METHODS

In total, 56 eyes of 28 patients were included. Bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Surgical Vision) during a bilateral delayed sequential refractive lens exchange procedure. Uncorrected and distance corrected reading acuity, reading distance, reading speed, and the smallest print size that could be read effectively at a set (40 cm/80 cm) and subjectively chosen near and intermediate distance were assessed using the Salzburg Reading Desk preoperatively and 6 months after surgery.

RESULTS

Uncorrected near reading acuity increased from 0.61 ± 0.16 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05 ± 0.09 logMAR postoperatively at the set near distance (40 cm) and from 0.60 ± 0.11 logMAR to 0.07 ± 0.08 logMAR at the subjectively preferred distance (39.6 ± 5.3 cm and 37.7 ± 4.3 cm). Uncorrected intermediate reading acuity was 0.39 ± 0.19 logMAR preoperatively and 0.08 ± 0.07 logMAR postoperatively at the set intermediate distance (80 cm) and 0.43 ± 0.21 logMAR preoperatively and 0.07 ± 0.08 logMAR postoperatively at the preferred intermediate distance (73.5 ± 9.5 cm and 73.3 ± 5.9 cm).

CONCLUSIONS

Uncorrected intermediate and near reading function considerably improved after bilateral implantation of the TECNIS Synergy IOL. Patients preferred a closer near and intermediate distance to the set distances. However, reading function was comparable for the set and subjectively preferred distances.

Visual performance, safety and patient satisfaction after bilateral implantation of a trifocal intraocular lens in presbyopic patients without cataract

Background

The aim was to evaluate the safety and efficacy of a trifocal intraocular lens (IOL) for the correction of presbyopia and to assess patient satisfaction.

Methods

Records from three centres were reviewed to select presbyopic patients having undergone bilateral refractive lens exchange and implantation of the AT LISA tri 839MP multifocal IOL. Postoperatively, monocular and binocular distance, intermediate and near visual acuities, corrected and uncorrected, and subjective refraction were measured. Patients also completed a quality of life questionnaire. Safety evaluation included IOL stability and postoperative complications.

Results

72 eyes (36 patients) were analysed. No clinically significant difference between pre- and postoperative corrected distance visual acuity (CDVA) was found for monocular or binocular measurements. Mean postoperative monocular CDVA was 0.02 ± 0.04 logMAR. Mean refractive values all improved statistically significantly compared with preoperative baseline (p ≤ 0.0064). Overall, 82.4% of eyes had spherical equivalent within ± 0.5 D and 97.1% within ± 1.0 D of emmetropia with a mean accuracy of -0.10 ± 0.41 D. Spectacle independence for distance, intermediate and near visual acuity was 87.5%, 84.4% and 78.1% respectively, and 78.1% of patients were satisfied with their postoperative, spectacle-free vision. Eight eyes received Nd:YAG laser treatment. No other IOL-related safety issues were reported.

Conclusion

AT LISA tri 839MP multifocal IOL bilaterally implanted in presbyopic patients provided excellent distance, intermediate and near visual outcomes with very accurate correction of refraction. These results were associated with a high level of spectacle independence and patient satisfaction.

Trial registration

Trial registered on https://clinicaltrials.gov/ under the identification NCT03790592 (31/12/2018).

Difference in Quality of Vision Outcome among Extended Depth of Focus, Bifocal, and Monofocal Intraocular Lens Implantation

We aimed to compare the postoperative quality of vision among patients who received extended depth of focus (EDOF), bifocal, and monofocal intraocular lens (IOL) implantation. A retrospective study was conducted, and 87 patients who underwent cataract surgery were enrolled. Patients were categorized into different groups according to IOL design, with 24, 29, and 34 individuals constituting bifocal, EDOF, and monofocal groups. Preoperative and postoperative visual acuity (VA), biometry data, refractive status, contrast sensitivity (CS), higher-order aberrations (HOAs), and a quality of vision questionnaire that consisted of 11 questions were obtained 1 month postoperatively. The Kruskal−Wallis test and Pearson’s chi-square test were applied for statistical analyses. The postoperative CDVA was better in the EDOF group than in the bifocal group (p = 0.043), and the residual cylinder was lower in the EDOF groups than in the other two groups (both p < 0.05). The CS was worse in the EDOF group than in the other two groups (all p < 0.05), while the spherical aberration and trefoil were lower in the EDOF group than in the bifocal group (both p < 0.05). In terms of the quality of vision, the scores were better in the monofocal group than in the EDOF group in seven items (all p < 0.05), and the quality of vision in the bifocal group was better than in the EDOF group in small print reading (p = 0.042). In addition, the incidence of glare was lower in the monofocal group than in the other two groups (p < 0.001), while the spectacle dependence ratio was significantly higher in the monofocal group compared to the other two groups (p < 0.001). In conclusion, the general quality of vision was better in the monofocal group compared to the bifocal and EDOF groups, while the spectacle dependence ratio was significantly higher in the monofocal group than in the other two groups.

Development and Pilot Usefulness Testing of an Interactive Computerized Patient Decision Aid for Intraocular Lens Selection Before Cataract Surgery

PURPOSE

Modern cataract surgeries aim to treat impaired vision and also improve quality of life. An appropriate pre-operative selection of the intraocular lens is important to post-operative quality of life. Patients often have difficulty in choosing the best fit for individual needs. Patient decision aids (PDAs) are useful tools to assist patients in such decision-making process. However, most PDAs are paper-based and lack user interaction. This study is aimed to develop and evaluate an interactive computerized patient decision aid (cPDA) to help patients in the selection of an appropriate intraocular lens model before cataract surgery.

MATERIALS AND METHODS

Patients and their families who were making the decision regarding intraocular lens selection before cataract surgeries were eligible to participate in this study. A cPDA was built on an interactive robot, to help the patients in the decision-making process. The usefulness of the cPDA was measured with the Decision Self-Efficacy (DSE) scale and Preparation for Decision Making (PrepDM) scale.

RESULTS

A total of 50 participants (18 men and 32 women) were enrolled in the pilot test. The mean pre-cPDA DSE score was 46.5 ± 13.6, and the post-cPDA DSE score was 72.6 ±12.8. The average gain score on DSE was 26.1, and the standard deviation was 8.0. The gain score on DSE was statistically significant, and the effect size was bigger than 3. The patients with junior or senior high degrees had the highest gain score on DSE, and the ones with college or above degrees had the lowest. The patients with college or above degrees had the highest PrepDM score, and the ones with elementary school or below had the lowest. Age and sex were not significant correlates of PrepDM. The patients with college or above degrees had the highest preparedness, but the lowest gain on DSE.

CONCLUSION

Education levels are associated with the usefulness of cPDA, both for the preparedness and decision efficacy of patients. The results provide insight into the feasibility of cPDA for the decision-making of pre-operative intraocular lens selection.

Patient-Reported Quality of Life and Satisfaction After Refractive Lens Extraction Using a Diffractive Trifocal IOL: A Multicenter Retrospective Cohort Study

PURPOSE

To assess patient satisfaction and quality of life after refractive lens exchange with a trifocal intraocular lens (IOL).

METHODS

Consecutive patients who underwent refractive lens exchange with the AT LISA tri or AT LISA tri toric IOL (Carl Zeiss Meditec AG) at one of five surgical centers were surveyed for their quality of life and satisfaction after surgery using a standardized questionnaire. Patient responses were compared to patient characteristics such as age, sex, axial lengths, and preoperative refraction.

RESULTS

A total of 102 patients with 204 treated eyes were included in the analysis. The mean age was 54.6 ± 5.2 years. A total of 172 eyes were hypermetropic, 3 were emmetropic, and 25 were myopic, with a mean preoperative refractive error of 0.93 ± 2.17 diopters. Reported postoperative satisfaction was as follows: 81.4% stated that their expectations were completely met and 17.6% stated that they were partially met. Self-reported refractive error quality of life improved significantly in all queried areas of life. Most frequently reported postoperative limitations were driving at night and driving in bad weather conditions. Halos were reported by 91 (90.1%) patients.

CONCLUSIONS

Patient satisfaction and self-reported quality of life after refractive lens exchange with the AT LISA tri or AT LISA tri toric IOL was high. Glare and halos remain the only significant drawback of the procedure, leading to 40% of patients experiencing difficulties in night driving. Preoperative communication of these drawbacks is obligatory to avoid postoperative disappointment. [J Refract Surg. 2021;37(11):768-774.].

Comparative Efficacy Between Trifocal and Bifocal Intraocular Lens Among Patients Undergoing Cataract Surgery: A Systematic Review and Meta-Analysis

The comparative efficacy of trifocal and bifocal intraocular lenses (IOLs) remained uncertain among patients undergoing cataract surgery. A systematic review and meta-analysis was performed to answer this question. PubMed, Cochrane Library and Embase were searched to capture relevant randomized controlled trials (RCTs). Visual acuity (VA) and patient's satisfaction were regarded as primary outcomes. Secondary outcomes included residual sphere, spherical equivalence, residual cylinder, posterior capsular opacification (PCO), spectacle independence, and other complications. Statistical analysis was done using RevMan 5.2.0. A total of 9 studies (11 RCTs) with 297 participants (558 eyes) were included. Meta-analysis showed significant differences between trifocal and bifocal IOLs in the uncorrected near VA (mean difference [MD], −0.008; 95% confidence interval [Cl], −0.015 to −0.001; P = 0.028) and uncorrected intermediate VA (MD, −0.06; 95% CI, −0.10 to −0.02; P < 0.01). Trifocal IOLs were associated with decreased PCO incidence when compared to bifocal IOLs (relative risk [RR], 0.54; 95% CI, 0.31 to 0.95; P = 0.03). Trifocal IOLs may be superior to bifocal IOLs because of its improved intermediate VA and reduced incidence of PCO.

Perception of Trifocal IOL Performance in Young Adults with High Astigmatism and Hyperopia and its Improvement Using Small Incision Lenticule Extraction

Background:

Hyperopia is a kind of refractive error in which incoming light is focused behind, instead of on, the retina wall due to insufficient accommodation by the lens. It is likely affected by ethnicity, geography, and a family history of hyperopia or accommodative esotropia and is categorized as low (≤ 2.00D), moderate (2.00–4.00 D), and high (> 4.00D). Beyond hyperopia refractive error, patients may have poor accommodative function or visual perceptual skills.

Objective:

This study aimed to present the latest approaches to planning trifocal intraocular lens (IOL) and toric trifocal IOL implantation for residual refractive errors in young adults with high astigmatism and hyperopia and increase the patients’ best visual outcome and satisfaction using Small Incision Lenticule Extraction (SMILE) after implantation.

Methods:

Eighty eyes of 40 consecutive patients who underwent refractive lensectomy were included in this retrospective study. It included patients aged 20–45 years seeking spectacle independence with pre-operative high spherical hypermetropia of 4D or higher and astigmatism of 3D or higher. Patients’ treatment status was categorized as trifocal IOL (n=40) and toric trifocal IOL (n=40).The mean patient follow-up time was six months after IOL implantation. First, we assessed visual acuity and satisfaction for both groups and then examined laser vision correction results of patients who were dissatisfied after IOL implantation (trifocal IOL group) and underwent SMILE surgery to increase satisfaction level.

Results:

There were no statistically significant differences between trifocal IOL and toric trifocal IOL for near (UNVA), intermediate (UIVA), and distance (UDVA) uncorrected visual acuity. Comparisons related to patient satisfaction six months after IOL implantation were statistically significant for using a computer and night driving. In the trifocal IOL group, compared to pre-operative values, sphere and cylinder at six months were significantly improved.

Conclusion:

In young adults, toric trifocal and trifocal IOL provided sufficient results in visual acuity; however, patients were dissatisfied after implantation. This study reported patient satisfaction levels, including quality of life and life without glasses by using Small Incision Lenticule Extraction (SMILE) surgery.

Visual function and subjective perception of vision after bilateral implantation of monofocal and multifocal IOLs: a randomized controlled trial

PURPOSE

To examine monocular and binocular visual function and patient-reported outcomes after implantation of multifocal IOLs (mIOLs) or monofocal IOLs, using a rigorous series of clinical assessments.

SETTING

BMI Southend Hospital, United Kingdom.

DESIGN

Prospective, randomized, double-masked clinical trial.

METHODS

One hundred patients were randomized for bilateral implantation of either a Bi-Flex 677MY mIOL or a Bi-Flex 677AB IOL and were assessed at 3 to 6 months (V1) and 12 to 18 months (V2). Primary outcomes included distance, intermediate, and near logarithm of the minimum angle of resolution (logMAR) visual acuities (VAs) and defocus curve profile assessment. Secondary outcomes included reading speed, contrast sensitivity (CS), and the subjective perception of quality of vision.

RESULTS

Forty-seven subjects with monofocal IOL and 43 mIOL subjects completed the study. Uncorrected (mIOL: 0.10 ± 0.09 logMAR; IOL: 0.09 ± 0.11 logMAR) and corrected (mIOL: 0.04 ± 0.06 logMAR; IOL: 0.01 ± 0.07 logMAR) distance VAs were comparable (P > .05). Uncorrected near VA (mIOL: 0.23 ± 0.13 logMAR; IOL: 0.55 ± 0.20 logMAR, P < .001) and distance-corrected near VA (mIOL: 0.24 ± 0.13 logMAR; IOL: 0.54 ± 0.17 logMAR, P < .001) were significantly improved with mIOLs. There was no significant difference in distance-corrected intermediate VA (mIOL: 0.38 ± 0.13 logMAR; IOL: 0.39 ± 0.13 logMAR, P = .431). Defocus curves demonstrated an increased range-of-focus among mIOLs (mIOL: 4.14 ± 1.10 diopter [D]; IOL: 2.57 ± 0.77 D). Pelli-Robson CS was different at V1 (P < .001) but similar by V2 (P = .059). Overall satisfaction was high (>90%) in both groups for distance tasks whereas significantly different for near tasks (mIOL, 18.45 ± 16.53 logUnits; IOL, 55.59 ± 22.52 logUnits).

CONCLUSIONS

Uncorrected near visual acuity was demonstrably better with mIOLs and there was greater subjective satisfaction with quality of near vision. Halos reported by the mIOL group were significant compared with the IOL group but did not show an adverse effect on overall satisfaction.

Comparison of clinical outcomes of 3 trifocal IOLs

PURPOSE

To compare the clinical outcomes obtained after implantation of 1 of 3 models of diffractive trifocal IOLs.

SETTING

Hospital da Luz, Lisbon, Portugal.

DESIGN

Prospective randomized comparative study.

METHODS

Patients undergoing cataract surgery with bilateral implantation of 1 of 3 models of diffractive trifocal IOLs were enrolled. The IOL models implanted were the FineVision POD F, RayOne Trifocal, or the AcrySof IQ PanOptix IOL (30 eyes of 15 patients in each group). Visual acuity (VA), refraction, defocus curve, and contrast sensitivity outcomes were evaluated during a 3-month follow-up. Furthermore, the Quality of Vision questionnaire (QoV) was used to evaluate the frequency, severity, and discomfort of different visual symptoms.

RESULTS

A total of 90 eyes of 45 patients were included. No statistically significant differences were found between groups in distance, intermediate, and near VA (P ≥ .112) and postoperative refraction (P ≥ .059). Postoperative binocular uncorrected intermediate VA of 0.10 logarithm of the minimum angle of resolution (logMAR) or better was found in 14 (93.33%) patients in the 3 groups. Postoperative binocular uncorrected near VA of 0.10 logMAR or better was found in 13 (86.67%), 14 (93.33%), and 13 (86.67%) patients in the POD F, RayOne, and PanOptix IOLs groups, respectively. No statistically significant differences were found between groups in scotopic contrast sensitivity with and without glare and in the QoV scores (P ≥ .057), except for the difference between the POD F and RayOne IOLs groups in depth perception severity, which was less in the RayOne IOL group (P = .019).

CONCLUSIONS

The 3 trifocal IOLs evaluated provided a complete visual restoration with good visual quality outcomes.

One-year Results of Health-related and Vision-related Quality of Life After Clear Lens Extraction and Multifocal Intraocular Lens Implantation

PURPOSE

Multifocal intraocular lenses (MIOLs) are effective in treating presbyopia before cataracts develop. This study measured health-related quality of life (HRQoL) and vision-related quality of life (VRQoL) after clear lens extraction (CLE) and MIOL implantation.

DESIGN

Before-and-after study METHODS: Patients were treated in Medilaser Coronaria, CorGroup, Oulu, Finland. HRQoL was measured by a generic 15-dimension (15D) instrument. VRQoL was measured with Visual Function Index-14 (VF-14) questionnaire.

RESULTS

CLE and MIOL implantation was performed in 137 patients. The patient age was 57 ± 6.2 years (mean ± standard deviation), and 58% were women. The near add was 2.1±0.3 diopters (D). The overall HRQoL 15D score increased from 0.938±0.058 to 0.955±0.057 at 6 months (P < .0001 vs baseline) and to 0.948±0.060 at 1 year (P = .02 vs baseline). The VRQoL VF14 score increased from 85.32±15.57 to 96.57±5.07 at 6 months (P < .0001 vs baseline) and to 96.61±6.48 at 1 year (P < .0001 vs baseline). The increase of HRQoL was correlated with the increase of VRQoL (P < .04).

CONCLUSIONS

CLE and MIOL implantation improved HRQoL and VRQoL compared to spectacles in this 1-year follow-up study. Improvement of HRQoL was correlated with VRQoL.

Posterior capsular opacification evaluation through contrast sensitivity defocus curves with two multifocal intraocular lenses of similar material

PURPOSE

To assess the degree of posterior capsular opacification (PCO) and its influence on contrast sensitivity defocus curve (CSDC) after implantation of two trifocal intraocular lenses (IOLs), Alsafit (AT) and Liberty (L), during a 12-month follow-up. A secondary aim was to evaluate the Nd:YAG capsulotomy rate in a long time.

METHODS

Data from 63 subjects, 34 implanted with AT and 29 with L, were retrospectively analyzed for this pilot study. In those eyes without capsulotomy during the first year (n = 58), CSDC at 3 and 12 months after surgery and PCO grading were measured, with additional answering of a visual function questionnaire (VF-14) and a question of general satisfaction. The period after surgery up to capsulotomy or last on-demand visit without Nd:YAG was recorded for survival analysis beyond the 12-month follow-up.

RESULTS

Total area under CSDC (TAUC) between 3 and 12 months decreased from 2.96 to 1.71 for AT (p < 0.05) and from 2.73 to 2.21 (p > 0.05) for L. Of eyes, 51.6, 19.3, and 29% with AT were graded as level 0, 1, and 2 of PCO, while 85.1, 11.1, and 3.7% of eyes with L were graded as level 0, 1, and 2 (p < 0.05). PCO grading was correlated with a decrease of TAUC (ρ =  - 0.27, p = 0.04). Median time to require capsulotomy was 22 months with AT and 30 months with L (p < 0.05).

CONCLUSIONS

PCO decreases CSDC in patients with trifocal lenses. Despite using the same hydrophilic material, PCO grading and Nd:YAG capsulotomy rate was higher for AT than for L.

Long-Term Evaluation of Visual Outcomes and Patient Satisfaction after Binocular Implantation of a Bioanalogic Lens

Purpose

Long-term evaluation of the visual refractive outcomes and the quality of life after implantation of the WIOL-CF (Medicem, Czech Republic) in both eyes.

Design

retrospective, nonrandomized noncomparative case series.

Methods

50 eyes of 25 patients, including 11 women (44%) and 14 men (56%). The age range of the patients was 38 to 77 years (mean age 55.48 ± 10.97 years). All patients underwent bilateral implantation of the WIOL-CF. Exclusion criteria were previous ocular surgeries except for cataract surgery and refractive lens exchange, irregular corneal astigmatism of >1.0 diopter, and ocular pathologies or corneal abnormalities. Postoperative examinations were performed at 14 days and 3, 6, 12 months of surgery; the last follow-up was between 24 and 36 months after the procedure. All exams included manifest refraction, monocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) in 5 m (Snellen), monocular uncorrected visual acuity in 70 cm and 40 cm (Jeager) and binocular UCVA, DCVA in 5 m, 70 cm, and 40 cm, binocular contrast sensitivity (CS) under photopic conditions, binocular defocus curves, high-order aberrations, quality-of-vision VF-14 questionnaire, and spectacle independence.

Results

Significant improvement in monocular visual acuity at all distances was demonstrated; the mean postoperative spherical equivalent was 0.32 ± 0.45D. The postoperative means of binocular distance UCVA and BCVA were also improved (p < .001) and so were the mean uncorrected intermediate VA (2.053 ± 1.268) and near uncorrected VA (2.737 ± 1.447). There was a significant improvement in contrast sensitivity at all spatial frequencies and higher-order aberration, compared to preoperative results.

Conclusions

The evaluation of a WIOL-CF showed good distance, intermediate, and near visual acuity. Contrast sensitivity increased after surgery in all spatial frequencies. Patient satisfaction was high despite some optical phenomena. The rate of postoperative spectacle independence also turned out high. Financial Disclosure. No author has a financial or proprietary interest in any material or method mentioned.

Long-Term Efficacy, Visual Performance and Patient Reported Outcomes with a Trifocal Intraocular Lens: A Six-Year Follow-up

(1) Background: To evaluate the efficacy at 6 years postoperative after the implantation of a trifocal intraocular lens (IOL) AT Lisa Tri 839MP. The secondary objective was to evaluate the contrast sensitivity defocus curve (CSDC), light distortion analysis (LDA), and patient reported outcomes (PROs). (2) Methods: Sixty-two subjects participated in phone call interviews to collect data regarding a visual function questionnaire (VF-14), a patient reported spectacle independence questionnaire (PRSIQ), and questions related to satisfaction and decision to be implanted with the same IOL. Thirty-seven of these subjects were consecutively invited to a study visit for measurement of their visual acuity (VA), CSDC, and LDA. (3) Results: The mean monocular distance corrected VA was −0.05, 0.08, and 0.05 logMAR at far and distances of 67 cm and 40 cm, respectively. These VAs were significantly superior to those reported in previous literature (p < 0.05). The total area under the CSDC was 2.29 logCS/m⁻¹ and the light distortion index 18.82%. The mean VF-14 score was 94.73, with 19.4% of subjects requiring spectacles occasionally for near distances, and 88.9% considering the decision of being operated again; (4) Conclusions: Long-term AT LISA Tri 839MP IOL efficacy results were equal or better than those reported 12 months postoperatively in previous studies. The spectacle independence and satisfaction rates were comparable to those reported in short-term studies.

Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines EDOF and Multifocal profiles

PURPOSE

To evaluate clinical outcomes delivered by a new hybrid presbyopia-correcting intraocular lens: Tecnis Synergy ZFR00V IOL model (Johnson & Johnson Vision) SETTING:: Hospital da Luz Lisboa, Lisbon, Portugal DESIGN:: Prospective observational study METHODS:: A total of 27 patients undergoing bilateral IOL implantation were included. Visual acuity (VA) was measured for far distance, intermediate (66 cm) and near (40 cm) vision under both photopic and mesopic conditions. In addition, at the 3-month follow-up visit, the defocus curve was obtained for binocular vision and questionnaires were administered to measure spectacle-independence and level of satisfaction (QoV and Catquest-SF9) with the surgical outcomes.

RESULTS

At 3-month follow-up, under photopic conditions, VA values were: CDVA = -0.02 ± 0.07, DCIVA = 0.03 ± 0.11, and DCNVA = 0.00 ± 0.08, while under mesopic conditions, VA values were: CDVA = -0.01 ± 0.05, and DCNVA = 0.07 ± 0.09. The binocular defocus curve revealed that mean visual acuity was better than 0.30 LogMAR within the +1.00 D to -4.00 D interval, and better than 0.10 LogMAR between +0.50 D and -3.00 D. All patients achieved distance-vision spectacle freedom, while 3.7% of them said they used them in certain intermediate- or near-vision situations. As much as 88% of the patients reported being fairly satisfied or very satisfied.

CONCLUSIONS

The Tecnis Synergy ZFR00V intraocular lens model used for cataract surgery is capable of restoring visual function while providing very good intermediate and near vision, under both photopic and mesopic conditions, resulting in a high level of patient satisfaction.

Visual performance of four types of diffractive multifocal intraocular lenses and a review of articles

AIM

To compare the clinical outcomes of a variety of multifocal intraocular lenses (MIOLs) in patients diagnosed with presbyopia or cataracts.

METHODS

This clinical trial study included 141 patients (282 eyes) with different MIOLs implantation. The Symfony (60 eyes), the ReSTOR (100 eyes), the AT LISAtri (60 eyes), and the PanOptix (62 eyes) intraocular lenses were evaluated in this prospective interventional study. The near, intermediate, and distant visual acuities, contrast sensitivity, and defocus curve were measured as valid criteria. To statistically analyze the results, we used the Statistical Package for Social Science software, the non-parametric Wilcoxon signed-rank t, the one-way analysis of variance and the Tukey's post-hoc test in our analysis. Moreover, we conducted a detailed literature search on the PubMed database in English about MIOLs, in total 59 studies were included in this review article.

RESULTS

The four approaches did not show any significant difference in the best-corrected distance visual acuity (P>0.05). The defocus curves at the contrast of 100% showed that trifocal IOLs had better intermediate performance than the bifocal IOL (P<0.05). There were no statistically significant differences between AT LISAtri and PanOptix lenses for visual acuity at all distances. The eyes with PanOptix, Symfony, and AT LISAtri IOL showed better contrast sensitivity than those ReSTOR at spatial frequencies of 1, 3, and 6 cpd in photopic and mesopic conditions (P<0.001).

CONCLUSION

All four groups of the multifocal lenses were satisfying in terms of distance and near vision. Also, the group of trifocal lenses led to satisfactory outcomes in intermediate vision, without degradation in quality of vision.

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.

Comparison of the intermediate distance of a trifocal IOL with an extended depth-of-focus IOL: results of a prospective randomized trial

PURPOSE

To compare visual outcomes, reading ability, and visual quality between the Symfony extended depth-of-focus intraocular lens (IOL) and the trifocal AT LISA tri 839MP IOL.

SETTING

University Eye Clinic Maastricht, The Netherlands.

DESIGN

Prospective randomized controlled trial.

METHODS

Patients were randomly assigned to bilateral Symfony IOL or AT LISA tri 839MP IOL implantation. The primary outcome measure was uncorrected intermediate visual acuity (UIVA measured at 66 cm). Secondary outcomes included uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), reading ability, and comparison of defocus curves, contrast sensitivity, optical adverse effects, and quality of vision.

RESULTS

The study enrolled 60 eyes of 30 patients. The mean UIVA was -0.02 ± 0.03 (SD) vs 0.01 ± 0.03 logarithm of the minimal angle of resolution (logMAR) in the Symfony and AT LISA tri 839MP groups, respectively (P = .047). The UDVA was 0.01 ± 0.12 and -0.05 ± 0.07 logMAR (P = .11) and the UNVA was 0.09 ± 0.05 and 0.04 ± 0.07 logMAR (P = .052) in the Symfony and AT LISA tri 839MP groups, respectively. Reading ability was similar in both groups at 40 cm and 66 cm (P = .87 and P = .14, respectively). Less than 10% of patients in both groups experienced disabling glare. Patients experienced disabling halos in the AT LISA tri 839 MP group compared to the Symfony group in 39% and 21% of cases, respectively (P = .12). The mean score for visual functioning was 88.0 ± 14.1 n the trifocal group and 88.2 ± 10.9 for the EDOF group (P = .96).

CONCLUSIONS

The UIVA was better in the Symfony group than in the AT LISA tri 839MP group. No significant differences were seen in the binocular UNVA and UDVA, contrast sensitivity, reading ability, incidence of photopic phenomena, and patient satisfaction.

Measures of visual disturbance in patients receiving extended depth-of-focus or trifocal intraocular lenses

The degree of visual disturbance associated with a particular model of intraocular lens (IOL) depends on several factors, including IOL optic, material, and mechanics. Characterization of visual disturbance profiles is paramount for informing clinical IOL selection. Although many studies evaluating presbyopia-correcting IOLs include subjective assessment of visual symptoms, the types of patient-reported outcome measures (PROMs) used to capture these outcomes are inconsistent across studies, complicating data contextualization. Furthermore, some tools produce more meaningful results than others. This review presents a discussion on the scientific literature published on the subjective and semiobjective (halo and glare simulator, light-distortion analyzer, vision monitor, and halometers) methods used to assess visual disturbances in patients implanted with trifocal or extended depth-of-focus IOLs, highlighting their advantages and limitations. It underscores the importance of between-study comparisons and the need for standardized PROMs in clinical IOL research to provide more accurate information for IOL selection.

Vision outcomes with a new monofocal IOL

PURPOSE

The aim of this study was to compare the distance, intermediate, and near visual performance of a new IOL (ICB00, Eyhance, Tecnis) and classic monofocal IOL (SN60WF IQ AcrySof, Alcon) after unilateral implantation.

METHODS

Sixty-three patients were unilaterally implanted with the ICB00 Eyhance IOL (study group) and 65 patients with the SN60WF IQ AcrySof (control group). Visual performance was assessed with monocular corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA) at 4 m, corrected intermediate visual acuity (CIVA) and uncorrected intermediate visual acuity (UIVA) at 60 cm, and corrected near visual acuity (CNVA) and uncorrected near visual acuity (UNVA) at 40 cm.

RESULTS

CDVA, UDVA, CNVA, and UNVA values did not differ significantly between the study and control groups (0.02 ± 0.02 vs. 0.03 ± 0.02, p = 0.523; 0.05 ± 0.13 vs. 0.05 ± 0.15, p = 0.637; 0.46 ± 0.17 vs. 0.46 ± 0.15, p = 0.821; and 0.47 ± 0.21 vs. 0.49 ± 0.25, p = 0.612; respectively), whereas the study group showed significantly better results for CIVA (0.28 ± 0.12 vs. 0.38 ± 0.13, p = 0.001) and UIVA (0.31 ± 0.16 vs. 0.41 ± 0.12, p = 0.001).

CONCLUSIONS

The Eyhance IOL, which features a new optical design based on a continuous power profile, was determined to be superior to a classic monofocal IOL for intermediate visual acuity and not inferior for corrected and uncorrected distance and near visual acuity.

A Comparative Evaluation of Diffractive Trifocal and New Refractive/Extended Depth of Focus Intraocular Lenses for Refractive Lens Exchange

PURPOSE

To evaluate and compare the visual performance and quality of life (QOL) associated with refractive/extended depth of focus (EDOF) intraocular lenses (IOLs) and diffractive trifocal IOLs in refractive lens exchange patients.

MATERIALS AND METHODS

This was a comparative interventional study of patients undergoing implantation of Lucidis (Swiss Advanced Vision, SAV‑IOL SA, Neuchâtel, Switzerland) or AT LISA tri 839MP (Carl Zeiss Meditec AG, Germany) IOLs. Near, intermediate, and distance best corrected and uncorrected visual acuities were collected at 1 and 3 months postoperatively. The vision-related QOL was evaluated 1 and 3 months after surgery, using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire).

RESULTS

A total of 74 patients underwent refractive lens exchange and IOL implantation, with 38 patients in the EDOF group and 36 in the trifocal group. Among all visual acuities, uncorrected near visual acuity was statistically significantly better with the Lucidis IOL at the first month (p = .02) and diminished at the third-month visit (p = .16). When we compared the VF-14 QOL questionnaire scores, reading small print, reading a newspaper or book, and driving at night were statistically significantly better in the Lucidis group at the first month (p = .00, for each). That difference persisted only in driving at night at the third-month visit (p = .04). Reading small print, driving at night, and doing fine handwork were the most difficult tasks in the AT LISA group at the first month, and only driving at night remained so at the third-month visit.

CONCLUSIONS

The refractive results and visual outcomes at all distances of EDOF and trifocal IOLs were highly satisfactory. However, the EDOF design in the Lucidis IOL achieves lower rates of glare in the early period after refractive lens exchange.

Multifocal and Extended Depth-of-Focus Intraocular Lenses in 2020

Ophthalmic surgeons have been overwhelmed by the influx of multifocal intraocular lens (IOL) options in recent years, with close to 100 IOLs on the market in 2020. This practical and technical update on a representative group of established as well as newly launched multifocal IOLs on the market focuses on multifocal IOLs, including extended depth-of-focus lenses. We also describe the optical basis of lens platforms used and thorough preoperative planning to aid decision making. This allows the surgeon the knowledge base to deliver the required relative customized spectacle independence with the least photic phenomenon and loss of contrast possible while achieving high individual patient satisfaction. Data of reviewed IOLs displayed in tabular format include mean monocular uncorrected distance, intermediate, and near visual acuities (logarithm of the minimum angle of resolution), with standard deviations and ranges where available. The range of vision targeted, pupil dependence, toric availability, as well as type of optical platform, are provided as a practical guide to demystify existing terminology on the market that may create interest around a seemingly new design that is actually not novel at all. Halos and glare experienced, levels of patient satisfaction, and spectacle independence achieved also are summarized. A wide range of multifocal IOLs options are available on the market to surgeons. Comprehensive patient selection and examination, combined with knowledge of the most recent options and adequate patient counseling, including neuroadaptation, can avoid dissatisfaction. Many recently available IOLs are awaiting formal results, but the methods by which we label and compare these types of IOLs must also be standardized.

Implantation of a diffractive-refractive trifocal intraocular lens with centralized diffractive rings: Two-year results

PURPOSE

To compare the optical performance and quality of life after implantation of a new progressively apodized diffractive multifocal intraocular lens (IOL) and report the visual and patient-reported outcomes and contrast sensitivity.

SETTING

Csolnoky Ferenc Hospital, Veszprem, Hungary.

DESIGN

Prospective case series.

METHODS

Patients had bilateral implantation of the trifocal IOL during cataract surgery. The preoperative corrected distance visual acuity (CDVA) and postoperative uncorrected distance visual acuity (UDVA), CDVA, uncorrected (UIVA) and corrected (CIVA) intermediate visual acuities, and uncorrected (UNVA) and corrected (CNVA) near visual acuities (all logarithm of the minimum angle of resolution) were collected. Contrast sensitivity, slitlamp photographs for evaluation of posterior capsule opacification, and a quality-of-vision questionnaire were assessed.

RESULTS

The study comprised 100 eyes (50 patients). The mean postoperative UDVA was 0.01 at 3, 6, 12, and 24 months. The mean CDVA was -0.02 ± 0.03 (SD) at 6 months, -0.04 ± 0.05 at 1 year, and 0.06 ± 0.05 at 2 years. The mean UIVA was 0.05 ± 0.11, 0.04 ± 0.09, and 0.06 ± 0.11, respectively. The mean CIVA was -0.01 ± 0.07, -0.02 ± 0.06, and -0.01 ± 0.07, respectively. The mean UNVA was 0.08 ± 0.08, 0.07 ± 0.08, and 0.10 ± 0.09, respectively. The mean CNVA was 0.03 ± 0.06 at 3 months, 0.04 ± 0.05 at 1 year, and 0.05 ± 0.07 at 2 years. The mesopic and photopic contrast sensitivity values were within the upper normal range for age-matched values.

CONCLUSIONS

Bilateral implantation of a new trifocal IOL with centralized diffractive rings provided good functional vision at all distances. The levels of spectacle independence and patient satisfaction were high with minimal dysphotopsia symtoms.

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 participants with presbyopia.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2019, Issue 9); 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 26 September 2019. We searched the reference lists of the retrieved articles and the abstracts from the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO) for the years 2005 to 2015.

SELECTION CRITERIA

We included randomized controlled trials that compared trifocal and bifocal IOLs among participants 30 years or older with presbyopia undergoing cataract surgery.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methodology.

MAIN RESULTS

We identified five studies conducted in Europe with a total of 175 participants. All five studies assessed uncorrected distance visual acuity (primary outcome of the review), while some 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 58 to 64 years. Only one study reported on gender of participants, and they were mostly women. We assessed all 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). In two studies, the investigators observed that participants' satisfaction or spectacle independence may be higher in the trifocal group at six months, although another study found no evidence of a difference in participant satisfaction or spectacle independence between groups. Adverse events Adverse events reporting varied among studies. Two studies reported information on adverse events at one year. One study reported that participants showed no intraoperative or postoperative complications, while the other study reported that four eyes (11.4%) in the bifocal and three eyes (7.5%) in the trifocal group developed significant posterior capsular opacification requiring YAG capsulotomy. The certainty of the evidence was low.

AUTHORS' CONCLUSIONS

There is low-certainty of evidence that compared to bifocal IOL, implantation of trifocal IOL may improve uncorrected intermediate visual acuity at one year. However, there is 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 and quality of life.

Long-term objective and subjective outcomes following bilateral implantation of diffractive bifocal or trifocal intraocular lenses

OBJECTIVE

To evaluate and compare the objective and subjective outcomes after the bilateral implantation of a diffractive bifocal and trifocal intraocular lens.

METHODS

This is a case-control, single-center observational study which included 27 patients; 16 patients were implanted bilaterally with the bifocal AcrySof IQ ReSTOR+3.0D and 11 patients with the trifocal AT LISA tri 839MP. Uncorrected visual acuity at distance, intermediate, and near under mesopic and photopic conditions using ETDRS charts with 10% and 100% contrast, corrected distance visual acuity, and binocular defocus curve in photopic conditions; binocular contrast sensitivity under mesopic and photopic conditions for far and near distances were assessed. The Visual Function Questionnaire-25 questionnaire was used to assess patients' satisfaction. All the measurements were performed 6-24 months after cataract surgery.

RESULTS

The ReSTOR group had better binocular uncorrected near visual acuity in photopic conditions with low and high contrast charts (p = 0.040 and p = 0.033, respectively), as well as in far contrast sensitivity measurement under mesopic conditions with a spatial frequency of 3 cycles per degree (p = 0.034). There was not a significant difference between the two study groups in uncorrected near, intermediate or distance vision under mesopic conditions. The AT LISA tri study group had better subjective outcomes.

CONCLUSION

Both intraocular lenses restore visual acuity after cataract surgery. The ReSTOR intraocular lens provides better objective outcomes than the AT LISA tri, although the latter provides better subjective outcomes. The relevance of this study is the evaluation of both objective and subjective outcomes.

Comparative Analysis of Visual Performance and Optical Quality with a Rotationally Asymmetric Multifocal Intraocular Lens and an Apodized Diffractive Multifocal Intraocular Lens

Purpose

To compare the short-term visual outcomes and intraocular optical performance of a rotationally asymmetric multifocal intraocular lens (MIOL) (SBL-3, Lenstec, Inc., Christ Church, Barbados) and an apodized diffractive MIOL (the Acrysof IQ ResTOR SN6AD1, Alcon Laboratories, Inc., Fort Worth, Texas, United States).

Methods

A prospective, comparative, nonrandomized, and single-center study. Sixty-eight age-related cataract patients (81 eyes) after phacoemulsification cataract surgery and in-the-bag MIOL implantation were enrolled. Thirty-eight eyes received SBL-3, and 43 eyes received SN6AD1. Ophthalmological evaluation included uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), modulation transfer function (MTF), Strehl ratio (SR), intraocular aberrations (4 mm optical zone), and defocus curve at 3 months postoperatively. The Chinese version of the visual function index-14 (VF-12-CN) and spectacle independence were assessed in all patients.

Results

There was no statistically significant difference between groups in postoperative UDVA (p = 0.186). Postoperative UIVA and UNVA were significantly better for the SBL-3 group than for the SN6AD1 group (p < 0.01). Statistically significant differences were revealed in defocus levels from –3.50 D to −4.00 D with better visual acuities for the SBL-3 group (p < 0.01). For intraocular optical quality outcomes, statistically significant differences between groups were observed in RMS of intraocular total aberrations, coma, and trefoil high-order aberrations, presenting significantly higher values of these parameters in the eyes of the SBL-3 group (p < 0.01). Statistically significant differences were revealed in the MTF values at spatial frequencies of 5 and 10 cycles/degree between groups. There were no significant differences in scores of VF-12-CN, and spectacle independence between the groups (p > 0.05).

Conclusions

Both MIOLs were able to successfully restore visual function after cataract surgery. SBL-3 provided better UIVA and UNVA with a wider range of intermediate vision.

A novel standardized test system to evaluate dynamic visual acuity post trifocal or monofocal intraocular lens implantation: a multicenter study

OBJECTIVES

To compare the dynamic visual acuity (DVA) following implantation of trifocal with monofocal intraocular lenses (IOL) and using a novel test system.

METHODS

The present research was a retrospective, multicenter clinical study. Two hundred and ten eyes of 149 patients that underwent cataract phacoemulsification and IOL implantation were enrolled. One hundred and ten eyes of patients received trifocal (AT LISA tri839MP, Carl Zeiss Meditec, Germany) and 100 eyes received monofocal (Tecnis ZCB00, Abbott, United States) lenses and were evaluated 3 months after implantation. Outcome measures included monocular uncorrected distance (UDVA), intermediate (UIVA) and near (UNVA) visual acuity and best corrected distance visual acuity (BCDVA; logMAR units); contrast sensitivity under photopic, mesopic, with glare conditions; and dynamic visual acuity using a self-developed system.

RESULTS

There was no statistically significant difference in baseline characteristics between groups. Monocular UDVA, UIVA, and UNVA were significantly better (all p < 0.001) in the trifocal IOL group, but not BCDVA. The trifocal IOL group showed better contrast sensitivity under photopic, mesopic, with or without glare conditions (p < 0.05) and statistically significantly better dynamic vision at 15, 30, 60, and 90 degrees per second (dps) compared with the monofocal group (all p < 0.001). The strength of positive association only between UIVA and dynamic visual acuity increased as the velocity increased, but not UDVA or UNVA.

CONCLUSIONS

Diffractive trifocal IOL provides better postoperative full range vision acuity, contrast sensitivity, and dynamic vision compared with monofocal IOLs. And intermediate visual acuity is increasingly associated with DVA as the velocity increasing.

Visual Function after Implantation of a Presbyopia-Correcting Trifocal Intraocular Lens

PURPOSE

To evaluate distance, intermediate, and near visual performance in patients implanted with a trifocal aspheric presbyopia-correcting intraocular lens (IOL).

METHODS

Forty patients were bilaterally implanted with the AcrySofIQ PanOptix IOL after femtosecond laser-assisted lens surgery. Binocular best corrected distance visual acuity (CDVA) (4 m), best distance-corrected near visual acuity (DCNVA) (40 and 30 cm), best corrected distance intermediate visual acuity (DCIVA) (70, 60, and 50 cm), binocular distance contrast sensitivity under photopic conditions (85 cd/m2), and defocus curves were evaluated at 6-months.

RESULTS

Six months postoperatively, the mean binocular Snellen decimal CDVA and DCNVA were 0.94 ± 0.10 (ranging from 0.70 to 1.25) and 0.85 ± 0.13 (ranging from 0.63 to 1.00), respectively. At a distance, all patients showed a cumulative binocular distance-corrected visual acuity of 0.8 or better, and about 80% (n = 31) of the patients had a value of 1.0 (20/20). At near and intermediate distances, all patients showed a cumulative distance-corrected visual acuity of 0.5 (20/40) or better at 30, 40, 50, 60, and 70 cm. Specifically, 50 cm showed the highest percentage of patients with larger values of visual acuity (60% [n = 26] with 20/20). Defocus curve showed a wide range of useful vision with two peaks of best visual acuity at distance and at 50 cm, and the binocular distance contrast sensitivity was within normal limits.

CONCLUSIONS

The outcomes of the present study show that the visual performance obtained with bilateral implantation of the trifocal aspheric AcrySofIQ PanOptix IOL is good at far, intermediate, and near distances.

AcrySof IQ PanOptix Intraocular Lens Versus Extended Depth of Focus Intraocular Lens and Trifocal Intraocular Lens: A Clinical Overview

AcrySof IQ PanOptix Model TFNT00 (Alcon Laboratories, Fort Worth, TX) is a 1-piece aspheric hydrophobic presbyopia-correcting intraocular lens (IOL) launched in 2015. Unlike traditional trifocal IOLs that usually have an intermediate focal point of 80 cm, the PanOptix IOL is designed to have an intermediate focal point of 60 cm (arms-length), a more natural and comfortable working distance to perform functional tasks on computers, laptops, mobiles, among others. The non-apodized PanOptix IOL uses the ENhanced LIGHT ENergy (ENLIGHTEN; Alcon Laboratories, Fort Worth, TX) optical technology that provides high (88%) utilization of light energy, low dependence on pupil size in all lighting conditions, and a more comfortable near-to-intermediate range of vision than traditional trifocal IOLs. This review provides an overview of the clinical performance of the PanOptix IOL and discusses it in the context of other commercially available trifocal IOLs, FineVision Micro F (PhysIOL, Liege, Belgium), the AT LISA tri 839MP (Carl Zeiss Meditec AG, Jena, Germany) and the extended depth of focus IOL, TECNIS Symfony (Abbott Medical Optics, Santa Ana, CA). A literature search was performed in the PubMed database to identify studies that have assessed the visual and other clinical outcomes with the PanOptix IOL. In total, 12 studies were included in this review article. Overall, the clinical evidence suggests that in general good visual outcomes, along with a high degree of spectacle independence, are achieved in patients implanted with the PanOptix, FineVision, AT LISA and Symfony IOLs. However, every MIOL has its benefits and limitations, which along with patient's needs and clinical conditions are important factors to consider while selecting an IOL to achieve best possible post-operative outcomes.

Comparison of postoperative visual performance between bifocal and trifocal intraocular Lens based on randomized controlled trails: a meta-analysis

BACKGROUND

To compare the clinical performance of bifocal and trifocal intraocular lenses (IOLs) in cataract surgery, a meta-analysis on randomized controlled trials was conducted.

METHODS

A comprehensive literature retrieval of PubMed, Science Direct and EMBASE was performed in this systematic review. Clinical outcomes included visual acuity (VA), contrast sensitivity (CS), spectacle independence, postoperative refraction and surgical satisfaction.

RESULTS

There were 8 RCTs included in this study. The difference of uncorrected near VA (UNVA) between the bifocal IOLs and trifocal IOLs had no significance [MD = 0.02, 95%CI: (- 0.03,0.06)]. There was no significant difference in the distant-corrected near VA (DCNVA) with MD of 0.04 [95%CI (- 0.02, 0.10)]. Compared with trifocal group, the uncorrected intermediate visual acuity (UIVA) [MD = 0.09,95%CI:(0.01,0.17)] was significantly worse in the bifocal group. No difference was found in distance-corrected intermediate VA (DCIVA) [MD = 0.09, 95%CI: (- 0.04, 0.23)] between two groups. Analysis on AT LISA subgroup indicated the bifocal group had worse intermediate VA than trifocal group (AT LISA tri 839 M) [MD = 0.18, 95%CI: (0.12, 0.24) for UIVA and MD = 0.19, 95%CI: (0.13, 0.25) for DCIVA]. However, there was no statistically significant difference between the two groups in the uncorrected distance VA (UDVA) and corrected distance visual acuity (CDVA) [MD = 0.01, 95%CI: (- 0.01,0.04) for UDVA; MD = 0.00, 95%CI: (- 0.01,0.01) for CDVA]. The postoperative refraction of bifocal group was similar to that of trifocal group [MD = -0.08, 95% CI: (- 0.19, 0.03) for spherical equivalent; MD = -0.09, 95%CI: (- 0.21, 0.03) for cylinder; MD = -0.09, 95% CI: (- 0.27, 0.08) for sphere]. No difference was found for spectacle independence, posterior capsular opacification (PCO) incidence and patient satisfaction between bifocal IOLs and trifocal IOLs. [RR = 0.89, 95% CI: (0.71, 1.12) for spectacle independence; RR = 1.81, 95% CI: (0.50, 6.54) for PCO incidence; RR = 0.98, 5% CI: (0.86, 1.12) for patient satisfaction].

CONCLUSION

Patients receiving trifocal IOLs, especially AT LISA tri 839 M, have a better intermediate VA than those receiving bifocal IOLs. Near and distance visual performance, spectacle independence, postoperative refraction and surgical satisfaction of bifocal IOLs were similar to those of trifocal IOLs.

Comparison of visual quality and subjective outcomes among 3 trifocal intraocular lenses and 1 bifocal intraocular lens

PURPOSE

To compare visual quality and subjective outcomes between 3 trifocal intraocular lenses (IOLs) and 1 bifocal IOL.

SETTING

Clínica Oftalmológica Martínez de Carneros, Madrid, Spain.

DESIGN

Prospective case series.

METHODS

This study comprised patients having bilateral phacoemulsification and implantation of an AcrySof IQ PanOptix, AT LISA tri 839MP, FineVision, or Tecnis ZLB00 IOL. Postoperative evaluation included logarithm of the minimum angle of resolution (logMAR) uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and distance-corrected near visual acuity (DCNVA); reading speed; through-focus logMAR visual acuity at 100%, 50%, and 12% contrast; and contrast sensitivity function (CSF) under photopic and mesopic conditions. Subjective outcomes were assessed using the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25).

RESULTS

The study enrolled 160 patients, 40 in each group. Six months postoperatively, there were no statistically significant between-group differences in the spherical equivalent, UDVA, CDVA, DCNVA, reading performance, or CSF under photopic and mesopic conditions. The defocus curves at 100%, 50%, and 15% of contrast showed that trifocal IOLs, especially the AcrySof PanOptix, had better intermediate performance than the bifocal IOL and comparable outcomes at far and near distances. There were no statistically significant differences in the postoperative NEI VFQ-25 questionnaire scores between the 4 IOL groups.

CONCLUSION

The trifocal IOLs provided better intermediate distance vision than the bifocal IOL without compromising distance or near vision.

Evaluation of quality of life after implantation of a new trifocal intraocular lens

PURPOSE

To evaluate the vision-related quality of life (QOL) after implantation of a new trifocal intraocular lens (IOL), by using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire).

SETTING

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

DESIGN

Prospective noncomparative case series.

METHODS

Consecutive patients who had a new trifocal IOL (PanOptix) bilaterally implanted were included in the study. The vision-related QOL was assessed 3 months after the surgery in the second eye. The VF-14 QOL questionnaire was used, with a grading scale of 0, no difficulty; 1, a little difficulty; 2, moderate difficulty; 3, quite difficult; 4, impossible to perform. A subgroup of 14 patients, with an interval of at least 3 months between the surgery in the first eye and the surgery in the fellow eye, were also interviewed 3 months after the monocular IOL implantation. In this subgroup, the QOL with monocular and binocular implantation was compared.

RESULTS

The study comprised 48 patients. Reading small print, driving at night, and doing fine handwork were the most difficult tasks to perform, with the mean values of the VF-14 QOL questionnaire being 0.94 ± 0.81 (SD), 0.89 ± 0.68, and 0.64 ± 0.67, respectively. Binocular implantation was associated with improvement in vision-related QOL when compared with monocular implantation, with significant differences in doing fine handwork such as sewing (P = .02) and using a computer (P = .03).

CONCLUSIONS

With mean values of 1.00 or lower for each question, the results of the VF-14 QOL questionnaire indicated that patients who have the new trifocal IOL bilaterally implanted have an overall high satisfaction rate and a high vision-related QOL.

Trifocal versus Bifocal Diffractive Intraocular Lens Implantation after Cataract Surgery or Refractive Lens Exchange: a Meta-analysis

BACKGROUND

We compared the efficacy between trifocal and bifocal diffractive intraocular lens (IOL) implantation.

METHODS

Through PubMed, MEDLINE, EMBASE, and CENTRAL, we searched potentially relevant articles published from 1990 to 2018. Defocus curves, visual acuities (VAs) were measured as primary outcomes. Spectacle dependence, postoperative refraction, contrast sensitivity (CS), glare, and higher-order aberrations (HOAs) were measured as secondary outcomes. Effects were pooled using random-effects method.

RESULTS

We included 11 clinical trials, with a total of 787 eyes (395 subjects). The trifocal IOL group showed better binocular distance VA corrected with defocus levels of -0.5, -1.0, -1.5, and -2.5 diopter than the bifocal IOL group (All P ≤ 0.004). The trifocal IOL group showed better monocular uncorrected distance and intermediate VAs (mean difference [MD], -0.04 logarithm of the minimum angle of resolution [logMAR]; 95% confidence interval [CI], -0.07, -0.01; P = 0.006 and MD, -0.07 logMAR; 95% CI, -0.13, -0.01; P = 0.03, respectively). Postoperative refraction, glare, CS, and HOAs were not significantly different from each other.

CONCLUSION

The overall findings indicate that trifocal diffractive IOL implantation is better than the bifocal diffractive IOL in intermediate VA, and provides similar or better in distance and near VAs without any major deterioration in the visual quality.

Medical Litigations Associated with Cataract Surgery in Korea

BACKGROUND

To analyze the results of court rulings about medical litigations related to cataract surgery in Korea.

METHODS

We collected 50 anonymized judgements regarding cataract surgery between 2000 and 2016 and analyzed the reasons for the medical litigations, the court rulings, the reasons for compensation, and the amount claimed and finally awarded.

RESULTS

Forty-eight litigations (96%) resulted from errors in treatment, and the reasons were as follows: endophthalmitis, dissatisfaction of visual outcome or ocular discomfort, bullous keratopathy or corneal opacity, retinal detachment, glaucoma or vitreous hemorrhage due to the progression of an underlying diabetic retinopathy, and others in order. Two litigations (4%) arose due to errors in diagnosis. Among the 50 final cases, 21 litigations (42%) were decided in favor of the plaintiff, and 29 litigations (58%) were decided against the plaintiff and dismissed. Ten cases awarded damages to the plaintiffs because of a violation of duty of care, and 11 cases awarded damages due to a violation of informed consent. When comparing cases with errors in diagnosis to cases with errors in treatment, there was no significant difference in the relative risk of a defendant's verdict (P = 0.503). The total amount of awarded damages was KRW 439,124,496 (USD 399,204), and the average amount was KRW 20,910,690 (USD 19,010).

CONCLUSION

Nearly half of the cases were decided in favor of the plaintiff due to the violation of informed consent. This study's results will be helpful in understanding the results of medical litigations regarding cataract surgery and reducing future lawsuits.

Clinical outcomes with a diffractive trifocal intraocular lens

PURPOSE

To evaluate clinical and visual outcomes, quality of near vision, and intraocular optical quality of patients bilaterally implanted with a trifocal PanOptix intraocular lens.

METHODS

In this prospective consecutive case-series study, 52 eyes of 26 bilateral patients (mean age, 60.2 ± 7.4 years) were implanted with the AcrySof IQ Panoptix intraocular lens. Visual acuity, defocus curve, contrast sensitivity (Pelli-Robson test), near activity visual questionnaire, and internal aberrations with Osiris were evaluated. A prototype light-distortion analyzer was used to quantify the postoperative light-distortion indices. The follow-up was 6 months after surgery.

RESULTS

Uncorrected, corrected distance, and uncorrected near visual acuities improved with the surgery (p ≤ 0.02). Distance corrected near visual acuity was 0.13 ± 0.10, 0.13 ± 0.13, and 0.13 ± 0.08 at 1, 3, and 6 months after surgery, respectively (p = 0.82). Distance corrected intermediate visual acuities were 0.09 ± 0.13, 0.13 ± 0.15, and 0.12 ± 0.12 at 1, 3, and 6 months, postoperatively. Binocular contrast sensitivity was 1.86 ± 0.15 Log Units. Defocus curve provided a visual acuity equal or better to 0.30 LogMAR between defocus levels of +0.50 to -3.00 D. The near activity visual questionnaire scores improved significantly with the surgery (p < 0.01).

CONCLUSION

The AcrySof IQ Panoptix intraocular lens is able to restore visual function with an acceptable intermediate and near vision after cataract surgery with good contrast sensitivity and an improvement in the near activity visual questionnaire.