Differences in contrast sensitivity between monofocal, multifocal and accommodating intraocular lenses: long-term results

Comparison of the Visual Outcomes of Enhanced and Standard Monofocal Intraocular Lens Implantations in Eyes with Early Glaucoma

This study aimed to compare the efficacies and safety of enhanced and standard monofocal intraocular lenses (IOLs) in eyes with early glaucoma. Patients with concurrent cataracts and open-angle glaucoma (OAG) were enrolled. They underwent cataract surgery with IOL implantation. The comprehensive preoperative ophthalmic examination included the manifest refraction; monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA); visual field (VF); and contrast sensitivity (CS); defocus curves and questionnaires were assessed three months postoperatively. Totals of 34 and 38 patients had enhanced and standard monofocal IOLs, respectively. The enhanced monofocal IOL provided better UIVA than the standard monofocal IOL (p = 0.003) but similar UDVA, CDVA, and UNVA. The enhanced monofocal IOL had more consistent defocus curves than the standard monofocal IOL, especially at -1 (p = 0.042) and -1.5 (p = 0.026) diopters. The enhanced monofocal IOL provided better satisfaction (p = 0.019) and lower spectacle dependence (p = 0.004) than the standard monofocal IOL for intermediate vision, with similar VF and CS outcomes. In conclusion, enhanced monofocal IOLs are recommended for patients with OAG because they provide better intermediate vision, higher satisfaction, and lower dependence on spectacles than standard monofocal IOLs, without worsening other visual outcomes.

Clinical outcomes of bilateral implantation of new generation monofocal IOL enhanced for intermediate distance and conventional monofocal IOL in a Korean population

BACKGROUND

To compare the clinical outcomes of bilateral implantation of enhanced intermediate function intraocular lenses (IOLs) and standard monofocal IOLs.

METHODS

In this prospective, randomized, comparative controlled study, we compared the visual outcomes of patients who underwent bilateral cataract surgery at the Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, with either enhanced monofocal IOLs (Tecnis Eyhance, ICB00, Johnson and Johnson Vision Care, Inc) (Group 1) or standard monofocal IOLs (Tecnis, ZCB00, Johnson and Johnson Vision Care, Inc) (Group 2). The assessment included monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate (UIVA at 60 cm) and near (UNVA at 40 cm) visual acuity, uncorrected defocus curves, contrast sensitivity testing (CST), and reading speed test using Quality of vision was evaluated using the Visual Function Questionnaire (VFQ-25).

RESULTS

At 3-months postoperatively, monocular and binocular outcomes of UIVA and UNVA were statistically significantly better in Group 1 (P < 0.05). The binocular uncorrected defocus curve of Group 1 showed statistically significantly better outcomes at vergence ranges of -1.5 to -4.0 D (P < 0.05). Significantly higher reading speed test was also observed in Group 1 in all ranges tested (1.0 to 0.1 LogMAR) (P < 0.05). There were no statistically significant differences in CST between groups.

CONCLUSIONS

Bilateral implantation of enhanced monofocal IOLs provided better vision at intermediate and near distances compared to standard monofocal IOLs, while maintaining good distance vision and contrast sensitivity.

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

PURPOSE

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

SETTING

Csolnoky Ferenc University Hospital, Veszprém, Hungary.

DESIGN

Prospective, longitudinal, single-center, interventional study.

METHODS

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

RESULTS

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

CONCLUSIONS

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

Visual Performance of Two Diffractive Trifocal Intraocular Lenses: A Randomized Trial

PURPOSE

To compare two trifocal intraocular lenses (IOLs), the RayOne Trifocal RAO603F IOL (closed-loop haptic IOL; Rayner Intraocular Lenses Limited) and the AT Lisa tri 839 MP IOL (plate-haptic IOL; Carl Zeiss Meditec AG), concerning optical and capsular bag performance.

METHODS

Patients scheduled for cataract surgery received either a closed-loop haptic IOL or a plate-haptic IOL in the first eye and the other IOL in the second eye. Three months postoperatively, autorefraction and subjective refraction, uncorrected and corrected distance visual acuity at 4 m, 80 cm, and 40 cm, an objective reading test (Salzburg Reading Desk; SRD Vision), a defocus curve, IOL tilt and decentration, a questionnaire about dysphotopsia, and grading of halos with a halometer were performed.

RESULTS

Eighty-eight eyes of 44 patients were included. Visual acuity was comparable between both IOLs. The closed-loop haptic IOL performed better in the defocus curve at -1.50 diopters (D) (0.08 ± 0.10 vs 0.12 ± 0.09 logMAR; P < .01). The plate-haptic IOL had better contrast sensitivity without glare under mesopic and photopic conditions in miosis (P = .0018 and .002, respectively) and mydriasis (P = .017 and .003, respectively). Significant differences were found for less overall subjective disturbance (P = .047) and starbursts (P = .039) for the plate-haptic IOL, but not for the other positive dysphotopsia symptoms.

CONCLUSIONS

Both trifocal IOLs delivered good and comparable visual function with low degrees of disturbing dysphotopsia. The closed-loop haptic IOL was slightly superior in the defocus curve, whereas the plate-haptic IOL was slightly superior concerning contrast sensitivity and positive dysphotopsia. [J Refract Surg. 2021;37(7):460-465.].

Bilateral Implantation of a New Refractive Multi-Segmented Multifocal Intraocular Lens in Cataract or Refractive Lens Exchange Patients

Purpose

To evaluate the safety and efficacy of a new multi-segmented refractive multifocal intraocular lens (IOL) after phacoemulsification and refractive lens exchange (RLE).

Patients and Methods

In this prospective, multicenter clinical trial, 63 presbyopic subjects who had cataract or where RLE candidates were bilaterally implanted with the Precizon Presbyopia IOL (Ophtec BV, Groningen, the Netherlands) after phacoemulsification. The study was conducted at 6 clinical centers in Germany, the Netherlands, Belgium, Turkey and Spain. Subjects were evaluated at baseline and at 1 day, 1 week, 1 and 3 months postoperatively for monocular and binocular uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), uncorrected (UNVA), corrected (CNVA) and distance-corrected near visual acuity (DCNVA), contrast sensitivity and quality of vision.

Results

Three months postoperatively, binocular UDVA and CDVA of ≥20/40 was achieved in 98.4% (60/61) and 100%, respectively. Binocular UIVA and DCIVA of ≥20/40 was achieved in 96.7% (59/61) and 93.4% (57/61) respectively. Binocular UNVA, CNVA and DCNVA of ≥20/40 was achieved in 93.4% (57/61), 98.4% (60/61) and 95% (57/60) subjects, respectively. Complete spectacle independence was achieved in 80% (49/61) patients; 93% of patients reported that they were quite or very satisfied with the outcomes of the procedure.

Conclusion

Precizon Presbyopia IOL implantation is a safe and effective method to provide good visual acuity at all distances in presbyopic and cataract patients.

Standard Results and Contrast Sensitivity Reestablishment after Implantation of a Trifocal Intraocular Lens

PURPOSE/AIM

To assess, following the standards, the results of safety, efficacy and predictability for a trifocal intraocular lens and to evaluate contrast sensitivity and visual acuity defocus curve.

MATERIALS AND METHODS

Fifty subjects operated on cataract surgery or refractive lens exchange with a trifocal intraocular lens have been recruited for the study. The monocular uncorrected visual acuity (VA) at far, intermediate (67 cm) and near (40 cm) distances in addition to corrected VA at far and near distances was evaluated at 1 week, 1 month and 3 months after surgery. Postoperative refraction, binocular contrast sensitivity function (CSF) and binocular defocus curves were also collected at the 3-month follow-up visit.

RESULTS

Mean uncorrected VA was 0.10, 0.07 and 0.05 logMAR at far, intermediate and near distances. Corrected distance VA at far and near distances was 0.04 and 0.02 logMAR. Ninety percent and 100% achieved a spherical equivalent in ±0.50 D and ±1.00 D, respectively. CSF was above normal range for 12 and 18 cycles per degree (cpd) in all the conditions, inside the normal range in 1.5, 3 and 6 cpd and only decreased below normal range for 1.5 and 3 cpd in mesopic vision without glare.

CONCLUSIONS

The procedure achieved a safety, efficacy and predictability similar to those reported by previous studies. The CSF was generally enhanced after the procedure in comparison to those reported in non-operated subjects above 60 years old. Previous studies might underestimate the effective distance of the intermediate and near foci.

Prospective Comparison of Clinical Performance and Subjective Outcomes Between Two Diffractive Trifocal Intraocular Lenses in Bilateral Cataract Surgery

PURPOSE

To compare clinical outcomes and subjective experience after bilateral implantation of two non-toric diffractive trifocal intraocular lenses (IOLs).

METHODS

In a prospective, comparative case series, patients were randomly allocated to receive bilateral implantation of either the preloaded RayOne Trifocal (Rayner, Worthing, UK) or the FineVision POD F (PhysIOL, Liège, Belgium). At the 3-month follow-up, the main outcomes were monocular and binocular uncorrected and corrected distance (UDVA, CDVA), intermediate at 80 cm (UIVA, DCIVA), and near at 40 cm (UNVA, DCNVA) visual acuities, refractive outcomes, and defocus curves. Patients' satisfaction in terms of visual disturbance was also evaluated.

RESULTS

Each group comprised 30 eyes (15 patients). The mean monocular UDVA was 0.03 ± 0.11 (RayOne Trifocal) and 0.04 ± 0.08 (FineVision POD F) logMAR (P = .605); DCIVA was 0.05 ± 0.13 and 0.05 ± 0.10 logMAR, respectively (P > .999); and DCNVA was 0.02 ± 0.12 and 0.03 ± 0.11 logMAR (P = .742). A better manifest spherical equivalent was found in the RayOne Trifocal than in the FineVision POD F group (P = .035) and depth perception issues were less severe with the RayOne Trifocal IOL (P = .042). There was no significant difference in other photic phenomena between groups.

CONCLUSIONS

Both IOLs provided good visual outcomes at all distances with no differences between the groups. Refractive accuracy was better for the RayOne Trifocal IOL. The results indicated that the new trifocal IOL may represent a safe and effective option for presbyopic patients. [J Refract Surg. 2019;35(7):418-425.].

Multifocal Intraocular Lenses Implantation in Presbyopia Correction. Literature Review

Reduced dependence on glasses is an increasingly common expectation among those who want to take advantage of new surgical opportunities, especially for patients who lead an active lifestyle. Currently, due to the increase in the duration of active life in people over 40, there is a need for effective correction of presbyopia. Multifocal intraocular lenses are increasingly used in the treatment of presbyopia. After implantation of multifocal intraocular lenses most patients have no need for spectacle or contact vision. However, complications can affect the patient’s quality of life and level of satisfaction. The most common complications of multifocal correction are blurred vision and the presence of optical phenomena (“halo” and “glare”), associated with residual ametropia, clouding of the posterior capsule, large pupil size, anomalies of the wave front, dry eye and lens decentration. The main reasons for this are the failure to attempt to neuroadapt a patient, the dislocation of the lens, the residual refractive error and the clouding of the lens. The review presents the main features of various models of multifocal intraocular lenses, their implantation techniques, associated complications and methods for their correction. The development of multifocal correction of presbyopia and ametropia seems to be a promising direction in ophthalmic surgery.

Visual outcomes, spectacle independence and satisfaction after diffractive trifocal intraocular lens implantation

PURPOSE

To investigate visual outcomes, spectacle independence, and patient satisfaction after trifocal intraocular lens implantation.

METHODS

A retrospective study conducted on 5,186 patients who underwent phacoemulsification and were implanted with a diffractive trifocal intraocular lens (FineVision Micro F, PhysIOL SA, Liège, Belgium).

RESULTS

The mean pre-operative keratometry was 43.61±1.55 D, and mean keratometric cylinder was -0.86±0.66 D. At 3 months post-operatively, values changed to 43.59±1.56 and -0.71±0.46 D, respectively. Mean sphere varied from 2.04±2.60 to 0.14±0.38 D, and mean spherical equivalent from 1.64±2.61 to -0.05±0.36 D. More than 60% of the patients achieved better corrected distance visual acuity. The majority had a final residual refractive error (predictability) lower than 1 D (99.1%), with 14.3% needing optical adjustment (bioptics). Posterior capsulotomy was performed in 2.2%, and the lens was replaced in 5 patients. A high percentage of patients were satisfied in terms of vision and spectacle independence at all distances. Although 2% referred to worsening of night vision quality, only 2% were not very satisfied and 20 patients were dissatisfied. The causes were: blurred vision (7 cases), spectacle dependence (10), dysphotopsia (7), and dry eye (4).

CONCLUSIONS

The implantation of this model provided good visual performance in all distances, as well as high levels of spectacle independence and satisfaction.

Clinical Results of Diffractive, Refractive, Hybrid Multifocal, and Monofocal Intraocular Lenses

Purpose

To present the outcomes of hybrid multifocal and monofocal intraocular lenses (IOLs) and to compare with refractive and diffractive multifocal IOLs (MFIOLs).

Methods

Three hundred twenty eyes (160 patients) underwent cataract surgery with randomized IOLs bilateral implantation. Changes in uncorrected and distance-corrected logMAR distance, intermediate and near (UNVA and DCNVA) visual acuity (VA), contrast sensitivity (CS), presence of dysphotopsia, spectacle independence, and patient satisfaction were analyzed.

Results

Postoperative VA in the hybrid (OptiVis) group was improved in all distances (p < 0.001). OptiVis acted superiorly to monofocal IOLs in UNVA and DCNVA (p < 0.001 for both) and to refractive ones in DCNVA (p < 0.005). Distance, mesopic, without glare CS in OptiVis was lower than in the monofocal group and similar to other MFIOLs. No differences in dysphotopsia pre- and postoperatively and spectacle independence in near for OptiVis and refractive MFIOLs were detected. OptiVis patients were more satisfied than those with monofocal IOLs (p=0.015).

Conclusions

After cataract surgery, patients with OptiVis improved VA in all distances. Near and intermediate VA was better than monofocal, and DCNVA was better than the refractive group. CS was lower in OptiVis than in the monofocal group, but there was no difference between MFIOLs. Patient satisfaction was higher in OptiVis than in the monofocal group. This trial is registered with NCT03512626.

In vitro optical quality measurements of three intraocular lens models having identical platform

BACKGROUND

With recent advances in technology and introduction of new intraocular lens (IOL) models, surgeons today have the opportunity to choose from various optical designs, which can influence the postoperative quality of vision. In our laboratory study, we compared the optical quality of three different IOLs that use the identical platform and are produced by the same manufacturer. The study included two diffractive multifocal IOLs, a bifocal and a trifocal one, as well as a monofocal IOL.

METHODS

Three IOL models: monofocal CT ASPHINA 409 M, diffractive bifocal AT LISA 809 M, and diffractive trifocal AT LISA Tri 839MP (Carl Zeiss Meditec AG, Germany) were assessed for optical quality by measuring modulation transfer function (MTF) and Strehl Ratio (SR) values at pupil sizes of 3.0 and 4.5 mm on the OptiSpheric® IOL PRO (Trioptics GmbH, Germany). The United States Air Force (USAF) Target images were also recorded to comfirm the optical performance qualitatively.

RESULTS

For far focus at 50 lp/mm and 3.0 mm pupil size, MTF value of the monofocal lens (MTF = 0.798) was 1.8-fold and 2.1-fold better than the bifocal (MTF = 0.446) and the trifocal (MTF = 0.382) IOLs, respectively. For near focus, bifocal IOL (MTF = 0.265) was 1.4-fold better than trifocal IOL (MTF = 0.187), while for intermediate focus, the trifocal IOL (MTF = 0.148) was 1.7-fold better than the bifocal IOL (MTF = 0.086). For the same pupil size, total sum of light loss amounted to 5.2% for the monofocal, 16.0% for the bifocal and 6.0% for the trifocal IOL. For a larger pupil, the amount of light loss increased significantly for the multifocal IOLs.

CONCLUSIONS

The monofocal IOL performed the best for far, the bifocal IOL for near and the trifocal IOL for intermediate focus. While the monofocal IOL created the least amount of light loss for both pupil sizes, the trifocal IOL created less than half the amount of light loss than the bifocal IOL for small pupil. For large pupil, however, less light scatter was observed for the bifocal than the trifocal IOL.

Patient-Centered and Visual Quality Outcomes of Premium Cataract Surgery: A Systematic Review

Purpose

Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options.

Methods

PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange.

Results

Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations.

Conclusions

Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients’ expectations and how those expectations can be impacted by premium versus monofocal—including monovision—options.

Visual performance with accommodating and multifocal intraocular lenses

AIM

To compare the visual functional outcomes with accommodating and multifocal intraocular lenses (IOLs).

METHODS

Our retrospective comparative study included 51 patients (60 eyes) received implantation of an accommodating IOL (Tetraflex; 16 patients, 20 eyes), a refractive multifocal IOL (ReZoom; 18 patients, 20 eyes), or a diffractive multifocal IOL (ZMA00; 17 patients, 20 eyes). Subjective refraction, visual acuity, contrast sensitivity (CS), intraocular aberration, and subjective photic phenomena were detected at 3mo after surgery.

RESULTS

The spherical equivalent in the three groups was -0.38±0.54 D, 0.14±0.56 D, and 0.35±0.41 D, respectively. No statistically significant differences were found in uncorrected and corrected distance visual acuity and uncorrected intermediate visual acuity among the groups (P=0.39). The ReZoom group had significantly better distance-corrected intermediate visual acuity than the ZMA00 group (P=0.003). The ZMA00 group had significantly better near visual acuity than the other groups (P<0.05). Better contrast sensitivity values were observed in the Tetraflex group under most of the spatial frequencies conditions (P=0.025). The total aberration was lowest in the ZMA00 group (P=0.000), and the spherical aberration was highest in the Tetraflex group (P=0.000). The three groups had similar frequency of ghosting and glare, and the Tetraflex group had a low rate of halos (P=0.01).

CONCLUSION

Both accommodating and multifocal IOLs can successfully restore distance and uncorrected intermediate visual acuities. Tetraflex accommodating IOLs perform better in CS and with less halos of photic phenomena. ReZoom refractive multifocal IOLs have better performance in distance-corrected intermediate visual acuity than ZMA00 diffractive multifocal IOLs, and the latter achieved better near visual acuity and efficiently decreased the optical aberration.

Near and intermediate reading performance of a diffractive trifocal intraocular lens using a reading desk

PURPOSE

To evaluate reading performance of a trifocal intra-ocular lens (IOL) at near and intermediate distances using the Salzburg Reading Desk.

SETTING

International Vision Correction Research Centre and David J. Apple Laboratory, University Eye Clinic, Heidelberg, Germany.

DESIGN

Prospective, nonrandomized clinical study.

METHODS

Follow-up examinations at a minimum of 3 months postoperatively included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA)) intermediate as well as uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity. Uncorrected and distance-corrected reading acuity at 40 cm for near, 80 cm for intermediate distance, and at the patient's preferred near and intermediate distances were evaluated with the reading desk.

RESULTS

In this study, 22 eyes of 11 patients having cataract surgery with implantation of the trifocal Finevision IOL were evaluated. Postoperative monocular Snellen median values were 20/21.44 (range 20/52.61 to 20/14.49) for UDVA, 20/20.47 (range 20/38.11 to 20/16.64) for UIVA, and 20/26.39 (range 20/43.76 to 20/18.24) for UNVA. Subjective intermediate distance at the binocular uncorrected examination on the reading desk was 64.2 cm (range 51.9 to 80.0) with a reading acuity of 0.10 logMAR (range 0.32 to 0.00). Subjective near distance at the uncorrected binocular reading desk examination was 36.5 cm (30.8 to 41.2) with a near reading acuity of 0.06 logMAR (range 0.23 to -0.01). The preferred distances differed significantly from the fixed ones of 40 and 80 cm. The preferred intermediate distance was almost consistent, with the intermediate addition of 1.75 D corresponding to 57.1 cm.

CONCLUSION

The visual and reading function of the trifocal IOL was better at the patient's preferred near and intermediate distances.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

[Multifocal intraocular lens (MIOL) surgery in young non-presbyopic ametropes : Reasonable and safe?]

BACKGROUND

Refractive lens exchange and implantation of a multifocal intraocular lens (MIOL) is mainly advised for ametropes with presbyopia. Non-presbyopic young ametropes who wish spectacle-independence are usually treated with corneal refractive surgery or phakic lenses.

OBJECTIVES

This retrospective case series aimed to analyse the refractive and subjective satisfaction outcome after MIOL surgery in both eyes of non-presbyopic ametropes where other treatment options were not possible.

MATERIALS AND METHODS

This retrospective case series comprised consecutively treated 32 eyes of 16 patients (5 myopic, 11 hyperopic patients; mean age 31 ± 6 years) who wished spectacle-independence and thus received an aspheric bifocal biconvex refractive-diffractive single-piece MIOL (Acri.Lisa 366/809, Carl Zeiss Meditec AG). Refractive data prior to and after surgery as well as subjective satisfaction at the 1‑year follow-up examination were assessed.

RESULTS

Related to distance corrected near visual acuity myopic eyes had a median efficacy index (EI) of 0.92 (±0.20) and hyperopes of 0.91 (±0.12) (P = 0.415). For intermediate vision, in both groups a lower EI (<0.5; P = 0.188) resulted in lower subjective satisfaction, which was higher for near and distance vision. Some of hyperopic patients reported limitations in near and distance vision, only one hyperopic patient would not have chosen this surgery again. None had a related complication during the follow-up.

CONCLUSIONS

When neither laser refractive surgery nor implantation of a phakic lens is possible, young non-presbyopic ametropes do profit from MIOL surgery with an aspheric bifocal biconvex refractive-diffractive MIOL.

Evaluation of Different Power of Near Addition in Two Different Multifocal Intraocular Lenses

Purpose. To compare near, intermediate, and distance vision and quality of vision, when refractive rotational multifocal intraocular lenses with 3.0 diopters or diffractive multifocal intraocular lenses with 2.5 diopters near addition are implanted. Methods. 41 eyes of 41 patients in whom rotational +3.0 diopters near addition IOLs were implanted and 30 eyes of 30 patients in whom diffractive +2.5 diopters near addition IOLs were implanted after cataract surgery were reviewed. Uncorrected and corrected distance visual acuity, intermediate visual acuity, near visual acuity, and patient satisfaction were evaluated 6 months later. Results. The corrected and uncorrected distance visual acuity were the same between both groups (p = 0.50 and p = 0.509, resp.). The uncorrected intermediate and corrected intermediate and near vision acuities were better in the +2.5 near vision added intraocular lens implanted group (p = 0.049, p = 0.005, and p = 0.001, resp.) and the uncorrected near vision acuity was better in the +3.0 near vision added intraocular lens implanted group (p = 0.001). The patient satisfactions of both groups were similar. Conclusion. The +2.5 diopters near addition could be a better choice in younger patients with more distance and intermediate visual requirements (driving, outdoor activities), whereas the + 3.0 diopters should be considered for patients with more near vision correction (reading).

Impact of Low Mesopic Contrast Sensitivity Outcomes in Different Types of Modern Multifocal Intraocular Lenses

Purpose

To investigate the low mesopic contrast sensitivity function (LMCSF) of patients implanted with different modern optical bifocal and trifocal designs of multifocal intraocular lenses (mfIOLs).

Methods

This prospective, comparative, nonrandomized consecutive case series included 180 eyes that underwent cataract surgery. Six groups of eyes were differentiated: group A, eyes with the diffractive AT LISA tri 839MP; group B, eyes with diffractive FineVision; group C, eyes with the bifocal Lentis Mplus-LS313; group D, eyes with the diffractive bifocal Acri.Lisa 366D; group E, eyes with the diffractive apodized Acrysof ReSTOR SN6AD1; group F, as the control group, implanted with a monofocal spherical intraocular lens. The LMCSF was evaluated with the OPTEC® 6500 device at 3 months postoperatively using a luminance of 3 cd/m2.

Results

No significant differences among groups were detected in LMCSF for the spatial frequencies of 1.5, 3.0, 6.0, and 12.0 cpd (1.5 cpd: F = 1.81, p = 0.13; 3.0 cpd: F = 1.14, p = 0.14; 6.0 cpd: F = 1.87, p = 0.11; 12.0 cpd: F = 1.26, p = 0.29), but significant differences were found among groups for the spatial frequency of 18 cpd (F = 2.62, p = 0.03). When comparing the groups in pairs, only statistically significant differences were observed between groups E and F for the spatial frequency of 18.0 cpd (t = 3.27, p = 0.03) with better values for group F.

Conclusion

No significant differences were observed in LMCSF among the different mfIOLs studied. The third focus of trifocal IOL models did not adversely affect the LMCSF. The ReSTOR SN6AD1 showed the poorest LMCSF for the highest spatial frequency analyzed when compared with the control group.

Visual Outcomes and Accommodative Response of the Lumina Accommodative Intraocular Lens

PURPOSE

To compare visual acuity, accommodation, and contrast sensitivity of the AkkoLens Lumina accommodative intraocular lens (AkkoLens Clinical b.v., Breda, The Netherlands) with a standard monofocal intraocular lens (IOL).

DESIGN

Randomized clinical trial.

METHODS

The study enrolled 86 eyes with cataract that all required cataract surgery and IOL implantation. The study group included 61 eyes that were implanted with the Lumina. The control group included 25 eyes that were implanted with an Acrysof SA60AT (Alcon, Fort Worth, TX, USA) monofocal IOL. The distance and near visual acuities, contrast sensitivity, and accommodation were measured over a 1-year follow-up period. Accommodation was measured subjectively, using defocus curves, and objectively, with an open-field autorefractor.

RESULTS

Uncorrected (UDVA) and corrected (CDVA) distance visual acuities did not differ significantly between the groups (P ≥ .21) over the 12 months. However, the uncorrected near visual acuity (UNVA) was 0.07 ± 0.08 logRAD for the Lumina group and 0.37 ± 0.19 logRAD for the control group (P < .01) and the corrected distance near visual acuity (CDNVA) was 0.11 ± 0.12 LogRAD for the Lumina group and 0.41 ± 0.15 LogRAD for the control group (P < .01). Defocus curves showed a statistically significant difference between groups for defocus ranging from -4.50 to -0.50 diopters (D) (P < .01) with significantly higher visual acuities for the Lumina group. Subjective accommodation, as determined from defocus curves, was 3.05 ± 1.06, 3.87 ± 1.27, and 5.59 ± 1.02 D for the Lumina group and 1.46 ± 0.54, 2.00 ± 0.52, and 3.67 ± 0.75 D for the control group at visual acuities of 0.10, 0.20, and 0.4 logMAR for both groups, respectively. The objective accommodation, measured by an open-field autorefractor, was 0.63 ± 0.41, 0.69 ± 0.45, 0.91 ± 0.51, and 1.27 ± 0.76 D for the Lumina group and 0.10 ± 0.15, 0.12 ± 0.15, -0.06 ± 0.09 and 0.07 ± 0.10 D for the control group at accommodation stimuli of 2.0, 2.5, 3.0, and 4.0 D, respectively. Contrast sensitivity was the same for both groups (P ≥ .26).

CONCLUSIONS

The Lumina accommodative IOL effectively restores the visual function, accommodation, and contrast sensitivity after cataract surgery with no influence on the postoperative contrast sensitivity.

Comparison of visual outcomes of 2 diffractive trifocal intraocular lenses

PURPOSE

To compare the visual outcomes after cataract surgery with bilateral implantation of 1 of 2 diffractive trifocal intraocular lenses (IOLs).

SETTING

Two clinical centers, Lisbon, Portugal.

DESIGN

Prospective comparative case series.

METHODS

Phacoemulsification with bilateral implantation of a Finevision Micro F IOL (Group 1) or an AT Lisa tri 839 MP IOL (Group 2) was performed. Over a 3-month follow-up, the main outcome measures were uncorrected distance visual acuity (UDVA), corrected monocular and binocular distance visual acuity, uncorrected intermediate visual acuity at 80 cm, distance-corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity at 40 cm, distance-corrected near visual acuity (DCNVA), spherical equivalent (SE) refraction, defocus curves, contrast sensitivity, presence of dysphotopsia, and use of spectacles.

RESULTS

Each group comprised 30 eyes (15 patients). The mean values at 3 months were UDVA, 0.03 logMAR ± 0.08 (SD) (Group 1) and 0.08 ± 0.12 (Group 2) (P = .765); DCIVA, 0.04 ± 0.07 logMAR and 0.18 ± 0.18 logMAR, respectively (P = .048); DCNVA, 0.03 ± 0.06 logMAR and 0.11 ± 0.08 logMAR, respectively (P = .032); SE, -0.25 ± 0.30 diopter (D) and -0.02 ± 0.39 D, respectively (P = .087). There was no significant difference in contrast sensitivity or dysphotopic phenomena between groups.

CONCLUSIONS

Both trifocal IOL models provided excellent distance, intermediate, and near visual outcomes. Monocular DCIVA and DCNVA appeared slightly better in Group 1. Predictability of the refractive results and optical performance were excellent, and all patients achieved spectacle independence.

FINANCIAL DISCLOSURE

Neither author has a financial or proprietary interest in any material or method mentioned.

Reduction in mean deviation values in automated perimetry in eyes with multifocal compared to monofocal intraocular lens implants

PURPOSE

To evaluate differences in mean deviation values in automated perimetry in healthy eyes with multifocal compared to monofocal intraocular lens (IOL) implants.

DESIGN

Prospective, age-matched, comparative analysis.

METHODS

SETTING

Single-center, tertiary referral academic practice.

PATIENT POPULATION

A total of 37 healthy eyes in 37 patients with bilateral multifocal (n=22) or monofocal (n=15) IOL implants were studied. INTERVENTION/OBSERVATION PROCEDURE: Humphrey Visual Field 10-2 testing was performed on all patients.

MAIN OUTCOME MEASURES

Mean deviation (MD) and pattern standard deviation (PSD) numerical values were evaluated and compared between groups.

RESULTS

The average MD was -2.84 dB (SD 2.32) for the multifocal IOL group and -0.97 dB (SD 1.58) for the monofocal IOL group (P=.006). There was no significant difference in PSD between the 2 groups (P=.99). Eyes that had the visual field 10-2 testing≥6 months from time of IOL placement showed no improvement in MD when compared to eyes that were tested within 6 months from IOL placement.

CONCLUSION

Multifocal IOL implants cause significant nonspecific reduction in MD values on Humphrey Visual Field 10-2 testing that does not improve with time or neuroadaptation. Multifocal IOL implants may be inadvisable in patients where central visual field reduction may not be tolerated, such as macular degeneration, retinal pigment epithelium changes, and glaucoma.

Visual performance after the implantation of a new trifocal intraocular lens

PURPOSE

To evaluate the subjective and objective visual results after the implantation of a new trifocal diffractive intraocular lens.

METHODS

A NEW TRIFOCAL DIFFRACTIVE INTRAOCULAR LENS WAS DESIGNED COMBINING TWO SUPERIMPOSED DIFFRACTIVE PROFILES: one with +1.75 diopters (D) addition for intermediate vision and the other with +3.50 D addition for near vision. Fifty eyes of 25 patients that were operated on by one surgeon are included in this study. The uncorrected and best distance-corrected monocular and binocular, near, intermediate, and distance visual acuities, contrast sensitivity, and defocus curves were measured 6 months postoperatively. In addition to the standard clinical follow-up, a questionnaire evaluating individual satisfaction and quality of life was submitted to the patients.

RESULTS

The mean age of patients at the time of surgery was 70 ± 10 years. The mean uncorrected and corrected monocular distance visual acuity (VA) were LogMAR 0.06 ± 0.10 and LogMAR 0.00 ± 0.08, respectively. The outcomes for the binocular uncorrected distance visual acuity were almost the same (LogMAR -0.04 ± 0.09). LogMAR -010 ± 0.15 and 0.02 ± 0.06 were measured for the binocular uncorrected intermediate and near VA, respectively. The distance-corrected visual acuity was maintained in mesopic conditions. The contrast sensitivity was similar to that obtained after implantation of a bifocal intraocular lens and did not decrease in mesopic conditions. The binocular defocus curve confirms good VA even in the intermediate distance range, with a moderate decrease of less than LogMAR 0.2 at -1.5 D, with respect to the best distance VA at 0 D defocus. Patient satisfaction was high. No discrepancy between the objective and subjective outcomes was evidenced.

CONCLUSION

The introduction of a third focus in diffractive multifocal intraocular lenses improves the intermediate vision with minimal visual discomfort for the patient.