Prospective comparative study of tolerance to refractive errors after implantation of extended depth of focus and monofocal intraocular lenses with identical aspheric platform in Korean population

Effect of residual sphere on uncorrected visual acuity and satisfaction in patients with monofocal and multifocal intraocular lenses

PURPOSE

To assess the effect of residual sphere on vision and satisfaction in pseudophakic patients.

SETTING

Private clinics, United Kingdom.

DESIGN

Retrospective case series.

METHODS

A multivariate model evaluated the effect of 1-month residual sphere on outcomes of pseudophakic patients. Odds ratios (ORs) were calculated to assess the relative risk of not achieving ≥20/20 monocular uncorrected distance visual acuity (UDVA), ≥20/50 uncorrected near visual acuity (UNVA), and not being satisfied with vision. ORs were assessed for residual sphere -1.00 to +1.00 diopter (D) in quarter-diopter steps, using 0.00 D as a reference.

RESULTS

The analysis included 38 828 multifocal and 11 571 monofocal intraocular lenses (IOLs). The residual myopic sphere ≤-0.25 D and hyperopic sphere ≥+0.50 D had a clinically meaningful effect on UDVA. Although monofocal IOLs had an improvement in UNVA with every additional 0.25 D of myopia, the change in ORs with increasing myopia was not significant for multifocal IOLs. The mean improvement in UNVA comparing eyes with 0.00 D and -1.00 D sphere was 0.26 logMAR for monofocal and 0.03 logMAR for multifocal IOLs. Low near-addition IOLs had a slightly higher gain in UNVA with increasing myopia, but the gain was not as substantial as with monofocal IOLs. The effect of ametropia on satisfaction was more pronounced for multifocal IOLs. For every 0.25 D of residual myopia, there was >25% increase in dissatisfied patients.

CONCLUSIONS

Although myopia improved UNVA in eyes with monofocal IOL, multifocal IOLs did not benefit from residual myopia. Multifocal IOL patients desiring distance vision should be targeted closest to emmetropia, even if it means targeting slight hyperopia.

Long-term Results after Bilateral Implantation of Extended Depth of Focus Intraocular Lenses with Mini-Monovision

PURPOSE

To assess long-term clinical results following bilateral Tecnis Symfony ZXR00 intraocular lens implantation with mini-monovision.

METHODS

The medical records of cataract patients who underwent bilateral implantation of ZXR00 with intended mini-monovision (target refraction of -0.3 diopters [D] in dominant eye and -0.6 D in nondominant eye) between April 2019 and March 2021 were assessed. Postoperative uncorrected distance visual acuity (UDVA), corrected distance VA (CDVA), uncorrected intermediate VA (UIVA), uncorrected near VA (UNVA), and rate of spectacle dependence for near distance were investigated at 3 months and 2 years after surgery.

RESULTS

This study included 61 patients (122 eyes) with average age of 61.8 ± 7.7 years. At 2 years postoperatively, binocular logarithm of the minimum angle of resolution UDVA, UIVA, UNVA, and CDVA were 0.086 ± 0.094, 0.056 ± 0.041, 0.140 ± 0.045, and 0.012 ± 0.024, respectively. The monocular manifest refraction spherical equivalent was -0.31 ± 0.38 in the dominant eye and -0.53 ± 0.47 in the nondominant eye at 3 months postoperatively, and -0.38 ± 0.43 in the dominant eye and -0.61 ± 0.54 in the nondominant eye at 2 years postoperatively. Eight out of 61 patients (13.1%) needed glasses 3 months after surgery, and nine out of 61 patients (14.8%) needed glasses 2 years after surgery.

CONCLUSIONS

The bilateral implantation of ZXR00s with mini-monovision allows for a good VA at wide range of distance from far to near, thereby resulting in high rate of spectacle independence. These results have held up well even after 2 years after surgery.

The tolerance of refractive errors of extended depth of focus intraocular lens in patients with previous corneal refractive surgery

PURPOSE

To evaluate the tolerance for refractive errors and visual outcomes of extended depth of focus intraocular lens (EDOF IOLs) in patients with previous corneal refractive surgery for myopia.

METHODS

Patients from Aier Eye Hospital of Wuhan University with previous myopia excimer laser correction underwent cataract surgery and implantation of an EDOF IOL. The follow-up period was three months. The uncorrected distance, intermediate, and near visual acuities (UDVA, UIVA, UNVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), defocus curve, optical quality, including modulation transfer functions (MTF) and Strehl ratio (SR), National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence, and dysphotopsia were assessed.

RESULTS

At the final visit, UDVA, CDVA, UIVA, and UNVA (LogMAR) were 0.06 ± 0.09, 0.01 ± 0.06, 0.11 ± 0.08, 0.20 ± 0.10, respectively. The mean spherical equivalent (SE) was - 0.57 ± 0.58D, sphere and cylinder were - 0.24 ± 0.60D, - 0.70 ± 0.58D respectively. No statistical difference in UDVA between eyes with SE in ± 0.50 D and in ± 1.0 D (p > 0.05). Corneal astigmatism > 1.00D has no significant effect on postoperative visual acuity (p > 0.05). The defocus curve showed that visual acuity could reach 0.2 in the refractive range of + 0.50D ~ - 1.50D. SR and MTF values were all higher than before the surgery. In bilateral implantation patients, the VF-14-CN questionnaire score and visual quality were quite excellent.

CONCLUSION

The EDOF IOL have a certain tolerance for refractive errors and corneal astigmatism, and it's recommended for patients with prior myopia excimer laser surgery to achieve satisfactory visual performance.

Short-term clinical outcomes after implantation of monofocal intraocular lens with enhanced intermediate function in eyes with epiretinal membrane

Our study evaluated the clinical outcomes after implantation of a monofocal intraocular lens (IOL) with enhanced intermediate function in eyes with epiretinal membrane (ERM). Patients with preexisting ERM who underwent cataract surgery with implantation of monofocal IOL with enhanced intermediate function were included retrospectively. According to the ERM grade and central subfield thickness (CST) obtained from preoperative optical coherence tomography, patients were divided into non-fovea-involving and fovea-involving ERM groups. At 1 month after surgery, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), contrast sensitivity, defocus curve, and satisfaction questionnaire were evaluated. Postoperative clinical findings were compared with age-matched controls without ERM. A total of 50 patients' eyes (28 and 22 in the non-fovea-involving and fovea-involving ERM groups, respectively) were compared with 42 control eyes. One month post-surgery, significant differences in UDVA, CDVA, and CST (corrected P was < 0.001, = 0.001, and < 0.001, respectively) were observed between the fovea-involving ERM and control group; however, no significant differences in UIVA and UNVA were observed between the two groups. Contrast sensitivity showed inferior results in the fovea-involving group without significance. Photic phenomena were reported less in the fovea-involving group than in the non-fovea-involving group. More than 70% of patients in both ERM groups were satisfied. Implantation of monofocal IOL with enhanced intermediate function could be a good option for patients with ERM that need intermediate vision.

IRIS® Registry (Intelligent Research In Sight) Analysis of the Incidence of Monovision in Cataract Patients with Bilateral Monofocal Intraocular Lens Implantation

Purpose

To determine the incidence of pseudophakic monovision among patients bilaterally implanted with monofocal intraocular lenses (IOLs) and to characterize the distribution of myopic offsets achieved.

Patients and Methods

This retrospective database study included data on patients receiving care from ophthalmologists who contributed to the Academy IRIS® (Intelligent Research In Sight) Registry. Anonymized data were collected, including patient age, ethnicity, procedure data (CPT code, date, laterality), and postoperative manifest refractive spherical equivalent (MRSE) in both eyes implanted with monofocal or monofocal toric IOLs. No data regarding IOL manufacturer, model, or power were collected. One primary outcome measure was the percentage of patients achieving monovision (defined as emmetropia within ±0.25 diopters [D] in one eye and a myopic offset of ≥0.50 D in the fellow eye) among all patients receiving bilateral monofocal IOLs at the time of cataract surgery between January 1, 2016, and September 1, 2019, with at least 90 days of follow-up. Other primary outcomes included the distribution and frequency of myopic offsets (anisometropia) between eyes.

Results

Of the 16,765 people receiving bilateral monofocal IOLs within the study period, 4796 (28.6%) achieved emmetropia in at least one eye, as defined by an MRSE within ± 0.25 D. The incidence of monovision among these patients was 34.2% (1638/4796). One-quarter (24.7%; 405/1638) of patients who achieved monovision had a myopic offset between 0.50 and 0.74 D, with more than one-third (35.2%; 576/1638) falling within 0.75-1.24 D and 18.0% within 1.25-1.74 D. A myopic offset ≥1.75 D was observed in 22.1% (362/1638) of patients who achieved monovision.

Conclusion

Pseudophakic monovision for presbyopia correction was achieved in ~34% of patients in the IRIS Registry bilaterally implanted with monofocal IOLs, with myopic offsets typically ranging from 0.5 to 1.24 D.

Clinical Outcomes with Extended Depth of Focus Intraocular Lenses in Cases in Which Multifocal Lenses Are Not Primarily Recommended

Purpose

The purpose of the study is to evaluate the visual and patient-reported outcomes of patients undergoing cataract surgery with implantation of an extended depth of focus (EDOF) intraocular lens (IOL) who were not primarily good candidates for multifocal IOL implantation.

Methods

Retrospective analysis of data from 30 eyes (23 patients) undergoing cataract surgery with implantation of one of two EDOF IOLs (follow-up: 37.9 ± 16.2 months) and prospective observational study including 106 eyes (78 patients) implanted with one of 6 different EDOF models (follow-up: 8.0 ± 7.7 months). Patients recruited had one of the following conditions: monofocal IOL implanted in the fellow eye, previous corneal refractive surgery, mild and nonprogressive maculopathy or glaucoma, age > 75 years, amblyopia, or previous vitrectomy.

Results

In the retrospective phase, significant improvements were found in uncorrected distance (UDVA), corrected distance (CDVA), and corrected near visual acuity (CNVA) (p ≤ 0.013), with a nonsignificant trend to improvement in uncorrected near visual acuity (UNVA). A total of 90% of patients were completely to moderately satisfied with the outcome achieved. In the prospective phase, significant improvements were found in UDVA, CDVA, UNVA, and CNVA (p ≤ 0.032), with a total of 85.5% of patients being completely to moderately satisfied (dissatisfaction 3.3%). In both phases, extreme difficulties were only reported by a limited percentage of patients for performing some near vision activities.

Conclusions

EDOF IOLs seem to be a viable option for providing an efficient visual rehabilitation with good levels of patient satisfaction and spectacle independence associated in patients that are not primarily good candidates for multifocal IOL implantation.

Comparing Visual Outcomes of Light Adjustable Intraocular Lenses in Patients With and Without Prior History of Corneal Refractive Surgery

PURPOSE

To assess visual outcomes of light adjustable intraocular lens (LAL; Calhoun Vision, Inc) implantation after cataract extraction in patients with a history of corneal refractive surgery.

METHODS

The records of patients who received LALs with and without a history of corneal refractive surgery were retrospectively reviewed. Data for 51 eyes (30 patients) with a history of corneal refractive surgery and 52 eyes (44 patients) without refractive surgery were analyzed. A total of 36 eyes of patients with and 43 eyes of patients without a history of corneal refractive surgery had 12-month follow-up data available. The primary outcomes evaluated were uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA).

RESULTS

At 12 months, 31% of eyes with a history of corneal refractive surgery had a UDVA of 20/20 or better and 97% of eyes were 20/40 or better. In contrast, 63% of patients with no history of corneal refractive surgery had 20/20 UDVA or better at 12 months and 100% were 20/40 or better. Of patients with a history of corneal refractive surgery, 55% and 83% of eyes at 12 months were within ±0.50 and ±1.00 diopters, respectively, of the target refraction compared to 89% and 96% of eyes without a history of corneal refractive surgery.

CONCLUSIONS

LALs are a promising platform for achieving excellent visual outcomes following cataract surgery. Patients with a prior history of corneal refractive surgery can achieve excellent visual outcomes with the LAL. However, this study found that patients with a history of corneal refractive surgery demonstrated less predictable visual acuity outcomes when compared to patients without a history of corneal refractive surgery. [J Refract Surg. 2023;39(5):311-318.].

Effect of larger corneal spherical aberration in improving the near visual acuity of eyes implanted with the TECNIS Symfony

Purpose

To explore the effect of corneal spherical aberration on the visual acuity and visual quality of eyes implanted with the TECNIS Symfony intraocular lens (IOL).

Methods

A total of 43 patients with age-related cataract (60 eyes) undergoing phacoemulsification and TECNIS Symfony IOL implantation were enrolled in this study. The uncorrected distance (UDVA), intermediate (UIVA), near visual acuity (UNVA), corrected distance visual acuity (CDVA), contrast sensitivity, and ocular spherical aberration were recorded 3 months after surgery. Preoperative and postoperative corneal spherical aberration were also measured using the iTrace device. Objective scattering index (OSI), modulation transfer function cut-off frequency (MTF cut-off), and Strehl ratio (SR) were measured by the Optical Quality Analyzing System. Catquest-9SF questionnaire were applied too. Spearman's correlation analysis was used to evaluate the relationship between spherical aberration and visual quality parameters.

Results

Patients were satisfied with their postoperatively visual quality. And the postoperative logMAR UDVA, UIVA, UNVA, and CDVA was 0.05 ± 0.07, 0.04 ± 0.06, 0.15 ± 0.07, and 0.03 ± 0.05, respectively. The mean preoperative corneal spherical aberration was 0.24 ± 0.10 μm, which is the only factor influencing postoperatively UNVA, and it was negatively correlated with UNVA and glare contrast sensitivity under 18 cpd (cycle/degree, cpd) spatial frequency (r = -0.403, -0.300, -0.360; all P < 0.05). Additionally, the greater the residual spherical aberration of the cornea, the better the near vision after operation. The mean postoperative ocular spherical aberration was -0.03 ± 0.07 μm, it was not correlated with visual acuity, contrast sensitivity, and visual quality (all P > 0.05).

Conclusion

Preoperative positive spherical aberration can benefit near vision while decrease contrast sensitivities at high spatial frequencies when implanted with the TECNIS Symfony IOL.

Clinical and Aberrometric Evaluation of a New Monofocal IOL with Intermediate Vision Improvement

Purpose

The aim of the study was to evaluate the visual outcomes, aberrometric results, and subjective and objective optical qualities 12 months after implantation of a new monofocal intraocular lens (Physiol IsoPure 1.2.3) in comparison with a standard monofocal intraocular lens (Tecnis PCB00).

Materials and Methods

Cataract patients without ocular comorbidities had bilateral implantation of the IsoPure IOL or the PCB00 IOL. One month after eye surgery, the visual acuity and monocular defocus curve were assessed. Twelve months after surgery, the visual acuity, binocular defocus curve, contrast sensitivity, and subjective/objective optical quality were assessed. Furthermore, wavefront analysis was performed. The primary endpoint was the best distance correct/uncorrected visual acuity at intermediate and far distances. The secondary endpoint was an aberration evaluation of the IOLs and contrast sensitivity.

Results

The study comprised a total of 42 patients (84 eyes). Monocular and binocular uncorrected and corrected distance were similar between groups, and uncorrected intermediate visual acuity was significantly higher in the IsoPure group. There was no difference in contrast sensitivity and subjective and objective optical qualities. The optical aberrations at 3.0 and 5.0 mm aperture diameters were similar in both groups.

Conclusion

The IsoPure IOL, based on greater depth of focus than the aspheric monofocal IOL, may offer a good option for the distance and intermediate vision without increasing optical aberrations and any photic phenomena.

Presbyopia correction after previous Intracor treatment: Combined implantation of a small-aperture and a non-diffractive extended-depth-of-focus lens

PURPOSE

We present the case of implantation of two different Extended depth of focus intraocular lenses (EDoF IOLs) in a patient with a history of unilateral intrastromal femtosecond laser treatment for presbyopia correction (Intracor).

OBSERVATIONS

The patient reported decreasing visual acuity at near distance and increasing spectacle dependence. Ten years earlier, he had Intracor treatment for presbyopia correction in his left eye. Corrected distance visual acuity (CDVA) was 0.08 logMAR for the right eye and 0.16 logMAR for the left eye. Apart from dysfunctional lens syndrome, the examination results were unremarkable. Phacoemulsification and subsequent IOL implantation was performed in both eyes. The left eye was implanted with an IC-8 (AcuFocus, Irvine, CA, USA), whereas the fellow eye was implanted with an AcrySof IQ Vivity IOL (Alcon, Fort Worth, TX, USA). Postoperatively, CDVA improved to 0.02 and 0.04 logMAR for the right and left eye. Uncorrected intermediate visual acuity (UIVA) was 0.24 logMAR for the right eye and -0.04 logMAR for the left eye, binocular UIVA was -0.04 logMAR. The patient reported a low level of photic phenomena and spectacle independence for far and intermediate distance.

CONCLUSIONS AND IMPORTANCE

Combined implantation of a non-diffractive and a small-aperture EDoF lens after previous unilateral Intracor treatment could successfully improve visual acuity at far and intermediate distance.

Defocus curves: Focusing on factors influencing assessment

ABSTRACT

Defocus curve assessment is used to emulate defocus over a range of distances and is a valuable tool that is used to differentiate the performance of presbyopia-correcting intraocular lenses. However, defocus curves are limited by a lack of standardization, and multiple factors can impact their generation and interpretation. This review discusses key factors that influence the assessment of defocus curves, including pupil size, level of contrast, sphere versus cylinder defocus, viewing distance, monocular versus binocular assessment, use of Snellen versus logarithm of the minimum angle of resolution charts, and diopter range and step size. There are also different methods to analyze defocus curves, including the direct comparison method, range-of-focus analysis, and area under the curve analysis, which can impact result interpretation. A good understanding of these factors and standardization of the methodology are important to ensure optimal cross-study comparisons.

Refractive Outcomes after Cataract Surgery

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

Comparison Between an Intraocular Lens With Extended Depth of Focus (Tecnis Symfony ZXR00) and a New Monofocal Intraocular Lens With Enhanced Intermediate Vision (Tecnis Eyhance ICB00)

PURPOSE

This study compared the extended depth of focus (EDOF) intraocular lens (IOL) (ZXR00; Tecnis Symfony, Johnson & Johnson Vision, Santa Ana, CA, US) to a novel, higher-order aspheric monofocal IOL (ICB00; Tecnis Eyhance, Johnson & Johnson Vision, Santa Ana, CA, US) which uses the same platform and material.

METHODS

Medical records of patients undergoing cataract surgery with ZXR00 or ICB00 implantation between March 2020 and January 2021 and with the data available for the 3-month visit were reviewed. The uncorrected near, intermediate, and distance visual acuity (VA); corrected distance VA; and optical quality parameters were the main outcome measures.

RESULTS

Among the 174 enrolled patients, 72 and 102 received the ZXR00 and ICB00, respectively. The average patient ages were 59.6 ± 10.6 (range: 49 to 70) and 65.2 ± 8.2 (range: 45 to 82) years in the ZXR00 and ICB00 groups, respectively, with significantly older patients in the ICB00 group. The other baseline parameters were not different for the 2 groups. Compared to the ICB00 group, the ZXR00 group showed markedly superior near VA (P < 0.05) at 3 months postoperatively. In terms of optical quality, ICB00 was, statistically, significantly superior to ZXR00.

CONCLUSIONS

The ZXR00 showed remarkable near vision and defocus curve smoothness, while the ICB00 achieved better optical quality. The 2 IOLs had comparable distance and intermediate vision.

Non-diffractive wavefront shaping extended depth of focus (EDoF) intraocular lens: visual performance and patient-reported outcome

PURPOSE

To evaluate visual performance and patient-reported outcomes after bilateral implantation of new non-diffractive wavefront shaping extended depth of focus (EDOF) intraocular lens (IOL).

SETTING

Department of Ophthalmology, Goethe University, Frankfurt, Germany.

DESIGN

Prospective, single-arm, single-center study.

METHODS

Patient population: We included 16 patients (32 eyes) who received bilateral implantation of a non-diffractive wavefront shaping EDOF IOL (AcrySof® IQ Vivity®, Alcon Research, TX, USA). Target refraction in both eyes was emmetropia. Observation procedure: Monocular and binocular uncorrected (UCVA) and distance-corrected (DCVA) visual acuity (VA), refractive outcome, defocus curve, contrast sensitivity (CS) were evaluated 3 months after surgery with a questionnaire on optical phenomena and spectacle independence. Main Outcome measure: Three months postoperative monocular and binocular UCVA and DCVA (logMAR); defocus curve; CS; and quality of vision (QoV) questionnaire results.

RESULTS

Mean spherical equivalent was -0.16 ± 0.37 D 3 month postoperatively. Binocular UDVA at distance, intermediate, and near was 0.01 ± 0.05 logMAR at 4m, 0.05 ± 0.05 logMAR at 80cm, 0.07 ± 0.06 logMAR at 66cm, and 0.25 ± 0.11 logMAR at 40cm, respectively. Despite some minor optical phenomena, 88% of patients would choose the same lens. 63% of patients reported no optical phenomena at all. Contrast sensitivity was 1.25 ± 0.41 logCS (photopic), 0.96 ± 0.24 logCS (mesopic) and 0.93 ± 0.24 (mesopic + glare).

CONCLUSIONS

This non-diffractive wavefront shaping EDOF IOL provides good VA at far and intermediate distance and functional near VA. It showed good QoV and CS, and high spectacle independence for distance and intermediate vision with significantly less optical phenomena than with other EDOF or MIOLs.

Clinical Outcomes of Combined Implantation of an Extended Depth of Focus IOL and a Trifocal IOL in a Korean Population

Purpose

To evaluate monocular and binocular visual performance and patient-reported outcomes following combined implantation of a diffractive extended depth of focus (EDoF) IOL (Carl Zeiss AT LARA 829MP) and a diffractive trifocal IOL (Carl Zeiss AT LISA tri 839MP).

Methods

This prospective study enrolled consecutive patients undergoing lens phacoemulsification of cataract and combined implantation of an EDoF IOL in the dominant eye and a trifocal IOL in the nondominant eye. Assessment included uncorrected visual acuity at near distances (UNVA), intermediate distances (UIVA), and far distances (UDVA), uncorrected defocus curve, contrast sensitivity (CS), reading speed, and patient satisfaction, evaluated six months after the surgery with the Visual Function Questionnaire (VFQ-25).

Results

A total of 25 patients were enrolled. At six months postoperatively, outcomes of binocular UNVA, UIVA, and UDVA were superior to those of monocular outcomes. The binocular defocus curve showed significantly better results in comparison with the AT LISA tri IOL eyes at defocus levels of −1.0 D and −1.5 D (P=0.008 and P=0.002, respectively) and compared to the AT LARA IOL eyes at defocus levels of −3.0, −3.5 D, and −4.0 D (P=0.019, P=0.019, and P=0.035, respectively). All of the patients were spectacle-free at far and intermediate distances, while 4% of patients needed spectacles at the near distance. Reading speed showed a rather high and gentle slope curve between 0.1 logMAR and 0.4 logMAR, and optical phenomena were improved after combined implantation of IOLs except halos. There were no significant differences in CS between the binocular and monocular results of each IOL.

Conclusions

The combined implantation of an EDoF IOL and a trifocal IOL seems to be a good option for patients with demands for spectacle independence in their daily life, with minimal photic phenomena.

Clinical Outcomes of a New Hybrid Monofocal IOL With Extended Depth of Focus

PURPOSE

To evaluate a new extended depth of focus intraocular lens (IOL), the xact Mono-EDOF ME4 (Santen Pharmaceuticals), Conformitè Europëenne-marked as a monofocal IOL, which has four diffractive rings intended to enhance intermediate vision.

METHODS

Results are reported for 47 IOLs implanted in 28 patients who underwent cataract surgery and implantation of the xact Mono-EDOF ME4 IOL in one (9 patients) or both (19 patients) eyes. Postoperative follow-up examinations included visual acuity testing (monocular and binocular; uncorrected distance visual acuity [UDVA], corrected distance visual acuity [CDVA], uncorrected intermediate visual acuity [UIVA], distance-corrected intermediate visual acuity [DCIVA]), defocus curve and contrast sensitivity testing, and dysphotopsia evaluation.

RESULTS

Follow-up at 6 months postoperatively revealed a monocular UDVA of 0.08 ± 0.15 logMAR, binocular UDVA of -0.02 ± 0.09 logMAR, monocular CDVA of -0.07 ± 0.08 logMAR, binocular CDVA of -0.09 ± 0.09 logMAR, monocular UIVA (70 cm) of 0.18 ± 0.16 logMAR, binocular UIVA (70 cm) of 0.09 ± 0.12 logMAR, monocular DCIVA (70 cm) of 0.25 ± 0.14 logMAR, and binocular DCIVA (70 cm) of 0.13 ± 0.11 logMAR. Defocus curve testing demonstrated a functional defocus of 1.25 diopters at 0.20 logMAR for monocular and 1.50 diopters at 0.20 logMAR for binocular testing. The contrast sensitivity corresponded to the age-appropriate normal values. Patients reported low levels of halo and glare.

CONCLUSIONS

The xact Mono-EDOF ME4 IOL showed good functional results for far and intermediate distance visual acuity while inducing a low level of photic phenomena. [J Refract Surg. 2021;37(9):601-608.].

Clinical Outcomes after Mix-and-Match Implantation of Extended Depth of Focus and Diffractive Multifocal Intraocular Lenses

Purpose

To evaluate the clinical outcomes after bilateral mix-and-match cataract surgery using extended depth of focus (EDOF) and diffractive multifocal (DMF) intraocular lenses (IOLs). Setting. Asan Medical Center, Seoul, South Korea.

Design

Prospective clinical study.

Methods

Thirty-seven patients underwent TECNIS Symfony EDOF IOL (ZXR00) implantation in the dominant eye, and TECNIS +3.25 DMF IOL (ZLB00) implantation in the nondominant eye. Patients were followed up for 3 months; uncorrected and corrected distance visual acuity (UDVA and CDVA), uncorrected intermediate and near visual acuity (UIVA and UNVA), contrast sensitivity, defocus curves, stereopsis, and patient satisfaction were assessed.

Results

At 3 months, the mean logarithm of the minimum angle of resolution (logMAR) of UDVA was 0.07 ± 0.09 in EDOF IOL eyes, 0.12 ± 0.11 in DMF IOL eyes, and 0.02 ± 0.05 in both eyes. UIVA was 0.11 ± 0.11 in EDOF IOL eyes, 0.16 ± 0.12 in DMF IOL eyes, and 0.04 ± 0.07 in both eyes. UNVA was 0.25 ± 0.15 in EDOF IOL eyes, 0.22 ± 0.16 in DMF IOL eyes, and 0.13 ± 0.13 in both eyes. Thirty patients (81.1%) were more than satisfied with near vision, and 8 patients (21.6%) complained of severe glare and halo. Spectacle independence for near vision was achieved in 34 patients (91.9%), and 31 patients (83.8%) had better than a 50-second arc of stereopsis.

Conclusion

Mix-and-match cataract surgery with EDOF and DMF IOL implantation provided good visual outcomes for all distances. Additionally, excellent patient satisfaction was achieved with a high level of spectacle independence and acceptable photic phenomena.

Comparison Between Bilateral Implantation of a Trifocal IOL and Mix-and-Match Implantation of a Bifocal IOL and an Extended Depth of Focus IOL

PURPOSE

To compare the clinical outcomes of mix-and-match implantation of a diffractive extended depth of focus intraocular lens (IOL) (TECNIS Symfony ZXR00; Johnson & Johnson Vision) and a diffractive bifocal IOL (TECNIS ZLB00 +3.25 diopters [D]; Johnson & Johnson Vision) and bilateral implantation of a diffractive trifocal IOL (AcrySof IQ PanOptix; Alcon Laboratories, Inc).

METHODS

This prospective comparative study compares the clinical outcomes of patients with age-related cataract undergoing cataract surgery using the IOLs described. Patients were divided into the mix-and-match group and the trifocal group. Assessment included monocular and binocular uncorrected distance visual acuity (UDVA), intermediate visual acuity (UIVA at 60 cm), and near visual acuity (UNVA at 40 cm), uncorrected defocus curves, contrast sensitivity, and reading speed. Quality of vision was measured with the Visual Function Questionnaire (VFQ-25).

RESULTS

A total of 50 patients (25 in each group) were enrolled. At 6 months postoperatively, outcomes of binocular UDVA, UIVA, and UNVA were similar in both groups. The binocular defocus curve only differed at vergences of -0.50 to -1.00 D (better for the mix-and-match group; P = .032 and .004, respectively) and at -4.00 D (better for the trifocal group; P = .001). Significantly higher reading speeds in the mix-and-match group were measured at 0.7 and 0.5 logMAR (P = .038 and .034, respectively). There were no significant differences between groups for contrast sensitivity and the results of the questionnaire.

CONCLUSIONS

The mix-and-match implantation seemed to be a good option for patients with high demands for distance and intermediate visual acuity, whereas the trifocal IOL appeared to be more suitable for patients with enhanced near vision demands. [J Refract Surg. 2020;36(8):528-535.].

Clinical Outcomes of New Monofocal Intraocular Lenses with Enhanced Intermediate Function Compared with Extended Depth of Focus Intraocular Lenses

PURPOSE

To compare clinical outcomes of a new monofocal intraocular lens (IOL) with enhanced intermediate function and an extended-depth-of-focus (EDOF) IOL.

SETTING

Asan Medical Center, Seoul, Korea.

DESIGN

Nonrandomized prospective comparative case series.

METHODS

Patients presenting for cataract surgery and meeting all inclusion and exclusion criteria were implanted with new monofocal IOLs with enhanced intermediate function (Tecnis Eyhance ICB00) or EDOF IOLs (Tecnis Symfony ZXR00) bilaterally. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), corrected distance visual acuity (CDVA), defocus curves, and contrast sensitivity were compared after 3 months. Patients were administered questionnaires regarding visual symptoms, spectacle independence, overall satisfaction, and lens recommendations.

RESULTS

Twenty-four patients (48 eyes) were enrolled in the Eyhance group and 20 patients (40 eyes) in the Symfony group. Monocular and binocular UDVA, UIVA, and CDVA were similar in the two groups. Monocular UNVA and spectacle independence for near distance were better in the Symfony group, whereas binocular UNVA did not differ significantly in the two groups. Contrast sensitivity, glare and halo, satisfaction, and recommendation rates were similar in the two groups. Although some dissatisfaction and severe glare and halo were reported in the Symfony group, none of these was reported in the Eyhance group.

CONCLUSIONS

Bilateral implantation of the new Eyhance ICB00 IOLs provided comparable clinical performances as bilateral implantation of Symfony ZXR00 IOLs. Binocular UNVA was similar, although spectacle independence was higher in the Symfony group, but this was at the expense of more glare and halos.

Unilateral implantation of a new non-diffractive extended range-of-vision IOL in a young patient with Curschmann-Steinert myotonic dystrophy

Purpose

We present the case of a 36-year old Curschmann-Steinert myotonic dystrophy patient with posterior subcapsular cataract that we treated with unilateral implantation of an extended depth of focus intraocular lens to address his wish for spectacle independence at far and intermediate distance.

Observations

The patient underwent phacoemulsification with subsequent implantation of the AcrySof IQ Vivity IOL (Alcon, Fort Worth, TX, USA) in his left eye. Uncorrected distance visual acuity (UDVA) on the left eye increased from +0.40 logMAR preoperatively to −0.12 logMAR at 3 months postoperatively. At the three months follow-up distance corrected intermediate visual acuity (DCIVA) at 80 cm distance was −0.08 logMAR and DCIVA at 66 cm distance was 0.14 logMAR for the left eye. The defocus curve showed a functional defocus of 2.0 diopters at 0.2 logMAR or better, corresponding to the extended depth of focus. Dysphotopsia evaluation with a Halo & Glare simulator (Eyeland-Design Network GmbH, Vreden, Germany) revealed a very low level of photic phenomena.

Conclusions and Importance

Unilateral implantation of a new generation, non-diffractive extended depth of focus IOL was well tolerated and provided good functional results for far and intermediate distances. The patient reported a very low level of photic phenomena.

Comparison of trifocal or hybrid multifocal-extended depth of focus intraocular lenses: a systematic review and meta-analysis

This meta-analysis aimed to evaluate the clinical outcomes following implantation of trifocal intraocular lenses (IOLs) or a hybrid multifocal-extended depth of focus (EDOF) IOL in cataract or refractive lens exchange surgeries. We examined 13 comparative studies with bilateral implantation of trifocal (898 eyes) or hybrid multifocal-EDOF (624 eyes) IOLs published through 1 March 2020. Better uncorrected and corrected near visual acuity (VA) were observed in the trifocal group (MD: − 0.143, 95% CI: − 0.192 to − 0.010, P < 0.001 and MD: − 0.149, 95% CI: − 0.217 to − 0.082, P < 0.001, respectively), while the hybrid multifocal-EDOF group presented better uncorrected intermediate VA (MD: 0.055, 95% CI: 0.016 to 0.093, P = 0.005). Trifocal IOLs were more likely to achieve spectacle independence at near distance (RR: 1.103, 95% CI: 1.036 to 1.152, P = 0.002). The halo photic effect was generated more frequently by the trifocal IOLs (RR: 1.318, 95% CI: 1.025 to 1.696, P = 0.031). Contrast sensitivity and subjective visual quality yielded comparable results between groups. Trifocal IOLs demonstrated better performance at near distance but apparently led to more photic disturbances. Our findings provided the most up-to-date and comprehensive evidence by comparing the benefits of advanced IOLs in clinical practice.

Comparison of two extended depth of focus intraocular lenses with a monofocal lens: a multi-centre randomised trial

Purpose

The AT LARA 829MP is a next-generation extended depth of focus (EDOF) intraocular lens (IOL) providing continuous vision over a range of distances. The aim of this prospective multi-centre randomised trial was to compare two EDOF IOLs and one monofocal IOL.

Methods

Cataract patients between 50 and 80 years were randomised for bilateral implantation with either the AT LARA 829MP (EDOF), the TECNIS Symfony (EDOF) or the CT ASPHINA 409MP (monofocal). Follow-up was at 1 to 2 weeks, 1 month and 4 to 6 months.

Results

A total of 211 patients were randomised and included in the final analysis. Monocular depth of focus was significantly better for AT LARA 829MP eyes compared with that for TECNIS Symfony at all thresholds (p = 0.024, 0.001 and 0.006, for 0.1, 0.2 and 0.3 logMAR respectively) with no significant difference for binocular depth of focus. LARA eyes had significantly better monocular depth of focus at all levels compared with ASPHINA eyes (all p < 0.0001), while there was no significant difference between Symfony and ASPHINA eyes at 0.1 logMAR and 0.2 logMAR. Both EDOF IOLs were significantly better than the monofocal ASPHINA at all levels for binocular depth of focus (LARA: all p < 0.0001; Symfony: all p = 0.002). Distance visual acuity was similar for all IOLs at 6 months; intermediate and near visual acuity were significantly better for the EDOF IOLs than for the monofocal (p < 0.0001). Refraction improved in all groups relative to baseline. Contrast sensitivity was higher with the CT ASPHINA 409MP but both EDOF lenses had a better spectacle independence rate. At 6 months, all IOLs were well centred with no cases of tilt. No general safety issues were raised for any of the groups.

Conclusion

The two EDOF intraocular lenses investigated provided good visual outcomes with comparable visual acuity at all distances. The AT LARA 829MP provided the widest monocular depth of focus at 0.1 and 0.2 logMAR, with a clear superiority compared with the monofocal IOL. TECNIS Symfony was superior to the monofocal control at 0.3 logMAR. Spectacle independence and patient satisfaction were comparable.

Trial registration

Trial registered on https://clinicaltrials.gov/ under the identification NCT03172351 (date of registration 1 June May 2017).

Comparison of new monofocal innovative and standard monofocal intraocular lens after phacoemulsification

PURPOSE

To evaluate the early findings of new monofocal intraocular lens (Tecnis^® Eyhance) in comparison with standard monofocal intraocular lens (Tecnis^® 1-piece) in patients who underwent cataract surgery.

METHODS

Sixty-four eyes of thirty-two patients (each intraocular lens model was implanted bilaterally in 16 patients) were included in this retrospective study. Preoperative and postoperative (at one month) manifest refraction, spherical equivalent (SE) values, monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UCIVA), distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), binocular defocus curve, photopic contrast-sensitivity, spectacle independence, photic phenomena, tolerance to residual refractive errors and complications were recorded.

RESULTS

The mean monocular postoperative UDVA, CDVA, DCNVA, spherical equivalent and cylinder values were comparable between each group (p > 0.05). Monocular and binocular DCIVA and UCIVA were significantly higher in Tecnis^® Eyhance group than Tecnis^® 1-piece group (p = 0.033, p = 0.038, respectively). No statistically significant difference was detected between groups regarding the photopic contrast sensitivities for any spatial frequency (p > 0.05). Spectacle independence was significantly higher in Tecnis^® Eyhance group than Tecnis^® 1-piece group. Tecnis^® Eyhance IOL revealed a good tolerance to unexpected residual refractive errors than Tecnis^® 1-piece IOL.

CONCLUSION

Tecnis^® Eyhance appears to be an effective option for both patients and surgeons regarding better intermediate visual acuities and more forgiving for residual refractive errors relative to the standard monofocal intraocular lenses. However, longer follow-up studies with larger group of patients are needed to evaluate the effectiveness of Tecnis^® Eyhance intraocular lens.

Clinical outcomes after mix-and-match implantation of diffractive multifocal intraocular lenses with + 2.75 and + 4.00 diopter add powers

Background

To evaluate the clinical outcomes of bilateral mix-and-match implantation of diffractive multifocal intraocular lenses (IOLs) with different add powers.

Methods

We retrospectively reviewed the medical records of 18 patients who underwent bilateral mix-and-match implantation of diffractive multifocal IOLs with different add powers. Multifocal IOLs with add powers of + 2.75 diopters (D) and + 4.00 D were implanted into the patients’ dominant and nondominant eyes, respectively. At 1 and 3-month postoperatively, monocular and binocular visual acuity was measured using logMAR charts and manifest refraction was performed. Specifically, logMAR charts were used to measure uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA). Defocus curves, contrast sensitivity, and patient satisfaction were assessed at 3-month postoperatively.

Results

Binocular logMAR measurements (mean ± standard deviation) at 3-month postoperatively were 0.01 ± 0.04 (UDVA), 0.16 ± 0.05 (UIVA), and 0.11 ± 0.07 (UNVA). Postoperative spherical equivalent was − 0.43 ± 0.35 D and − 0.39 ± 0.21 D in the dominant and nondominant eyes, respectively. Defocus curves showed significant differences between − 1.50 and − 4.00 D among binocular, dominant, and nondominant eye measurements, except between − 2.50 and − 3.00 D. Eyes implanted with + 2.75 and + 4.00 D IOLs showed good contrast sensitivity under photopic and mesopic conditions. Over 80% of patients reported high satisfaction with their near vision.

Conclusions

Bilateral mix-and-match implantation of diffractive multifocal IOLs with add powers of + 2.75 D and + 4.00 D showed good near, intermediate, and far vision.