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

A comparative study of two presbyopia-correcting intraocular lenses combining bifocal and extended depth-of-focus profiles

OBJECTIVE

To compare the visual performance of two presbyopia-correcting intraocular lenses (IOLs) that combine both bifocal and extended depth-of-focus profiles, Artis® Symbiose® Plus (Symbiose Plus; Cristalens Industrie, Lannion, France) and Tecnis® Synergy® (Synergy; Johnson & Johnson Vision, Santa Ana, CA, USA).

METHODS

The medical records of patients with cataract bilaterally implanted with either Symbiose Plus or Synergy between January 2022 and January 2023 were assessed. The principal measures of postoperative findings included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near (40 and 33 cm) visual acuity (UNVA), objective optical quality (OOQ) parameters, distance-corrected defocus curve analysis, and surveys of subjective satisfaction.

RESULTS

Total of 96 eyes from 48 patients were enrolled. Each group was equally composed of 24 patients, 48 eyes. There were no significant differences between the two groups on baseline characteristics. Both IOLs displayed excellent binocular UDVA, CDVA, and UNVA (40 and 33 cm) with no statistical difference (p = 0.467(UDVA), p = 0.584(CDVA), p = 0.096(40-cm UNVA), and p = 0.621(33-cm UNVA)). However, with regard to UIVA, the Synergy group showed significantly superior results (p < 0.001). In contrast, the Symbiose Plus group showed significantly better results on OOQ parameters and patient-reported quality of vision survey outcomes (both p < 0.001).

CONCLUSIONS

Both IOLs provided a decent continuous range of vision from near to far distance.

Clinical prospective intra-individual comparison after mix-and-match implantation of a monofocal EDOF and a diffractive trifocal IOL

OBJECTIVES

To assess intra-individually visual acuity (VA) and subjective outcome after mix-and-match implantation of a monofocal EDOF IOL and a diffractive trifocal IOL.

METHODS

The monofocal EDOF Isopure IOL was implanted in the dominant eye and the trifocal FineVision HP IOL in the non-dominant eye. Postoperative evaluation included VA at various distances, contrast acuity, monocular defocus curves, decentration and tilt, wavefront aberrometry, VF-7 questionnaire and a halo and glare simulator.

RESULTS

50 eyes of 25 subjects were enroled. The trifocal IOL performed better at monocular DCNVA (p < 0.01) and at defocus levels of -1.5D to -4.0D (p < 0.01), the monofocal EDOF IOL was better at -0.5D (p = 0.013). No differences in monocular BCDVA, DCIVA, contrast acuity, decentration or tilt were observed (p > 0.05). Wavefront analysis revealed lower HOAs in the trifocal group at 5 mm (p < 0.01) and no difference (p = 0.107) at 3 mm pupil aperture. The monofocal EDOF IOL displayed increased negative SA at 5 mm (p < 0.01) and 3 mm (p < 0.01) pupil diameter. Low values of optical phenomena and satisfying results of the VF-7 questionnaire were obtained.

CONCLUSION

Excellent visual performance and low rates of optical phenomena were achieved after mix-and-match implantation of the monofocal EDOF Isopure IOL and the trifocal FineVision HP IOL. Trifocal IOL implantation in the non-dominant eye may decrease optical disturbing phenomena. Similar results were observed for monocular distance, intermediate and contrast VA. The trifocal IOL provided better monocular near VA. Decentration and tilt and HOAs were low.

Clinical outcomes of a new four-haptic hydrophobic presbyopia-correcting intraocular lens

A new presbyopia-correcting intraocular lens (IOL) combining bifocal and extended-depth-of-focus profiles (Symbiose: Artis Symbiose Plus; Cristalens Industrie, Lannion, France) was introduced. We compared the output with that of a standard monofocal IOL (PL E: Artis PL E). The two four-haptic hydrophobic IOLs were made of the same material from the same company. Cataract patients bilaterally implanted with either PL E or Symbiose between November 2021 and August 2022 were reviewed. The principal measures of the postoperative results were uncorrected distance visual acuity (UDVA); corrected distance VA (CDVA); uncorrected intermediate VA; uncorrected near VA; objective optical quality; and distance-corrected defocus curves. This study included forty-eight patients (96 eyes), with 22 and 26 patients (44 and 52 eyes, respectively) being implanted with PL E and Symbiose, respectively. All patients received the same type of IOL implanted in both eyes. The average age of patients was 70.9 ± 7.1 and 60.0 ± 8.5 years in PL E and Symbiose groups, respectively, with significantly younger patients in Symbiose group (p < 0.001). Both IOLs displayed excellent UDVA and CDVA with no statistical difference (p = 0.081 (monocular UDVA), p = 0.599 (monocular CDVA), p = 0.204 (binocular UDVA), and p = 0.145 (binocular CDVA)). In comparison with PL E group, Symbiose group showed significantly superior postoperative intermediate and near VA (p < 0.001). PL E group showed significantly superior objective optical quality compared with Symbiose group (p < 0.001). Symbiose provides a continuous range of vision that ensures a seamless transition from far to near with no discontinuity. It also delivers a smooth defocus curve with a larger landing area than the PL E. But the objective optical quality was better in PL E.

Comparative analysis of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and bifocal profiles with a standard monofocal intraocular lens

Background

Recently, a new presbyopia-correcting intraocular lens (IOL) that combines extended depth-of-focus and bifocal profiles (ZFR00: Tecnis® Synergy®, Johnson & Johnson Vision, Santa Ana, CA, USA) has been established and several studies have been reported. We attempted to compare the performance with a standard IOL (ZCB00: Tecnis® monofocal, Johnson & Johnson Vision, Santa Ana, CA, USA) manufactured using the same material from the same company, which has been extensively used worldwide.

Methods

The medical records of patients undergoing cataract surgery with ZCB00 or ZFR00 implantation between March 2021 and September 2021 and with available 3-month visit data were reviewed. Uncorrected near, intermediate, and distance visual acuity (VA), corrected distance VA, and optical quality were the main outcome measures.

Results

This study included forty-six patients (64 eyes), with twenty-one patients (32 eyes) implanted with ZCB00 and twenty-five patients (32 eyes) implanted with ZFR00. The average age of the patients was 66.0 ± 10.1 (range: 40 to 82) and 65.1 ± 4.7 (range: 59 to 77) years in the ZCB00 and ZFR00 groups, respectively. The preoperative characteristics did not differ significantly between the two groups. Compared to the ZCB00 group, the ZFR00 group demonstrated significantly superior intermediate and near VA (p < 0.001) at 3 months postoperatively. The ZFR00 group showed significantly lower objective measured optical quality than that in the ZCB00 group.

Conclusions

The ZFR00 exhibited a continuous range of vision and a smooth defocus curve, while the ZCB00 provided superior objective optical quality.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12886-022-02516-6.

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.

Increased Near Vision Spectacle Dependence of Patients With Preoperative Myopia After Mix-and-Match Implantation of Trifocal EDOF and Trifocal IOLs

PURPOSE

To investigate the factors affecting near vision spectacle dependence after mix-and-match implantation of the trifocal extended depth of focus (EDOF) and trifocal intraocular lens (IOL).

METHODS

A total of 204 eyes of 102 patients who underwent mix-and-match implantation of one trifocal EDOF and one trifocal IOL were enrolled in this study. Patients were divided into two groups according to spectacle dependence for near vision: reading glasses and no glasses. Clinical characteristics were compared between the two groups and multivariate binary logistic regression analysis was performed to determine the odds ratio of factors potentially associated with the need for reading glasses.

RESULTS

Eighty-one patients (79.4%) did not need reading glasses and 21 (20.6%) did. The mean age of the no glasses group (55.6 ± 5.6 years) was significantly higher than that of the reading glasses group (52.7 ± 4.1 years). Preoperative refractions were more myopic in the reading glasses group than in the no glasses group. The postoperative uncorrected near visual acuities were better and the satisfaction scores were higher in the no glasses group compared to the reading glasses group. Multivariate binary regression analysis revealed that only pre-operative spherical equivalent (odds ratio: 1.397; P = .025) was related to the spectacle independence for near vision.

CONCLUSIONS

Patients who had preoperative myopia and underwent mix-and-match implantation of trifocal EDOF and tri-focal IOLs tended to need spectacles for near vision. Surgeons should be aware of patients with myopia when considering mix-and-match implantation of trifocal EDOF and trifocal IOLs. [J Refract Surg. 2021;37(11):746-753.].

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.

Evaluation of Visual and Subjective Outcomes with Mix-and-Match of Three One-Piece Tecnis Multifocal IOLs of Varying Add Powers

Purpose

To evaluate visual and subjective outcomes after bilateral mix-and-match implantation of one-piece diffractive multifocal IOLs in different near add powers (+2.75 D, +3.25 D, +4.0 D).

Setting

Four US clinics.

Design

Prospective, multi-center, parallel comparison clinical study design.

Patients and Methods

Two treatment groups received implantation with either the +3.25 D (ZLB00) or the +4.00 D (ZMB00) Tecnis^® Multifocal 1-piece IOL in their non-dominant eye, and the +2.75 D (ZKB00) Tecnis Multifocal 1-piece IOL in their dominant eye (Abbott Medical Optics, Inc., Santa Ana, CA). Each study patient underwent the same routine cataract extraction procedures for each eye, with the second eye scheduled to undergo cataract extraction within 7 to 30 days after the 1st eye surgery. Visual and subjective outcomes were evaluated at 90 days after 2nd eye surgery for the two groups: +3.25D/+2.75D (n=41) and +4.00D/+2.75D (n=36).

Results

Mean binocular uncorrected distance visual acuities at 90 days postop were 0.02 ± 0.082 (+3.25D/+2.75D) vs 0.07 ± 0.128 (+4.00D/+2.75D) (p=0.025). Mean binocular uncorrected intermediate visual acuities at 90 days postop were 0.14 ± 0.185 (+3.25D/+2.75D) vs 0.26 ± 0.261 (+4.00D/+2.75D) (p=0.024). Mean binocular uncorrected near visual acuities at 90 days postop were 0.06 ± 0.098 (+3.25D/+2.75D) vs 0.19 ± 0.286 (+4.00D/+2.75D) (p=0.018). Over 88% of patients reported “none” for visual symptoms of glare, halos, starburst, or other. Freedom from glasses or contacts was reported by groups +3.25D/+2.75D and +4.00D/+2.75D as follows: distance (95.1% vs 97.1%), intermediate (92.7% vs 94.1%), and near activities (82.9% vs 64.7%).

Conclusion

At 90 days postoperatively, both groups demonstrated good visual and subjective outcomes; however, differences in near and intermediate outcomes favored the +3.25/+2.75 IOL combination.

Clinicaltrials.gov Registration

NCT02863159 (08/11/2016).