Analysis of uncorrected near visual acuity after extended depth-of-focus AcrySof® Vivity™ intraocular lens implantation

Functional outcomes and quality of life after AcrySof IQ Vivity intraocular lens implantation in a real-world study

The extended depth-of-focus AcrySof IQ Vivity intraocular lens technology offers promising features for presbyopia management, evaluated in this research in a 6 months real-world setting. Prospective interventional mono-centric study including 40 patients who underwent elective bilateral phacoemulsification. We performed one pre-operative visit (V0) and one evaluation six months post-operatively (V1), evaluating uncorrected and corrected visual acuity for near (UNVA/CNVA), intermediate (UIVA/CIVA) and far (UDVA/UCVA), slit-lamp evaluation, tomography with static pupillometry, endothelial cell count and contrast sensitivity chart. In order to assess post-operative Quality of Life, we administered the patients McAlinden's Quality of Vision test and Morlock's Patient-Reported Spectacle Independence Questionnaire. We divided eyes in with Toric-IOL and with non-Toric IOL. A total of 36 eyes received non-tonic IOL implantation, whereas 44 eyes received toric IOL implantation. There were no statistically significant disparities observed in visual outcome measures and contrast sensitivity between the toric group and the non-toric group. Furthermore, we assessed the predictive preoperative refractive astigmatism (PPRA) and residual refractive astigmatism (RRA) in both cohorts, and no statistical significance was found between the two cohorts (p = 0.08). Twenty-one (53%) patients reported total independence from their glasses at all distances. The mean difference between the predicted and measured refractive error, as calculated by spherical equivalent, was 0.09 D. AcrySof IQ Vivity is a well-tolerated and effective IOL with optimal refractive target for both distant and intermediate vision, needing slight spherical addition for the best near vision. Great questionnaire-based satisfaction was reported by the patients.

Retinal Image Quality Through an Operating Microscope With Wavefront Shaping Extended Depth of Focus Intraocular Lens in Model Eye

PURPOSE

To compare the quality of images of gratings placed in a model eye viewed through an extended depth of focus (EDoF) intraocular lens (IOL) to that of diffractive bifocal IOL or monofocal IOL.

DESIGN

Experimental laboratory investigation.

METHODS

Nondiffractive wavefront shaping EDoF (CNAET0, Alcon Laboratories), echelette-designed EDoF (ZXR00V, Johnson & Johnson Vision), diffractive bifocal IOL with low power addition (SV25T, Alcon Laboratories), or monofocal IOL (CNA0T0, Alcon Laboratories) was placed in a fluid-filled model eye. A United States Air Force Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat or a wide-angle contact lens. The contrast of the gratings viewed through the EDoF or multifocal IOLs was compared to that through the monofocal IOL. A wavefront analyzer was used to measure the spherical power of the central 4.5 mm optics of the EDoF, multifocal, and monofocal IOLs. The distribution of the dioptric power and the dioptric power map were compared.

RESULTS

The gratings observed through the flat contact lens with CNAET0, ZXR00V, or SV25T were slightly blurred when viewed through the multifocal optics. The blurred area was in the circumferential area of CNAET0, the central area of SV25T, and the peripheral area of ZXR00V. The mean contrast was 0.258 ± 0.020 for CNAET0, 0.227 ± 0.025 for ZXR00V, and 0.221 ± 0.020 for SV25T for the 16.0 cyc/mm grating. The contrast was significantly lower for ZXR00V (P = .004) and SV25T (P = .004) than 0.303 ± 0.015 for CNA0T0 but the differences were not significant for CNAET0. For the wide-angle contact lens, the contrast for CNAET0 was 0.182 ± 0.009, for ZXR00V was 0.162 ± 0.011, and for SV25T was 0.163 ± 0.007 for the 16.0 cyc/mm grating, and none was significantly different from 0.188 ± 0.012 for CNA0T0. The dioptric variations of CNAET0 indicated a ring-shaped area of higher power corresponding to the circumferential blurred zone observed through the flat contact lens.

CONCLUSIONS

The wavefront shaping and echelette-designed EDoF-IOLs reduce the contrast of the grating more than the monofocal IOL when viewed through the flat contact lens. The degree of reduction depended on the design of the extended-focus optics. The difference was less through the wide-angle contact lens.

Optical and aberrometric evaluation of a new enhanced monofocal intraocular lens with isofocal optic design

PURPOSE

To evaluate the optical and aberrometric outcomes of an enhanced monofocal intraocular lens (ISOPure) compared with those of a standard monofocal lens (MicroPure) having the same platform and material.

METHODS

A prospective, comparative and randomised clinical study. A total of 28 eyes of 28 patients were randomly assigned to either group. Monocular visual acuity (VA) was measured at distance and intermediate under photopic and mesopic conditions. Aberrometry was analysed for 3.0-, 4.0-, 4.5- and 5.0 mm pupils. The contrast sensitivity defocus curve was measured for 3.0- and 4.5-mm pupils, while the modulation transfer function (MTF) and Strehl ratio (SR) were assessed with a double-pass system. All measurements were performed monocularly 3 months after surgery.

RESULTS

No significant differences were found for distance VA. Under photopic conditions, intermediate VA was better with the ISOPure lens, while no significant differences were found between the lenses under mesopic conditions. Internal and total aberrations were higher for the ISOPure lens. No significant differences were found for corneal aberrations. Additionally, both the contrast sensitivity defocus curve and optical quality showed similar behaviour for each lens, with the MTF cut-off frequency exceeding 30 c/deg in both cases.

CONCLUSION

The isofocal ISOPure lens enhanced intermediate VA without affecting distance VA under photopic conditions. Moreover, there were no significant differences in visual quality between the ISOPure and MicroPure lenses, despite the former exhibiting higher internal and total aberrations than the monofocal model.

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.

Agreement between Two Devices for Measuring Pupil Diameter in Patients Implanted with Multifocal Intraocular Lenses

The purpose of this study was to evaluate the agreement between three methods for measuring pupil size in patients implanted with multifocal intraocular lenses (MIOLs): Keratograph 5M (K5M), Pentacam AXL Wave (PW), and a simple hand ruler. Sixty-nine subjects implanted with MIOLs and measured at the three-month follow-up visit were included in this retrospective analysis. K5M and PW were used to measure the photopic (PP) and mesopic (MP) pupil sizes, and a hand ruler was used to measure the pupil under environmental light conditions (135 lux). The Bland-Altman method with its limits (LoAs) was used to assess the agreement. The median PP was 2.8, 2.95, and 3 mm for K5M, PW, and the ruler, respectively (p < 0.05). Differences in PP were statistically significant for all paired comparisons (p < 0.0005) except between PW and the ruler (p = 0.44). The LoAs for the difference in PP between K5M and PW was 0.63 mm. The mean difference for MP between K5M and PW was 0.04 mm (p = 0.34) with LoAs of 0.72 mm. MP measured with K5M and PW could be considered interchangeable, although a correction of -0.3 mm (IC95%: -0.23 to -0.39) should be applied to PP measured with PW to attain the K5M mean.

The Incidence of Optic Cracks or Fractures During a Foldable AcrySof or Acriva BB Acrylic Monofocal Intraocular Lens Implantation via the Manual Monarch Injector System With the Cartridge in Phacoemulsification Surgery

PURPOSE

To evaluate the incidence of optic cracks and/or fractures during foldable acrylic intraocular lens (IOL) implantation via the manual Monarch delivery system with the cartridge and to determine factors that help to avoid such complications.

METHODS

Small-incision phacoemulsification surgery was performed in 702 eyes with visually significant cataract formation. A foldable acrylic soft IOL (AcrySof^â MA60BM/MA30BA, Alcon, Fort Worth, TX, USA) or a single-piece acrylic soft IOL (Acriva BB^â, VSY Biotechnology, Amsterdam, The Netherlands) was inserted in all eyes using a cartridge and viscoelastic agents (sodium hyaluronate, Healon^®, Advanced Medical Optics, Santa Ana, CA, USA).

RESULTS

Postoperative central, paracentral, or peripheral optic cracks or fractures were encountered in a total of six of 702 eyes (0.85%). Four of six lenses (0.57%) had optic cracks within the IOL substance, whereas two of 702 cases (0.28%) had full-thickness IOL fractures in the substance in multiple locations. Three of the four lenses with optic cracks were noted to be handled by tying forceps during the cartridge insertion, and one of them was the complication of holding forceps. Two IOLs with full-thickness optic fractures were encountered during the insertion of the IOLs in the capsular bag as a result of direct trauma to the lens optic by the plunger of the injector system overriding the lens optic during cartridge passage. None of the patients suffered from glare or other visual disturbances postoperatively, and, therefore, none of the six eyes required lens replacement.

CONCLUSION

The unintentional extensive pressure effect of the forceps during the holding process of the IOL or the direct trauma to the lens optic by the plunger of injector systems may cause optic cracks or fractures. Physicians should continue to monitor the eyes postoperatively regularly and must determine the benefits and risks to be derived from lens replacement, if such patients complain of significant glare, image degradation, and visual disturbances. We recommend the use of preloaded lenses, which have their own delivery systems and cartridges, to minimize the risk of such complications.

Evaluation of extended depth-of-focus hydrophobic intraocular lens with an optic concept based on combination of high-order aberrations

Background

Extended depth-of-focus (EDOF) intraocular lenses (IOLs) provide a continuous range of uncorrected vision at different distances.

Objective

To assess visual acuity, refractive outcomes, and patient satisfaction after cataract surgery using the LuxSmart EDOF IOL (Bausch+Lomb).

Design

A two-center, prospective observational clinical study.

Methods

This study includes patients who have undergone bilateral phacoemulsification with bilateral implantation of the LuxSmart EDOF IOL, with the aim of achieving emmetropia. Visual acuity (VA) and subjective refraction were obtained in all patients preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Subjective measures were obtained using the Catquest-9SF questionnaire and the Patient-Reported Spectacle Independence Questionnaire (PRSIQ). Contrast sensitivity and a glare assessment were undertaken postoperatively. Safety outcomes were additionally assessed.

Results

Sixty eyes from thirty patients were recruited for this study. The mean spherical equivalent was 1.04 ± 1.67 D preoperatively and -0.30 ± 0.46 D at 6 months. Monocular uncorrected distance VA was 0.57 ± 0.32 (logMAR) preoperatively and 0.09 ± 0.12 (logMAR) at 6 months. Mean 6-month monocular uncorrected VA was 0.11 ± 0.13, 0.12 ± 0.15, and 0.31 ± 0.15 (logMAR) at 80, 66, and 40 cm, respectively. More than 90% of patients were either fairly or very satisfied with their vision. There was one case of suspected vitreomacular traction postoperatively.

Conclusion

The LuxSmart EDOF IOL offers good refractive, VA, and safety outcomes. The single elongated focal point designed to enhance the DOF shows good results for VA and patient satisfaction.