Subjective Perception Of Trifocal IOL Performance, Including Toric Models

Visual Outcomes and Patient Satisfaction After Bilateral Refractive Lens Exchange With a Trifocal Intraocular Lens in 5,226 Patients With Presbyopia

PURPOSE

To assess visual and refractive outcomes and visual function after bilateral RayOne Trifocal toric and nontoric intraocular lens (IOL) (Rayner) implantation in patients with presbyopia.

METHODS

Charts of patients with presbyopia who underwent refractive lens exchange with bilateral implantation of the RayOne Trifocal IOL (toric and non-toric) were retrospectively reviewed. Visual and refractive outcomes were evaluated at 3 months. Patient satisfaction, spectacle independence, and visual disturbance profile were assessed by questionnaires.

RESULTS

A total of 5,226 patients were assigned to one of two groups: 1,010 patients had toric IOL implantation (toric group) and 4,216 patients received the non-toric model (non-toric group). Mean ± standard deviation visual acuity at 3 months for the toric group was binocular uncorrected distance visual acuity (UDVA) of 0.07 ± 0.11 logMAR, monocular corrected distance visual acuity (CDVA) of 0.05 ± 0.07 logMAR, binocular uncorrected near visual acuity (UNVA) at 40 cm of 0.10 ± 0.09 logMAR, binocular uncorrected intermediate visual acuity (UIVA) at 40 cm of 0.13 ± 0.12 logMAR, postoperative spherical equivalent (SE) of -0.21 ± 0.47 diopters (D), and cylinder of -0.34 ± 0.40 D. The non-toric group had binocular UDVA of 0.04 ± 0.08 logMAR, monocular CDVA of 0.05 ± 0.07 logMAR, binocular UNVA of 0.10 ± 0.08 logMAR, binocular UIVA of 0.13 ± 0.11 logMAR, SE of -0.08 ± 0.38 D, and cylinder of -0.28 ± 0.34 D. No statistically significant differences were found in achieving spectacle independence and there were high levels of satisfaction in both groups.

CONCLUSIONS

In this retrospective analysis with more than 5,000 patients, both the toric and non-toric RayOne Trifocal IOL models provided good visual performance at all distances, resulting in excellent levels of spectacle independence and patient satisfaction. [J Refract Surg. 2024;40(7):e468-e479.].

Clinical outcomes of trifocal toric intraocular lenses

The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature search in different databases was carried out to identify clinical publications reporting outcomes of patients with this type of implant. The analysis considered information on the sample of eyes, type and power of the trifocal toric IOLs, biometric preoperative data, postoperative refraction, rotational stability, visual acuity at different distances and other analyses undertaken, such as contrast sensitivity or quality of vision questionnaires. 20 clinical studies, encompassing a total of 1404 eyes implanted with three commercially available trifocal toric IOLs, were included in this review. The analysis assessed the outcomes reported for the AT LISA tri toric 939MP IOL, involving 3 articles and 313 eyes; the FineVision toric POD FT IOL, with 7 articles studying 370 eyes, and the AcrySof IQ PanOptix toric IOL, involving 11 articles and 721 eyes. Our assessment of the outcomes of the various studies indicates that the efficacy of the refractive correction (both sphere and cylinder) and visual acuity at different distances was similar between the IOL models. The same was found for the patients' quality of vision and satisfaction levels, in addition to photic phenomena reported. The outcomes summarized in this report lead us to conclude that the use of trifocal toric IOLs allows complete visual restoration over a wide range of distances.

Toric Trifocal Intraocular Lens for Refractive Lens Exchange: A Multi-center, Multi-surgeon Large Cohort Study

PURPOSE

To assess the outcomes of a novel toric trifocal intraocular lens (IOL) for refractive lens exchange (RLE) in a large series of eyes with corneal astigmatism.

METHODS

Consecutive eyes that underwent RLE with the PanOptix Toric IOL (Alcon Laboratories, Inc) were included. Outcomes measures included postoperative distance (UDVA), 60 cm intermediate (UIVA), and 40 cm near (UNVA) uncorrected visual acuity, manifest refraction, spherical and defocus equivalent, efficacy and safety indices, and vector analyses of refractive and toric IOL accuracy.

RESULTS

A total of 4,933 eyes had a median follow-up of 3 months. UDVA of 20/20 and 20/40 was obtained in 65% and 99% of eyes monocularly and 87% and 100% binocularly, respectively. UIVA at 60 cm of 20/25 and 20/40 was achieved in 70% and 99% of eyes monocularly and in 77% and 100% binocularly, respectively. UNVA at 40 cm of 20/25 and 20/40 was achieved in 85% and 96% of eyes monocularly and in 95% and 100% binocularly, respectively. A total of 67%, 89%, 97%, and 99% of eyes had a SEQ within 0.25, 0.50, 0.75, and 1.00 diopter (D) of intended target (R² = 0.99). Postoperative refractive astigmatism of 0.50, 0.75, and 1.00 D or less was achieved in 86%, 95%, and 98% of eyes. The vector analysis correction index and index of success were 1.04 ± 0.35 and 0.41 ± 0.31 for toric IOL accuracy and 1.00 ± 0.46 and 0.36 ± 0.55 for refractive accuracy, respectively. The 3- and 12-month post-RLE excimer laser enhancement rates were 1.1% (95% CI: 0.8% to 1.4%) and 7.6% (95% CI: 6.9% to 8.3%), respectively.

CONCLUSIONS

The PanOptix Toric IOL performed well for a wide range of axial lengths and corneal astigmatism in eyes that had RLE. Most patients achieved effective uncorrected binocular near, intermediate, and distance vision for daily functioning. [J Refract Surg. 2023;39(5):302-310.].

Rate of Complete Spectacle Independence with a Trifocal Intraocular Lens: A Systematic Literature Review and Meta-Analysis

INTRODUCTION

A systematic literature review and meta-analysis was conducted to identify and obtain a precise single summary estimate on complete spectacle independence after bilateral implantation of a trifocal intraocular lens (IOL) (AcrySof PanOptix, TFNTXX/TFATXX) for patients undergoing cataract surgery.

METHODS

A search was conducted in PubMed from January 2017 to September 2021. Relevant congress presentations were also searched to include data from completed studies not yet published. Search terms included the intervention (TFNTXX, TFATXX, PanOptix) and outcomes of interest (patient-reported spectacle independence rates). A Bayesian random-effects meta-analysis was conducted, providing a pooled estimate (median and its 95% credible interval) of complete spectacle independence rates among cataract surgery patients. Subgroup analyses evaluated spectacle independence after cataract surgery across different working distances (near, intermediate, far).

RESULTS

Nineteen unique clinical studies were identified. Based on a meta-analysis of 13 studies (N = 513 patients), the complete spectacle independence rate after cataract surgery with TFNTXX/TFATXX IOL was 91.6% (95% credible interval 86.8-95.9%). Additionally, the spectacle independence rates at each focal point (N = 13 studies, 603 patients) were 89.6% (near), 96.3% (intermediate), and 95.9% (far).

CONCLUSIONS

This meta-analysis demonstrated that at least nine out of ten patients receiving TFNTXX/TFATXX trifocal IOL during cataract surgery can expect to achieve complete spectacle independence. This study provides informative data for clinicians and patients to feel confident in the use of trifocal intraocular lenses as presbyopia-correcting IOLs that offer high rates of complete spectacle independence.

Clinical outcome of a quadrifocal (trifocal) intraocular lens in Chinese patients: prospective, observational case series

PURPOSE

To report the visual outcomes and quality of vision and life after bilateral implantation of a single-piece trifocal intraocular lens (IOL) in Chinese patients.

SETTING

Hong Kong Sanatorium & Hospital, Hong Kong, China.

DESIGN

Prospective, observational case series.

METHODS

Patients with bilateral implantation of AcrySof IQ PanOptix multifocal IOL were included. Distance, intermediate (60 cm), and near (40 cm) visual acuities (VAs) and contrast sensitivity (CS), defocus curve, preoperative higher-order aberration (HOA), dysphotopsia (0 to 5), satisfaction (1 to 5), spectacle independence, and quality of life were evaluated. The association between preoperative HOA and postoperative halos was also assessed.

RESULTS

54 eyes of 27 patients were included. The mean binocular distance, intermediate, and near uncorrected VA was -0.05 ± 0.06 (20/18), 0.06 ± 0.10 (20/23), and 0.04 ± 0.05 (20/22), respectively. No eyes lost more than 1 line of vision. Binocular CS was comparable with the monocular population norm of older adults. The defocus curve demonstrated that the binocular VA of 20/25 or better was achieved at a power of -3.00 to +0.50 diopters. The mean scores for halos, glare, and starbursts were 2.4 ± 1.4, 0.2 ± 0.8, and 1.4 ± 1.4 (of 5), respectively. The mean satisfaction score was 4.3 ± 0.7 (of 5). All the patients (100%) reported total spectacle independence. The mean vision-targeted composite score of the vision-related quality-of-life questionnaire was 97.2 ± 9.7 (of 100). Preoperative HOA was not associated with postoperative halos.

CONCLUSIONS

Implantation of the trifocal IOL provided satisfactory visual outcomes and quality of vision and life, which resulted in a high rate of spectacle independence.

Visual performance following implantation of presbyopia correcting intraocular lenses

OBJECTIVE

To compare the visual outcomes following bilateral implantation of 3 presbyopia correcting IOLs.

METHODS

Results are reported for patients who underwent phacoemulsification with bilateral implantation of one of the following IOLs: Panoptix IOL, AT LISA tri IOL and Symphony IOL. Six months postoperative examination included monocular UIVA at 80 and 60 cm and monocular UNVA and DCNVA at 40 cm, monocular UDVA and CDVA, Spherical equivalent (SE) refraction, binocular defocus curve, contrast sensitivity, photopic phenomena, and spectacle independence.

RESULTS

UIVA at 80 cm was significantly better in the AT LISA group and the Symfony groups than the Panoptix group, while UIVA at 60 cm was better in the Symfony group and the Panoptix group than the AT LISA group. A worse DCNVA was recorded in the Symfony group. At a defocus of -2.50 D, the near VA was similar in the PanOptix and AT LISA groups (0.05, 0.07 logMAR respectively), which were significantly better than the Symfony group (0.3 LogMAR). Binocular photopic and scotopic contrast sensitivity outcomes were similar among the three groups at all spatial frequencies. In Symphony group, the frequency and the degree of bother of photic phenomena was relatively higher than the other two groups. Higher percentage of patients in symphony group reported their need for reading glasses.

CONCLUSION

PanOptix IOL and AT LISA IOL would be a good choice for patients aiming for an optimum near vision, while Symfony IOL seems suitable for patients having the priority for good intermediate vision.

Vision-related Quality of Life after Bilateral Implantation of Monofocal and Multifocal Intraocular Lenses

Purpose

To evaluate vision-related quality of life in two sets of patients after routine cataract surgery implanting with traditional versus multifocal intraocular lens (IOLs).

Methods

In a cross-sectional prospective study, 58 and 33 candidates for cataract surgery were divided into traditional (Acrysof SN60WF, Alcon Laboratories, Inc) and multifocal IOL (AcrySof IQ PanOptix IOL TFNT00, Alcon Laboratories, Inc.) groups, respectively. The primary outcome was VFQ-25 scores. The secondary outcomes were making comparisons between the two IOL types in the near vision and the driving items.

Results

mean patients' age in traditional and multifocal IOL groups was 60.85 ± 7.40 (55% female) and 59.85 ± 8.95 (36% female) years, respectively. The mean VFQ-25 total scores in traditional and multifocal IOL groups before and after surgery were 63.69 ± 4.95 and 72.15 ± 9.66, and 98.08 ± 0.70 and 95.70 ± 1.30, respectively (P = 0.001 & 0.001). The mean scores of night driving in traditional and multifocal IOL groups were 38.79 ± 20.50 and 44.35 ± 21.12 (P = 0.1) before surgery which improved to 97.41 ± 7.68 and 56.45 ± 11.12 after surgery, respectively (P = 0.001). The mean scores of near vision in traditional and multifocal IOL groups were 46.83 ± 10.56 and 50.53 ± 8.58 (P = 0.2) before surgery which improved to 89.94 ± 4.87 and 100.00 ± 0.00 after surgery, respectively (P = 0.001).

Conclusion

Vision-related quality of life after cataract surgery with either type of traditional or multifocal (PanOptix) IOLs improved to an excellent level. Traditional IOLs provided more satisfaction in nighttime driving while multifocal IOLs provided increased satisfaction in near and intermediate vision.

Patient Expectation, Satisfaction and Clinical Outcomes with a New Multifocal Intraocular Lens

Purpose

To report patient expectations, visual performance and satisfaction with AcrySof IQ PanOptix multifocal intraocular lens in a heterogeneous patient group. Additionally, determine if identifiable pre-operative characteristics can predict post-operative satisfaction.

Methods

Data were prospectively collected for 67 consecutive patients (134 eyes) who underwent bilateral Panoptix implantation in a private ophthalmology clinic. A pre-operative questionnaire was completed regarding vision satisfaction, visual phenomena and expectations. Routine clinical parameters were collected 1 month and follow-up questionnaire administered 3 months post-operatively.

Results

Post-operative unaided distance vision was 20/20 (0.01 ± 0.10) and binocular near vision 20/25^-2 (N5; 0.14 ± 0.06). Patients satisfied with vision increased from 6% (n=4) unaided and 48% (n=32) aided pre-operatively to 94% (n=63) unaided post-operatively (p<0.001). There was marked increase in frequency of halo from 14% (n=9) to 69% (n=46; p<0.001) but no corresponding increase in how bothersome this symptom was (p=0.193) nor the frequency of other visual phenomena. Worse post-operative vision and fluctuating vision were associated with lower post-operative satisfaction. There was no difference in satisfaction or residual astigmatism in those implanted with toric lenses. A total of 96% (n=64) of patients were spectacle-free at 3-months and would recommend this procedure to others.

Conclusion

This study supports the trend towards increased patient expectations of multifocal intraocular lenses, matched by excellent visual outcomes and satisfaction. Visual phenomena may be less troubling with new multifocal lenses than previously reported. A pre-operative questionnaire may be a useful education tool but could not isolate pre-operative characteristics that predict post-operative satisfaction.

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

Background:

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

Objective:

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

Methods:

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

Results:

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

Conclusion:

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

Subjective and objective clinical outcomes of a new trifocal toric intraocular lens and effect of femtosecond laser cataract surgery

PURPOSE

To evaluate the clinical outcomes and quality of life following implantation of PanOptix toric intraocular lens (IOL) and to compare the outcomes following femtosecond laser assisted cataract surgery (FLACS) and standard cataract surgery (SCS).

METHODS

This comparative retrospective study included 79 eyes of 55 patients underwent cataract or refractive lens exchange surgery between April 2017 and January 2020 in Bayindir Hospital and Kaskaloglu Eye Hospital. Corneal (CA) and refractive astigmatism (RA), uncorrected visual acuities for distant, intermediate, and near (UDVA, UIVA, and UNVA), low contrast distance visual acuity, rotational stability, defocus curves, photopic and mesopic contrast sensitivity (CS), visual function-14 (VF-14) test, presence of dysphotopsia, and need for spectacles were evaluated at postoperative third month. Outcomes were compared between FLACS and SCS group.

RESULTS

The mean UDVA, UIVA, and UNVA were 0.05 ± 0.07, 0.08 ± 0.08, and 0.06 ± 0.07 logMAR, respectively. All patients achieved ⩾0.3 logMAR uncorrected visual acuity for all distances. UDVA was found significantly better in FLACS group (p = 0.03). All eyes had ⩽1 D of subjective postoperative RA. Defocus curve had two peaks at 0 and -1.50 D. Spectacle independence was achieved in 88.7% of patients. Photopic and mesopic CS was within normal range in all patients. The mean VF-14 score was 98 ± 2. The mean IOL axis rotation was 2.1° ± 2.3°. Only one patient reported seeing disturbing halos.

CONCLUSIONS

This trifocal toric IOL effectively reduced refractive astigmatism and provided excellent visual outcomes with high spectacle independence, patients' satisfaction, and good rotational stability. FLACS might have an impact on optimal postoperative results.

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

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