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Giglio R, Vinciguerra AL, Presotto M, Jonak K, Rejdak R, Toro MD, Nanavaty MA, Tognetto D. Visual outcomes and patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens: a single-masked prospective randomized study. Int Ophthalmol 2024; 44:112. [PMID: 38407686 PMCID: PMC10896881 DOI: 10.1007/s10792-024-02946-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 12/04/2023] [Indexed: 02/27/2024]
Abstract
PURPOSE To evaluate and compare the visual outcomes of an enhanced monofocal intraocular lens (IOL) with two different monofocal IOLs. SETTING Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy. DESIGN Prospective, single-center, single-masked, randomized controlled clinical study. METHODS The study included patients undergoing phacoemulsification and IOL implantation. Patients were consecutively randomized by block randomization and assigned in a 1:1:1 allocation ratio to three study arms to bilaterally receive Tecnis Eyhance™ (model ICB00) or Tecnis® monofocal 1-piece (model PCB00) or Clareon® monofocal (model CNA0T0), respectively. Monocular and binocular (both corrected and uncorrected) visual acuities for far, intermediate and near were registered and compared among groups at 3 months. To track changes in patient quality of life, the Catquest-9SF questionnaire was administered to each patient before and after cataract extraction. RESULTS Ninety patients (30 for each group) were enrolled. At 3 months follow-up, statistically significant differences for intermediate visual acuities were found between the three groups. Nonstatistically significant differences were observed for distance visual acuities and the changes in Catquest-9SF scores. CONCLUSION Tecnis Eyhance™ provided better results in intermediate visual outcomes without adverse effects on patients' quality of life.
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Affiliation(s)
- Rosa Giglio
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale Maggiore, Piazza Ospedale 1, 34129, Trieste, Friuli-Venezia Giulia, Italy
| | - Alex Lucia Vinciguerra
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale Maggiore, Piazza Ospedale 1, 34129, Trieste, Friuli-Venezia Giulia, Italy.
| | - Marianna Presotto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale Maggiore, Piazza Ospedale 1, 34129, Trieste, Friuli-Venezia Giulia, Italy
| | - Kamil Jonak
- Department of Biomedical Engineering, Lublin University of Technology, 20-618, Lublin, Poland
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, 20-093, Lublin, Poland
| | - Robert Rejdak
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093, Lublin, Poland
| | - Mario Damiano Toro
- Department of General and Pediatric Ophthalmology, Medical University of Lublin, 20-093, Lublin, Poland
- Eye Clinic, Public Health Department, University of Naples Federico II, 80138, Naples, Italy
| | | | - Daniele Tognetto
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Ospedale Maggiore, Piazza Ospedale 1, 34129, Trieste, Friuli-Venezia Giulia, Italy
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Niazi S, Gatzioufas Z, Dhubhghaill SN, Moshirfar M, Faramarzi A, Mohammadi F, Kheiri B, Peyman A, Heidari M, Doroodgar F. Association of Patient Satisfaction with Cataract Grading in Five Types of Multifocal IOLs. Adv Ther 2024; 41:231-245. [PMID: 37884810 DOI: 10.1007/s12325-023-02698-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION This study investigated patient satisfaction levels in five premium intraocular lenses (IOLs). A secondary aim was to determine whether patient satisfaction was associated with the cataract grade before lens surgery. METHODS In this multicenter prospective comparative study, 164 patients from diverse backgrounds underwent cataract surgery and were assigned for identical bilateral implantation of multifocal IOLs. In addition to visual performance, quality of life was measured using the National Eye Institute Refractive Error Quality Of Life Instrument (NEI-RQL 42) scoring questionnaire. The Sirius Scheimpflug Analyzer was used to evaluate the posterior cornea and aberrations. Finally, the association of patient satisfaction reports with the Pentacam Cataract Grading Scale (PCGS) and Lens Opacities Classification System (LOCS III) was evaluated. RESULTS A considerable subjective improvement was observed in uncorrected far, near (40 cm), and intermediate (60 cm) visual acuity in the five groups (P values < 0.001). A significant difference was observed in mesopic and photopic contrast sensitivity between Symfony, Trinova, and AT LISA at the spatial frequency of 12 cycles per degree, favoring Symfony (P < 0.001). PanOptix users had considerably lower mean coma values (P < 0.001), while AT LISA users had lower mean spherical aberrations (P = 0.009) compared to the other groups. No additional safety concerns relating to IOLs were recorded. Mean satisfaction had a high correlation with LOCS and Pentacam Nuclear Staging (PNS) in each lens group, e.g., correlation coefficient and P value for AT LISA were respectively r = 0.99, P < 0.001 and r = 0.97, P = 0.004. CONCLUSION Despite discrepancies between groups of lenses, most patients who received multifocal IOLs reported satisfaction at more than 3 years after the initial operation. A growing number of patients with cataracts are seeking spectacle-free vision with presbyopia-correcting IOLs. Hence, the high satisfaction rate among patients with cataract could indicate the value of offering a wider range of available lenses.
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Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Science, Tehran, Iran
| | | | - Sorcha N Dhubhghaill
- Antwerp University Hospital, Edegem, Belgium
- Faculty of Health Sciences, Antwerp University, Edegem, Belgium
| | - Majid Moshirfar
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, USA
| | - Amir Faramarzi
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Farzad Mohammadi
- Translational Ophthalmology Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Bahar Kheiri
- University Eye Hospital Basel, Basel, Switzerland
| | - Alireza Peyman
- Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Heidari
- Department of Epidemiology and Biostatistics, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Science, Tehran, Iran.
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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LoBue SA, Martin CR, Benson KK, Trosclair KB, Shelby CL, Coleman III WT. The Role of Early Nd:YAG Laser Capsulotomy in Improving Visual Performance in Mild to Moderately Symptomatic Trifocal Patients. Clin Ophthalmol 2023; 17:3991-4000. [PMID: 38148832 PMCID: PMC10750775 DOI: 10.2147/opth.s448784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/12/2023] [Indexed: 12/28/2023] Open
Abstract
Purpose To determine the effect of early Nd:YAG (neodymium:yttrium-aluminum-garnet) laser capsulotomy on objective and subjective visual quality in symptomatic trifocal intraocular lens (IOL) patients. Methods A single-center, prospective study examined symptomatic patients after bilateral cataract extraction with trifocal IOL implantation. A ten-question survey was conducted one month after surgery. Study endpoints included the assessment of monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), contrast sensitivity (CS), and subjective visual quality before and after Nd:YAG capsulotomy prior to 4 months after cataract surgery. Results A total of 38 eyes from 21 patients were included with a TFAT00 (n = 23) or TFAT30-60 (n = 15). Overall satisfaction with the IOL was 8.55 ± 1.77 (range 5-10). A Nd:YAG capsulotomy was performed at 55 ± 26 days. Monocular UDVA and UNVA > 20/25 before Nd:YAG were 53.0% and 42.0%, which improved post-Nd:YAG to 63.0% and 66.0%, respectively (P = 0.41, P = 0.051). Binocular UDVA and UNVA >20/25 before Nd:YAG were 82.0% and 63.0%, which increased to 97% and 97%, respectively (P < 0.05, P < 0.001). CS increased in all post-Nd:YAG capsulotomies (P < 0.01). The presence of glare was documented at 74% pre-Nd:YAG, which decreased to 41% post-Nd:YAG (P < 0.01). Glare which limited activities was documented at 24%, which decreased to 5% post-Nd:YAG (P = 0.21). Conclusion Early treatment of posterior capsule opacities in mild to moderately dissatisfied trifocal IOL patients may be beneficial in improving CS, visual quality, and reducing the presence and severity of dysphotopsias.
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Affiliation(s)
- Stephen A LoBue
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Curtis R Martin
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Krysta K Benson
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Krystle B Trosclair
- Department of Graduate Medical Education, Statistics, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Christopher L Shelby
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
| | - Wyche T Coleman III
- Department of Ophthalmology, Willis-Knighton Medical Center, Shreveport, LA, USA
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Hong ASY, Ang BCH, Dorairaj E, Dorairaj S. Premium Intraocular Lenses in Glaucoma-A Systematic Review. Bioengineering (Basel) 2023; 10:993. [PMID: 37760095 PMCID: PMC10525961 DOI: 10.3390/bioengineering10090993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 09/29/2023] Open
Abstract
The incidence of both cataract and glaucoma is increasing globally. With increasing patient expectation and improved technology, premium intraocular lenses (IOLs), including presbyopia-correcting and toric IOLs, are being increasingly implanted today. However, concerns remain regarding the use of premium IOLs, particularly presbyopia-correcting IOLs, in eyes with glaucoma. This systematic review evaluates the use of premium IOLs in glaucoma. A comprehensive search of the MEDLINE database was performed from inception until 1 June 2023. Initial search yielded 1404 records, of which 12 were included in the final review of post-operative outcomes. Studies demonstrated high spectacle independence for distance and good patient satisfaction in glaucomatous eyes, with positive outcomes also in post-operative visual acuity, residual astigmatism, and contrast sensitivity. Considerations in patient selection include anatomical and functional factors, such as the type and severity of glaucomatous visual field defects, glaucoma subtype, presence of ocular surface disease, ocular changes after glaucoma surgery, and the reliability of disease monitoring, all of which may be affected by, or influence, the outcomes of premium IOL implantation in glaucoma patients. Regular reviews on this topic are needed in order to keep up with the rapid advancements in IOL technology and glaucoma surgical treatments.
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Affiliation(s)
- Ashley Shuen Ying Hong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Bryan Chin Hou Ang
- Department of Ophthalmology, National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Department of Ophthalmology, National Healthcare Group Eye Institute, Woodlands Health Campus, Singapore 768024, Singapore
| | - Emily Dorairaj
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33431, USA;
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, FL 32224, USA;
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Zhu M, Fan W, Zhang G. Visual outcomes and subjective experience with three intraocular lenses based presbyopia correcting strategies in cataract patients. Sci Rep 2022; 12:19625. [PMID: 36380047 PMCID: PMC9666430 DOI: 10.1038/s41598-022-23694-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Abstract
To compare the visual outcomes and subjective experience of three intraocular lenses (IOL) implant strategies. Retrospective comparative study. This study comprised patients who underwent phacoemulsification and bilateral implantation of extended depth of focus (EDOF) IOL (ZXR00; EDOF group), blended implantation of EDOF and bifocal IOL (ZXR00/ZLB00; blended group), and bilateral implantation of trifocal IOL (AT LISA tri 839MP; trifocal group). The outcomes included visual acuity (VA), visual defocus curve, contrast sensitivity, visual quality, quality of life, spectacle independence, and patient satisfaction. Follow-up was performed 3 months after the surgery. This study included 114 eyes of 57 patients (20 in EDOF group; 16 in blended group; 21 in trifocal group). Patients in the three groups had high quality of life, patient satisfaction, and good contrast sensitivity. The EDOF group had the worst near VA, but the visual quality was the best. The blended group had good VA and slight photic disturbance. The trifocal group obtained the best whole range of VA, but the photic disturbance was significantly severe than the EDOF group. Both the blended and trifocal groups achieved high spectacle independence, but some patients in the EDOF group need spectacle when dealing with close-range tasks.
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Affiliation(s)
- Meiyi Zhu
- grid.12955.3a0000 0001 2264 7233Department of Ophthalmology, Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, No.336 Xiahe Road, Xiamen, 361001 China ,Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, 361002 Fujian China
| | - Wei Fan
- grid.12955.3a0000 0001 2264 7233Department of Ophthalmology, Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, No.336 Xiahe Road, Xiamen, 361001 China ,Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, 361002 Fujian China
| | - Guangbin Zhang
- grid.12955.3a0000 0001 2264 7233Department of Ophthalmology, Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, School of Medicine, Xiamen University, No.336 Xiahe Road, Xiamen, 361001 China ,Fujian Provincial Key Laboratory of Corneal & Ocular Surface Diseases, Xiamen, 361002 Fujian China
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Cho JY, Won YK, Park J, Nam JH, Hong JY, Min S, Kim N, Chung TY, Lee EK, Kwon SH, Lim DH. Visual Outcomes and Optical Quality of Accommodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses in Presbyopia-Correcting Cataract Surgery: A Systematic Review and Bayesian Network Meta-analysis. JAMA Ophthalmol 2022; 140:1045-1053. [PMID: 36136323 PMCID: PMC9501783 DOI: 10.1001/jamaophthalmol.2022.3667] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 07/26/2022] [Indexed: 12/15/2022]
Abstract
Importance A bayesian network meta-analysis (NMA) can help compare the various types of multifocal and monofocal intraocular lenses (IOLs) used in clinical practice. Objective To compare outcomes of presbyopia-correcting IOLs frequently recommended in clinical practice through a bayesian NMA based on a systematic review. Data Sources Medline (PubMed) and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on May 15, 2021, from inception. Study Selection Based on the research question, randomized clinical trials assessing multifocal IOLs in patients who underwent bilateral cataract extraction were searched. Nonrandomized studies, studies in patients with unilateral or contralateral cataract extractions, duplicated studies, conference abstracts, and nonpeer-reviewed articles were excluded. Data Extraction and Synthesis Descriptive statistics and outcomes were extracted. The NMA was conducted to compare different types of IOLs. The mean differences for continuous variables, odds ratios for binary variables, 95% credible intervals (CrIs), and ranks of interventions were estimated. Main Outcomes and Measures The outcomes examined included binocular visual acuities by distance and optical quality, including glare, halos, and spectacle independence. Results This NMA included 27 studies comprising 2605 patients. For uncorrected near visual acuity, trifocal IOLs (mean difference, -0.32 [95% CrI, -0.46 to -0.19]) and old bifocal diffractive IOLs (mean difference, -0.33 [95% CrI, -0.50 to -0.14]) afforded better visual acuity than monofocal IOLs. Regarding uncorrected intermediate visual acuity, extended depth-of-focus IOLs provided better visual acuity than monofocal IOLs. However, there were no differences between extended depth-of-focus and trifocal diffractive IOLs in pairwise comparisons. For uncorrected distant visual acuity, all multifocal IOLs were comparable with monofocal IOLs. There were no statistical differences between multifocal and monofocal IOLs regarding contrast sensitivity, glare, or halos. Conclusions and Relevance For patients considering a multifocal IOL due to presbyopia, bilateral implantation of a trifocal IOL might be an optimal option for patients without compromising distant visual acuity.
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Affiliation(s)
- Jeong-Yeon Cho
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Yeo Kyoung Won
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jongyeop Park
- Department of Ophthalmology, Dongguk University College of Medicine, Gyeongju, Republic of Korea
| | - Jin Hyun Nam
- Division of Big Data Science, Korea University Sejong Campus, Sejong, Republic of Korea
| | - Ji-Yoon Hong
- Health Insurance Research Institute, National Health Insurance Service, Wonju, Gangwon, Republic of Korea
| | - Serim Min
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Nahyun Kim
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Tae-Young Chung
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eui-Kyung Lee
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Sun-Hong Kwon
- School of Pharmacy, Sungkyunkwan University, Suwon, Republic of Korea
| | - Dong Hui Lim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
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Far and Near Contrast Sensitivity and Quality of Vision with Six Presbyopia Correcting Intraocular Lenses. J Clin Med 2022; 11:jcm11144150. [PMID: 35887913 PMCID: PMC9316344 DOI: 10.3390/jcm11144150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/12/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
The objective of this prospective, randomized, double-masked study was to compare the contrast sensitivity and quality of vision of patients bilaterally implanted with the following six different presbyopia correcting intraocular lenses (IOLs): SV25T0 (n = 19), ATLISA 809M (n = 18), ATLISA TRI 839MP (n = 19), ZKB00 (n = 20), ZLB00 (n = 20) and Symfony ZXR00 (n = 20). For comparison purposes, 36 patients were implanted with a monofocal lens (ZA9003). Contrast sensitivity was assessed binocularly at distance under photopic, mesopic and mesopic plus glare conditions, and at near under photopic conditions. Quality of vision was explored in terms of photic phenomena and spectacle independence. Overall, the monofocal lens offered better contrast sensitivity, under all illumination conditions, and less occurrence and intensity of photic phenomena. Amongst the multifocal IOL (MIOL) designs, the extended depth of focus Symfony ZXR00 provided better contrast sensitivity than the other MIOLs, particularly at intermediate and high spatial frequencies. Up to 40% and 50% of patients implanted with MIOLs reported glare and halos, respectively. The SV25T0 resulted in less occurrence and intensity of halos. The evaluation of photic phenomena and contrast sensitivity under different illumination conditions may reflect real-life, visually challenging situations, and thus provide insightful information to assist ophthalmic surgeons when selecting the best intraocular lens for their patients.
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Ungewiss J, Röck T, Wörner M, Wetzel D, Bartz-Schmidt KU, Schiefer U. Vergleich der Sehleistung mit monofokalen Intraokularlinsen mit und ohne verbesserte optische Eigenschaften in einem Nachtfahrsimulator: eine
Proof-of-Concept-Studie. Klin Monbl Augenheilkd 2022; 239:996-1004. [DOI: 10.1055/a-1773-1197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Zusammenfassung
Hintergrund Ziel dieser Studie war die Einführung einer Methode zum „Benchmarking“ von Intraokularlinsen beim Autofahren, insbesondere im Hinblick auf die Sehschärfe (visual acuity,
VA) und die Kontrastempfindlichkeit (contrast sensitivity, CS). Dazu wurden Patienten mit IOL-Implantaten: ICB00 (Tecnis Eyhance, Johnson & Johnson, Santa Ana, CA, USA) vs. CNA0T0
(Clareon, Alcon Laboratories Inc., Fort Worth, TX, USA) klinisch und in einem Nachtfahrsimulator untersucht.
Patienten und Methoden Klinische Tests zum Fernvisus bei hohem (high contrast visual acuity, HCVA) und niedrigem Kontrast (low contrast visual acuity, LCVA) sowie zur mesopischen CS
wurden bei Probanden mindestens 2 Monate nach einer binokularen IOL-Operation durchgeführt (Einschlusskriterien: Visus > 20/25, ophthalmologisch normal, außer Kataraktoperation). Alle
Patienten fuhren im Simulator eine gerade Strecke ab. Die VA, CS und Halogröße wurden binokular während des nächtlichen Autofahrens mit Landolt-Ringen in 4 verschiedenen (Fern- und
Intermediärbereichs-)Positionen und Entfernungen gemessen.
Ergebnisse Die Ergebnisse werden als Median/Interquartilsbereich angegeben: ICB00-Daten (CNA0T0-Daten): 5 (6) Probanden im Alter von 69,6/8,3 (71,1/13,0) Jahren wurden
eingeschlossen. Klinische Tests: logMAR HCVA 0,11/0,39 (0,00/0,51), logMAR LCVA 0,78/0,52 (0,80/0,54); logCS ohne 0,50/0,31 (0,30/0,65), mit Blendung 0,20/0,15 (0,20/0,5). Fahrsimulator bei
Nacht: Die logMAR-VA-Schwellenwerte für die rechte Straßenseite, das Armaturenbrett, den Navigationsbildschirm und den Innenrückspiegel betrugen 0,50/0,06 (0,57/0,22), 0,81/0,07 (0,91/0,14),
0,80/0,17 (0,92/0,27), 0,50/0,11 (0,63/0,26), logCS-Schwellenwerte 1,53/0,67 (1,00/0,81), 0,82/0,11 (0,61/0,19), 0,71/0,14 (0,50/0,15), 0,87/0,07 (0,81/0,11). Größe des Halos: 5,40°/0,89°
(5,88°/2,00°).
Schlussfolgerungen In einem Nachtfahrsimulator übertraf die ICB00-IOL die CNA0T0-IOL in Bezug auf logMAR (VA) und logCS um 0,1 log-Einheiten im Intermediärbereich. Klinische Tests
für Ferne und Nähe ergaben keinen Unterschied. Dies könnte darauf hindeuten, dass Fahrsimulatorexperimente im Hinblick auf die Leistungsprüfung von IOLs – insbesondere auch im
Intermediärbereich – sinnvolle Zusatzinformationen liefern können.
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Affiliation(s)
- Judith Ungewiss
- Kompetenzzentrum Vision Research, Studiengang Augenoptik, Hochschule Aalen, Deutschland
- Zeiss Vision Care, Carl Zeiss Vision International GmbH, Aalen, Deutschland
| | - Tobias Röck
- Department für Augenheilkunde, Universitäts-Augenklinik, Eberhard-Karls-Universität Tübingen, Deutschland
| | - Michael Wörner
- Kompetenzzentrum Vision Research, Studiengang Augenoptik, Hochschule Aalen, Deutschland
- Blickshift GmbH, Stuttgart, Deutschland
| | - Denise Wetzel
- Kompetenzzentrum Vision Research, Studiengang Augenoptik, Hochschule Aalen, Deutschland
| | - Karl Ulrich Bartz-Schmidt
- Department für Augenheilkunde, Universitäts-Augenklinik, Eberhard-Karls-Universität Tübingen, Deutschland
| | - Ulrich Schiefer
- Kompetenzzentrum Vision Research, Studiengang Augenoptik, Hochschule Aalen, Deutschland
- Department für Augenheilkunde, Universitäts-Augenklinik, Eberhard-Karls-Universität Tübingen, Deutschland
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Yangzes S, Kamble N, Grewal S, Grewal SPS. Comparison of an aspheric monofocal intraocular lens with the new generation monofocal lens using defocus curve. Indian J Ophthalmol 2021; 68:3025-3029. [PMID: 33229691 PMCID: PMC7856977 DOI: 10.4103/ijo.ijo_985_20] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: The aim of this study was to compare the visual outcomes of two monofocal intraocular lenses (IOLs), with emphasis on the defocus curve. Methods: A total of 116 consecutive eyes with cataract, undergoing phacoemulsification with IOL implantation were included in the observational case series, and divided into two groups. 71 eyes were implanted with Tecnis Eyhance and 45 with Tecnis 1 monofocal IOL. Eyes with ocular comorbidities, previous ocular surgeries and corneal astigmatism >1 Diopters (D) were excluded from the study. Complete ophthalmic evaluation including uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), corrected intermediate visual acuity (CIVA), uncorrected visual acuity (UNVA), corrected near visual acuity (CNVA) was noted and defocus levels ranging from - 4.00 D to + 1.00 D were plotted postoperatively in both groups. Results: Uncorrected intermediate visual acuity (UIVA) and uncorrected near visual acuity (UNVA) was significantly better in Tecnis Eyhance group compared to Tecnis 1 monofocal. Both the IOLs have similar performance for distance vision but visual acuity at intermediate and near is significantly better with Tecnis Eyhance compared to Tecnis 1 piece IOL. Conclusion: Tecnis Eyhance IOL with its better defocus curve, not only provides good distance, but intermediate vision as well. With significantly better visual acuity across the range of near and intermediate vision, Tecnis Eyhance IOL can prove to be a viable and reasonable option for patients who are more dependent on intermediate vision in daily activities.
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Affiliation(s)
- Sonam Yangzes
- Department of Lens, Cornea and Refractive Services, Grewal Eye Institute, Chandigarh, India
| | - Neha Kamble
- Department of Lens, Cornea and Refractive Services, Grewal Eye Institute, Chandigarh, India
| | - Sartaj Grewal
- Department of Lens, Cornea and Refractive Services, Grewal Eye Institute, Chandigarh, India
| | - Satinder P S Grewal
- Department of Lens, Cornea and Refractive Services, Grewal Eye Institute, Chandigarh, India
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Modi S, Lehmann R, Maxwell A, Solomon K, Cionni R, Thompson V, Horn J, Caplan M, Fisher B, Hu JG, Yeu E. Visual and Patient-Reported Outcomes of a Diffractive Trifocal Intraocular Lens Compared with Those of a Monofocal Intraocular Lens. Ophthalmology 2020; 128:197-207. [PMID: 33004211 DOI: 10.1016/j.ophtha.2020.07.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of a trifocal intraocular lens (IOL), the TFNT00 (Alcon, Fort Worth, TX), versus a monofocal IOL, the SN60AT (Alcon). DESIGN Food and Drug Administration-approved, prospective, multicenter, nonrandomized, parallel-group, assessor-masked, confirmatory trial. PARTICIPANTS Patients enrolled were 22 years of age or older with a diagnosis of bilateral cataract with planned removal by phacoemulsification with a clear corneal incision. METHODS Consented participants selected their preferred IOL, which was implanted sequentially into each eye of patients meeting eligibility criteria. MAIN OUTCOME MEASURES The coprimary effectiveness outcomes were mean photopic monocular best-corrected distance visual acuity (BCDVA; 4 m) and distance-corrected near visual acuity (DCNVA; 40 cm) at 6 months after surgery. Secondary effectiveness outcomes included mean monocular distance-corrected intermediate visual acuity (DCIVA; 66 cm) and proportion of participants responding "never" to question 1 of the Intraocular Lens Satisfaction questionnaire (regarding frequency of spectacle use in the past 7 days). Safety outcomes included frequency of "severe" and "most bothersome" visual disturbances. RESULTS Two hundred forty-three patients underwent cataract surgery with bilateral implantation of the TFNT00 (n = 129) or SN60AT (n = 114) and were followed up for 6 months. Noninferiority of TFNT00 to SN60AT in mean photopic monocular BCDVA (95% upper confidence limit of the difference was <0.1 logarithm of the minimum angle of resolution [logMAR] margin), and superiority in mean photopic monocular DCNVA (difference of 0.42 logMAR; P < 0.001) and DCIVA (difference of 0.26 logMAR; P < 0.001) were demonstrated. The proportion of patients never requiring glasses overall was superior for TFNT00 versus SN60AT (80.5% and 8.2%, respectively). Starbursts, halos, and glare were the most frequently rated severe symptoms with TFNT00; however, less than 5% of patients were very bothered at month 6. CONCLUSIONS The TFNT00 exhibited superior monocular DCNVA and DCIVA to a spherical monofocal IOL, with comparable monocular BCDVA. Binocular visual acuity was 20/25 or better for distance to near (+0.5 D to -2.5 D), resulting in high levels of spectacle independence. Less than 5% of patients were very bothered by the photic visual disturbances associated with the TFNT00 at 6 months after surgery.
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Affiliation(s)
| | | | | | - Kerry Solomon
- Carolina Eyecare Physicians, LLC, Mount Pleasant, South Carolina
| | | | | | | | | | - Bret Fisher
- Eye Center of North Florida, Panama City, Florida
| | - Jerry G Hu
- Texas Eye and Laser Center, Hurst, Texas
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11
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Tanabe H, Tabuchi H, Shojo T, Yamauchi T, Takase K. Comparison of visual performance between monofocal and multifocal intraocular lenses of the same material and basic design. Sci Rep 2020; 10:15490. [PMID: 32968124 PMCID: PMC7511318 DOI: 10.1038/s41598-020-72473-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
To compare the visual performance of a monofocal intraocular lens (IOL) (ZCB00) and a multifocal IOL (ZMB00) of the same material and basic design, we evaluated postoperative parameters at 10 weeks after the last surgery in cataract patients who underwent bilateral ZCB00 or ZMB00 implantation from December 13, 2010, to July 29, 2019, with the right and left lenses implanted within 3 months of each other. The study enrolled 2,230 eyes of 1,115 patients. The monofocal group comprised 904 eyes of 452 patients (72.3 ± 6.8 years; females/males, 268/184), and the multifocal group comprised 1,326 eyes of 663 patients (67.0 ± 7.8 years; females/males, 518/145). Contrast sensitivity (4.0/2.5/1.6/1.0/0.7 degrees), contrast sensitivity with glare (1.6/1.0/0.7 degrees), and the VFQ-25 score for driving at night were significantly better in the monofocal group (p < 0.00068, Wald test). Uncorrected intermediate/near visual acuity and near spectacle independence were significantly better in the multifocal group (p < 0.00068, Wald test). The two IOL groups had different characteristics in terms of contrast sensitivity, night-time driving, uncorrected intermediate/near visual acuity and near spectacle independence.
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Affiliation(s)
- Hirotaka Tanabe
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan.
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan.,Department of Technology and Design Thinking for Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohiro Shojo
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
| | | | - Kosuke Takase
- Department of Ophthalmology, Tsukazaki Hospital, Himeji, Japan
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12
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Evans JR, de Silva SR, Ziaei M, Kirthi V, Leyland MD. Outcomes in randomised controlled trials of multifocal lenses in cataract surgery: the case for development of a core outcome set. Br J Ophthalmol 2020; 104:1345-1349. [PMID: 31959592 DOI: 10.1136/bjophthalmol-2019-315410] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS To describe and summarise the outcomes reported in randomised controlled trials of multifocal versus monofocal intraocular lenses in cataract surgery. METHODS We identified all randomised controlled trials of multifocal versus monofocal lenses in a Cochrane review (last search date June 2016). We extracted and summarised data on all outcomes reported using the framework of domain, measurement, metric and method of aggregation. RESULTS All studies collected data on distance and near visual acuity but there was considerable variation in the measures used and whether these outcomes were unaided or best corrected. Most studies reported final value measurements, rather than change from baseline. Approximately half of the studies reported data as a continuous measure only, one-third reported both continuous and categorical measures and a minority reported categorical measures only. There was little consensus as to cut-points. Although a majority of studies included one or more patient-reported outcome measures, none of the studies reported patient involvement in the choice of outcomes. CONCLUSION The collection and analysis of data on outcome measures in studies of multifocal intraocular lenses in cataract surgery are complicated. As a result, there is considerable heterogeneity in collection and reporting in the medical literature. This makes it difficult to synthesise such data to provide robust estimates of effect and is a potential source of research waste. Investigators in this field must produce a core outcome set that is informed by patients' views and we propose an initial set of outcomes on which these could be based.
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Affiliation(s)
- Jennifer R Evans
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mohammed Ziaei
- Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand
| | - Varo Kirthi
- Department of Ophthalmology, King's College Hospital, London, UK
| | - Martin D Leyland
- Department of Ophthalmology, The Royal Berkshire NHS Foundation Trust, Reading, UK
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13
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Grzybowski A, Kanclerz P, Tuuminen R. Multifocal intraocular lenses and retinal diseases. Graefes Arch Clin Exp Ophthalmol 2020; 258:805-813. [PMID: 31955239 PMCID: PMC7575463 DOI: 10.1007/s00417-020-04603-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Multifocal intraocular lenses (MIOLs) are often discouraged in patients with or at risk of retinal disorders (including diabetic retinopathy, age-related macular degeneration, and epiretinal membranes), as MIOLs are believed to reduce contrast sensitivity (CS). Concerns with MIOLs have also been raised in individuals with visual field defects, fixation instability or eccentric preferred retinal locations. The aim of this study is to review the influence of MIOL on quality of vision in patients with retinal diseases. Methods We reviewed the PubMed and Web of Science databases to identify relevant studies using the following keywords: multifocal intraocular lens, cataract surgery, cataract extraction, lens exchange, diabetic retinopathy, age-related macular degeneration, and contrast sensitivity. Results Studies evaluating CS in MIOLs present conflicting results: MIOLs either did not influence CS or resulted in worse performance under low-illuminance conditions and higher spatial frequencies when compared to monofocal IOLs. Nevertheless, MIOLs preserved CS levels within the age-matched normal range. Two studies reported that patients with concurrent retinal diseases receiving a MIOL, both unilaterally and bilaterally, reported a significant improvement in visual-related outcomes. Individuals with a monofocal IOL in one eye and a MIOL in the fellow eye reported greater subjective satisfaction with the MIOL. Conclusion We were unable to find evidence suggesting that patients with retinal diseases should be advised against MIOLs. Nevertheless, more research is needed to address the aforementioned concerns and to optimize the use of MIOLs in eyes with retinal disease. Electronic supplementary material The online version of this article (10.1007/s00417-020-04603-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland. .,Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland.
| | | | - Raimo Tuuminen
- Helsinki Retina Research Group, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland
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14
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Kim BH, Hyon JY, Kim MK. Effects of Bifocal versus Trifocal Diffractive Intraocular Lens Implantation on Visual Quality after Cataract Surgery. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:333-342. [PMID: 31389209 PMCID: PMC6685823 DOI: 10.3341/kjo.2019.0001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the effects of bifocal versus trifocal diffractive intraocular lens (IOL) implantation on visual quality after phacoemulsification in patients with cataracts. Methods Eighty-eight eyes from 63 patients were analyzed. Trifocal (AT LISA tri 839MP), bifocal (AcrySof IQ ReSTOR) and bifocal (Tecnis MF ZLB00) IOLs were implanted into 53, 18, and 17 eyes, respectively. Uncorrected distance, intermediate and near visual acuity, refractive errors, contrast sensitivity, and patient satisfaction were measured at 1 week and 1 month after surgery. Refractive error was converted to a spherical equivalent and compared to predicted refraction calculated by IOL calculation formulas. Results Uncorrected distance, intermediate, and near visual acuity did not differ significantly between groups. One month after surgery, the mean refractive errors were −0.07 diopters (D) in the AT LISA tri 839MP group, +0.18 D in the AcrySof IQ ReSTOR group, and +0.31 D in the Tecnis MF ZLB00 group (p < 0.001). The predictive accuracy of IOL calculation formulas did not differ between groups. Contrast sensitivity, satisfaction, and spectacle independence in the trifocal group were comparable with those of the two bifocal groups. Conclusions Trifocal IOL and two different types of bifocal IOL implantation were all effective for improving visual quality, although refractive error in patients with trifocal IOL shows myopic tendencies.
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Affiliation(s)
- Bo Hee Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Laboratory of Ocular Regenerative Medicine and Immunology, Seoul Artificial Eye Center, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea.
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15
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Cao K, Wan XH. Authors' response to: Methodological challenges with randomized clinical trials for multifocal intraocular lenses (MFIOLs). Surv Ophthalmol 2019; 65:392-394. [PMID: 31705916 DOI: 10.1016/j.survophthal.2019.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xiu Hua Wan
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
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16
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Cao K, Friedman DS, Jin S, Yusufu M, Zhang J, Wang J, Hou S, Zhu G, Wang B, Xiong Y, Li J, Li X, He H, Chai L, Wan XH. Multifocal versus monofocal intraocular lenses for age-related cataract patients: a system review and meta-analysis based on randomized controlled trials. Surv Ophthalmol 2019; 64:647-658. [DOI: 10.1016/j.survophthal.2019.02.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 11/16/2022]
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17
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Titiyal JS, Kaur M, Bharti N, Singhal D, Saxena R, Sharma N. Optimal near and distance stereoacuity after binocular implantation of extended range of vision intraocular lenses. J Cataract Refract Surg 2019; 45:798-802. [PMID: 30876785 DOI: 10.1016/j.jcrs.2018.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate stereopsis and visual quality after bilateral implantation of extended range of vision intraocular lenses (ERV IOLs). SETTING R.P. Centre for Ophthalmic Sciences, AIIMS, New Delhi, India. DESIGN Prospective interventional study. METHODS Patients underwent phacoemulsification with bilateral implantation of ERV IOLs. The primary outcome measures were stereopsis (distance and near Randot) and visual quality (ray-tracing aberrometry). The secondary outcome measures were visual acuity and patient satisfaction. Follow-up was performed on day 1 and at 1, 3, 6, and 12 months postoperatively. RESULTS The study comprised 50 patients (100 eyes). The mean age of the patients was 58.9 years ± 8.9 (SD). At 1 year, the mean distance stereopsis was 103.6 ± 49.1 seconds of arc (arcsec) and near stereopsis was 21.1 ± 2.3 arcsec. Perfect near stereopsis of 20 arcsec was present in 80% of cases, and 82% had good distance stereopsis of 100 arcsec or better. Stereopsis correlated well with the patient satisfaction score (P < .001) and average internal modulation transfer function (MTF) (P < .015). The mean Strehl ratio was 0.029 ± 0.021, MTF was 0.24 ± 0.08, total higher-order aberrations were 0.62 ± 0.41 μm, and coma was 0.25 ± 0.18 μm. The mean binocular uncorrected decimal visual acuities were 0.98 ± 0.07 (distance), 0.82 ± 0.09 (intermediate) and 0.64 ± 0.08 (near). The mean patient satisfaction score was 9.08 ± 1.1, and no case required IOL explantation because of visually disturbing phenomena or patient dissatisfaction. CONCLUSION Excellent stereoacuity was observed after bilateral implantation of ERV IOLs, which correlated well with patient satisfaction and quality of vision.
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Affiliation(s)
- Jeewan S Titiyal
- Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.
| | - Manpreet Kaur
- Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Neha Bharti
- Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Singhal
- Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Squint & Neuro-ophthalmology Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Namrata Sharma
- Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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18
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Effectiveness of multifocal and monofocal intraocular lenses for cataract surgery and lens replacement: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2019; 257:863-875. [PMID: 30627791 DOI: 10.1007/s00417-018-04218-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022] Open
Abstract
PURPOSE Multifocal intraocular lenses (IOLs) offer the possibility of spectacle-free vision following cataract surgery compared to standard IOLs. Existing systematic reviews have generally concluded that multifocal IOLs result in better uncorrected near vision and greater spectacle independence, but more unwanted visual phenomena such as glare and halos, compared to monofocal IOLs. However, the certainty of evidence has been low for most outcomes, and pooled analyses have grouped together technologically obsolete lenses with newer lenses, potentially obscuring differences in performance across different lens types. METHODS We performed a systematic review searching for RCTs of a multifocal IOL to a standard IOL or monovision that reported spectacle independence, visual acuity, or quality of life. Databases were searched from 1/1/2006-4/30/2017. Existing reviews were used to identify older studies. Title/abstract screening and data extraction were done in duplicate. Where possible, random effects meta-analysis was performed to synthesize results. In addition to comparing multifocal IOLs as a group to monofocal IOLs, we also compared newer diffractive lenses to obsolete or refractive lenses. RESULTS Twenty-five eligible studies were identified. There was no difference in pooled estimates of corrected or uncorrected distance vision between multifocal and standard IOLs. Compared to monofocal IOLs, multifocal IOLs had statistically significantly better pooled results for the outcome of near vision (10 studies, 1025 patients, mean difference in logMAR of -0.26 (95% CI -0.37, -0.15)); spectacle dependence (12 studies, 1237 patients, relative risk of 0.27 (95% CI 0.20, 0.38)) and borderline significantly better quality of vision (6 studies, 596 patients, standardized mean difference of -0.54, (95% CI -1.12, 0.04)). Compared to monofocal IOLs, multifocal IOLs had statistically significantly worse pooled results for the outcomes of glare (9 studies, 847 patients, risk ratio of 1.36 (95% CI 1.15, 1.61) and halos (7 studies, 754 patients, risk ratio of 3.14 (95% CI 1.63, 6.08). Newer multifocal lenses had statistically significantly better outcomes than older diffractive lenses or refractive lenses, when compared to monofocal IOLs, in near vision, quality of vision, and risk of halos. CONCLUSIONS Multifocal IOLs compared to standard IOLs or monovision result in better uncorrected near vision and a higher proportion of patients who achieve spectacle independence, but greater risk of unwanted visual phenomena. Newer diffractive lenses may be better than refractive lenses in near vision and quality of vision outcomes, with less risk of halos than older diffractive lenses and refractive lenses. (PROSPERO registration CRD42017069949).
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Hovanesian JA. Patient-reported outcomes of multifocal and accommodating intraocular lenses: analysis of 117 patients 2-10 years after surgery. Clin Ophthalmol 2018; 12:2297-2304. [PMID: 30518993 PMCID: PMC6239103 DOI: 10.2147/opth.s182943] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of this study was to determine the satisfaction levels of patients at least 2 years after cataract surgery implantation with bilateral accommodating or bilateral multifocal intraocular lenses (IOLs) and to determine the relative rate of spectacle independence and adverse symptoms in that same time frame. Design Patient questionnaire administered in a single-center private practice at least 2 years after cataract surgery with presbyopia-correcting IOL implantation. Methods Patients who had undergone uncomplicated cataract surgery with an accommodating or multifocal IOL implant were eligible for inclusion. Patients with visually significant non-IOL-related postoperative morbidity were excluded. Patients with astigmatism or residual refractive error were not excluded. The main outcome measure was patient satisfaction at least 2 years after IOL implantation. Results Sixty-eight patients who received accommodating lenses and 49 patients who received multifocal lenses completed the questionnaire. The mean age of all patients was 75.7 years at the time of survey; the mean number of years since cataract surgery was 5.4 years. Overall, there were no significant differences between the two groups or within each group between the different lenses used. About 90% of patients in each group were “very satisfied” or “somewhat satisfied” with their vision at least 2 years after the initial surgery. Conversely, only one in eleven patients found his vision to be worse than expected. Conclusions The majority of patients who received either accommodating or multifocal IOLs remain satisfied with their lens of choice more than 5 years after the original surgery. Glare and halos remain more noticeable in patients who received multifocal lenses.
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Affiliation(s)
- John A Hovanesian
- Harvard Eye Associates, Laguna Hills, CA, USA, .,Clinical Faculty, UCLA Jules Stein Eye Institute, Los Angeles, CA, USA,
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Cochener B, Boutillier G, Lamard M, Auberger-Zagnoli C. A Comparative Evaluation of a New Generation of Diffractive Trifocal and Extended Depth of Focus Intraocular Lenses. J Refract Surg 2018; 34:507-514. [PMID: 30089179 DOI: 10.3928/1081597x-20180530-02] [Citation(s) in RCA: 159] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 05/25/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate and compare the performance of two diffractive trifocal and one extended depth of focus (EDOF) intraocular lenses (IOLs). METHODS In this 6-month, single-center, prospective, randomized, comparative study, patients undergoing routine cataract surgery were randomized to receive one of two trifocal IOLs (AcrySof IQ PanOptix; Alcon Laboratories, Inc., Fort Worth, TX, or FineVision Micro F; PhysIOL SA, Liège, Belgium) or an EDOF IOL (TECNIS Symfony; Abbott Medical Optics, Inc., Abbott Park, IL). There were 20 patients in each group. The primary outcome was binocular and monocular uncorrected distance (UDVA), intermediate (UIVA), and near (UNVA) visual acuity. The secondary outcomes were quality of vision and aberrometry. RESULTS There was no statistically significant difference between groups in either monocular (P = .717) or binocular (P = .837) UDVA. Monocular and binocular UNVA were statistically and significantly better for both trifocal lenses than for the EDOF IOL (P = .002). The percentage of patients with J2 UNVA was 52.5% monocularly and 70% binocularly for the TECNIS Symfony IOL, 81.5% monocularly and 100% binocularly for the AcrySof IQ PanOptix IOL, and 82.5% monocularly and 95% binocularly for the FineVision Micro F IOL. There was no significant difference in binocular UIVA between groups; VA was better than 0.6 in 55%, 53%, and 35% of patients with the TECNIS Symfony, AcrySof IQ Pan-Optix, and FineVision Micro F IOLs, respectively. Overall, 90% patients achieved spectacle independence. There were no differences in visual symptoms and aberrometry among groups. CONCLUSIONS All three IOLs provided good visual acuity at all distances, a high percentage of spectacle independence, and little or no impact of visual symptoms on the patients' daily functioning. Near vision was statistically better for both trifocal IOLs compared to the EDOF IOL. [J Refract Surg. 2018;34(8):507-514.].
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Clinical Results of Diffractive, Refractive, Hybrid Multifocal, and Monofocal Intraocular Lenses. J Ophthalmol 2018; 2018:8285637. [PMID: 30046464 PMCID: PMC6036790 DOI: 10.1155/2018/8285637] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To present the outcomes of hybrid multifocal and monofocal intraocular lenses (IOLs) and to compare with refractive and diffractive multifocal IOLs (MFIOLs). Methods Three hundred twenty eyes (160 patients) underwent cataract surgery with randomized IOLs bilateral implantation. Changes in uncorrected and distance-corrected logMAR distance, intermediate and near (UNVA and DCNVA) visual acuity (VA), contrast sensitivity (CS), presence of dysphotopsia, spectacle independence, and patient satisfaction were analyzed. Results Postoperative VA in the hybrid (OptiVis) group was improved in all distances (p < 0.001). OptiVis acted superiorly to monofocal IOLs in UNVA and DCNVA (p < 0.001 for both) and to refractive ones in DCNVA (p < 0.005). Distance, mesopic, without glare CS in OptiVis was lower than in the monofocal group and similar to other MFIOLs. No differences in dysphotopsia pre- and postoperatively and spectacle independence in near for OptiVis and refractive MFIOLs were detected. OptiVis patients were more satisfied than those with monofocal IOLs (p=0.015). Conclusions After cataract surgery, patients with OptiVis improved VA in all distances. Near and intermediate VA was better than monofocal, and DCNVA was better than the refractive group. CS was lower in OptiVis than in the monofocal group, but there was no difference between MFIOLs. Patient satisfaction was higher in OptiVis than in the monofocal group. This trial is registered with NCT03512626.
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Primary sulcus implantation of a diffractive multifocal pseudophakic piggyback intraocular lens. J Cataract Refract Surg 2018; 44:266-273. [DOI: 10.1016/j.jcrs.2017.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/20/2017] [Accepted: 11/09/2017] [Indexed: 11/19/2022]
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Visual and Refractive Outcomes following Bilateral Implantation of Extended Range of Vision Intraocular Lens with Micromonovision. J Ophthalmol 2018; 2018:7321794. [PMID: 29545954 PMCID: PMC5818926 DOI: 10.1155/2018/7321794] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the outcomes following bilateral ERV intraocular lens implantation with micromonovision. Methods 25 subjects underwent bilateral Tecnis Symfony IOL implantation with micromonovision. The dominant eye was targeted for emmetropia and the nondominant eye for myopia of -0.75 D. Uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CIVA), and near visual acuity (UNVA, DCNVA); reading performance; defocus curve; and contrast sensitivity were studied. Follow-ups were conducted at 1 week and 1 and 6 months postoperatively. Results At 6 months postoperatively, the mean binocular UDVA, CDVA, UNVA, and DCNVA were -0.036 ± 0.09, -0.108 ± 0.07, 0.152 ± 0.11, and 0.216 ± 0.10 logMAR, respectively. Binocular UIVA and DCIVA were 0.048 ± 0.09 and 0.104 ± 0.08 logMAR, respectively, at 60 cm and -0.044 ± 0.09 and 0.012 ± 0.09 logMAR, respectively, at 80 cm. All patients had ≥0.2 logMAR UDVA and UNVA. Reading acuity and reading speeds showed improvement over time. Between defocus range of -2.50 and +1.00 D, the visual acuity remained ≥0.2 logMAR. Contrast sensitivity scores were within the normal range. 4 patients used reading glasses for very fine print. Conclusion Bilateral ERV IOL implantation leads to excellent outcomes for far and intermediate vision, satisfactory outcomes for near vision, and good tolerance to micromonovision at the end of the 6 months. This trial is registered with CTRI/2015/10/006246.
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Palomino Bautista C, Carmona González D, Castillo Gómez A, Cristóbal Bescos JA. Evolution of Visual Performance in 250 Eyes Implanted with the Tecnis ZM900 Multifocal IOL. Eur J Ophthalmol 2018; 19:762-8. [DOI: 10.1177/112067210901900513] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Visual Acuity, Contrast Sensitivity, Subjective Quality of Vision, and Quality of Life with 4 Different Multifocal IOLs. Eur J Ophthalmol 2018; 22:175-87. [DOI: 10.5301/ejo.2011.8371] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2011] [Indexed: 11/20/2022]
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Multifocal intraocular lenses: An overview. Surv Ophthalmol 2017; 62:611-634. [DOI: 10.1016/j.survophthal.2017.03.005] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 01/18/2023]
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Kelava L, Barić H, Bušić M, Čima I, Trkulja V. Monovision Versus Multifocality for Presbyopia: Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Ther 2017; 34:1815-1839. [PMID: 28674958 DOI: 10.1007/s12325-017-0579-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Refractive surgery in presbyopia tends to achieve spectacle independence with minimal optical disturbances. We compared monovision to multifocality procedures regarding these outcomes. METHODS We conducted a systematic review of published (till November 21, 2016) randomized controlled trials (RCTs) comparing any monovision to any multifocality method or comparing different monovision/multifocality methods to each other that enabled direct or indirect comparisons between particular monovision and particular multifocality procedures in presbyopic patients undergoing cataract-related or unrelated surgery in respect to spectacle independence, unaided binocular visual acuity (VA), contrast sensitivity (CS), and adverse events. RESULTS Three trials comparing monovision (monofocal lenses, LASIK) to multifocal intraocular lenses (MFIOLs; Isert refractive or Tecnis diffractive) and 6 comparing other MFIOLs to Tecnis were included (1-12 months duration). Spectacle independence. All reporting trials were of sufficient quality. Directly, pseudophakic monovision was inferior to Isert (1 trial, N = 75, RR = 0.49, 95% CI 0.28-0.80) and Tecnis (1 trial, N = 211, RR = 0.36, 95% CI 0.25-0.52) in cataract patients, and LASIK was comparable to Tecnis (1 trial, N = 100, RR = 0.93, 0.78-1.10) in refractive surgery. In network meta-regression (6 trials, 14 arms) pseudophakic monovision in cataract patients was inferior to Tecnis. Indirect data suggest also that it is inferior (ReZoom refractive, TwinSet diffractive) or tends to be inferior (Array refractive) to other MFIOLs. LASIK was comparable to Tecnis in refractive surgery. Indirect data suggest also that it tends to superiority vs. ReZoom or Array refractive MFIOLs. Adverse events. No pooling was possible (heterogeneity of assessment and reporting). One quality direct RCT indicated less glare/dazzle with pseudophakic monovision vs. Tecnis in cataract patients. Unaided VA and CS data were burdened with heterogeneity (assessment, reporting) and insufficient quality. CONCLUSIONS Randomized comparisons of monovision to multifocality are scarce. Existing estimates regarding spectacle independence (imprecision, indirectness) and particularly regarding unaided VA and CS (assessment/reporting heterogeneity, bias, imprecision, indirectness) are burdened with uncertainty. Dysphotopsia is less common with monovision, but estimate uncertainty is high (bias, imprecision).
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Kim EJ, Sajjad A, Montes de Oca I, Koch DD, Wang L, Weikert MP, Al-Mohtaseb ZN. Refractive outcomes after multifocal intraocular lens exchange. J Cataract Refract Surg 2017; 43:761-766. [PMID: 28732609 DOI: 10.1016/j.jcrs.2017.03.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/07/2017] [Accepted: 03/15/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Eric J Kim
- From the Cullen Eye Institute (Kim, Sajjad, Montes de Oca, Koch, Wang, Weikert, Al-Mohtaseb), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; the Shanxi Eye Hospital (Wang), Taiyuan, Shanxi Province, China
| | - Ahmar Sajjad
- From the Cullen Eye Institute (Kim, Sajjad, Montes de Oca, Koch, Wang, Weikert, Al-Mohtaseb), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; the Shanxi Eye Hospital (Wang), Taiyuan, Shanxi Province, China
| | - Ildamaris Montes de Oca
- From the Cullen Eye Institute (Kim, Sajjad, Montes de Oca, Koch, Wang, Weikert, Al-Mohtaseb), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; the Shanxi Eye Hospital (Wang), Taiyuan, Shanxi Province, China
| | - Douglas D Koch
- From the Cullen Eye Institute (Kim, Sajjad, Montes de Oca, Koch, Wang, Weikert, Al-Mohtaseb), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; the Shanxi Eye Hospital (Wang), Taiyuan, Shanxi Province, China
| | - Li Wang
- From the Cullen Eye Institute (Kim, Sajjad, Montes de Oca, Koch, Wang, Weikert, Al-Mohtaseb), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; the Shanxi Eye Hospital (Wang), Taiyuan, Shanxi Province, China
| | - Mitchell P Weikert
- From the Cullen Eye Institute (Kim, Sajjad, Montes de Oca, Koch, Wang, Weikert, Al-Mohtaseb), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; the Shanxi Eye Hospital (Wang), Taiyuan, Shanxi Province, China
| | - Zaina N Al-Mohtaseb
- From the Cullen Eye Institute (Kim, Sajjad, Montes de Oca, Koch, Wang, Weikert, Al-Mohtaseb), Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; the Shanxi Eye Hospital (Wang), Taiyuan, Shanxi Province, China.
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Patient-Centered and Visual Quality Outcomes of Premium Cataract Surgery: A Systematic Review. Eur J Ophthalmol 2017; 27:387-401. [DOI: 10.5301/ejo.5000978] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2017] [Indexed: 11/20/2022]
Abstract
Purpose Over 8 million cataract surgeries are performed in the United States and the European Union annually, with many patients choosing to pay out of pocket for premium options including premium intraocular lens implants (IOLs) or laser-assisted cataract surgery (LACS). This report provides a systematic review evaluating patient-centered and visual quality outcomes comparing standard monofocal IOLs to premium cataract surgery options. Methods PubMed and EMBASE were searched for publications published between January 1, 1980, and September 18, 2016, on multifocal, accommodative, and toric IOLs, monovision, and LACS, which reported on 1) dysphotopsias, 2) contrast sensitivity, 3) spectacle independence, 4) vision-related quality of life or patient satisfaction, and 5) IOL exchange. Results Multifocal lenses achieved higher rates of spectacle independence compared to monofocal lenses but also had higher reported frequency of dysphotopsia and worse contrast sensitivity, especially with low light or glare. Accommodative lenses were not associated with reduced contrast sensitivity or more dysphotopsia but had only modest improvements in spectacle independence compared to monofocal lenses. Studies of monovision did not target a sufficiently myopic outcome in the near-vision eye to achieve the full potential for spectacle independence. Patients reported high levels of overall satisfaction regardless of implanted IOL. No studies correlated patient-reported outcomes with patient expectations. Conclusions Studies are needed to thoroughly compare patient-reported outcomes with concomitant patient expectations. In light of the substantial patient costs for premium options, patients and their surgeons will benefit from a better understanding of which surgical options best meet patients’ expectations and how those expectations can be impacted by premium versus monofocal—including monovision—options.
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de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev 2016; 12:CD003169. [PMID: 27943250 PMCID: PMC6463930 DOI: 10.1002/14651858.cd003169.pub4] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES To assess the visual effects of multifocal IOLs in comparison with the current standard treatment of monofocal lens implantation. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2016. SELECTION CRITERIA All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. We also considered trials comparing multifocal IOLs with "monovision" whereby one eye is corrected for distance vision and one eye corrected for near vision. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed the 'certainty' of the evidence using GRADE. MAIN RESULTS We found 20 eligible trials that enrolled 2230 people with data available on 2061 people (3194 eyes). These trials were conducted in Europe (13), China (three), USA (one), Middle East (one), India (one) and one multicentre study in Europe and the USA. Most of these trials compared multifocal with monofocal lenses; two trials compared multifocal lenses with monovision. There was considerable variety in the make and model of lenses implanted. Overall we considered the trials at risk of performance and detection bias because it was difficult to mask participants and outcome assessors. It was also difficult to assess the role of reporting bias.There was moderate-certainty evidence that the distance acuity achieved with multifocal lenses was not different to that achieved with monofocal lenses (unaided VA worse than 6/6: pooled RR 0.96, 95% confidence interval (CI) 0.89 to 1.03; eyes = 682; studies = 8). People receiving multifocal lenses may achieve better near vision (RR for unaided near VA worse than J3/J4 was 0.20, 95% CI 0.07 to 0.58; eyes = 782; studies = 8). We judged this to be low-certainty evidence because of risk of bias in the included studies and high heterogeneity (I2 = 93%) although all included studies favoured multifocal lenses with respect to this outcome.People receiving multifocal lenses may be less spectacle dependent (RR 0.63, 95% CI 0.55 to 0.73; eyes = 1000; studies = 10). We judged this to be low-certainty evidence because of risk of bias and evidence of publication bias (skewed funnel plot). There was also high heterogeneity (I2 = 67%) but all studies favoured multifocal lenses. We did not additionally downgrade for this.Adverse subjective visual phenomena were more prevalent and more troublesome in participants with a multifocal IOL compared with monofocals (RR for glare 1.41, 95% CI 1.03 to 1.93; eyes = 544; studies = 7, low-certainty evidence and RR for haloes 3.58, 95% CI 1.99 to 6.46; eyes = 662; studies = 7; moderate-certainty evidence).Two studies compared multifocal lenses with monovision. There was no evidence for any important differences in distance VA between the groups (mean difference (MD) 0.02 logMAR, 95% CI -0.02 to 0.06; eyes = 186; studies = 1), unaided intermediate VA (MD 0.07 logMAR, 95% CI 0.04 to 0.10; eyes = 181; studies = 1) and unaided near VA (MD -0.04, 95% CI -0.08 to 0.00; eyes = 186; studies = 1) compared with people receiving monovision. People receiving multifocal lenses were less likely to be spectacle dependent (RR 0.40, 95% CI 0.30 to 0.53; eyes = 262; studies = 2) but more likely to report problems with glare (RR 1.41, 95% CI 1.14 to 1.73; eyes = 187; studies = 1) compared with people receiving monovision. In one study, the investigators noted that more people in the multifocal group underwent IOL exchange in the first year after surgery (6 participants with multifocal vs 0 participants with monovision). AUTHORS' CONCLUSIONS Multifocal IOLs are effective at improving near vision relative to monofocal IOLs although there is uncertainty as to the size of the effect. Whether that improvement outweighs the adverse effects of multifocal IOLs, such as glare and haloes, will vary between people. Motivation to achieve spectacle independence is likely to be the deciding factor.
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Affiliation(s)
| | - Jennifer R Evans
- London School of Hygiene & Tropical MedicineCochrane Eyes and Vision, ICEHKeppel StreetLondonUKWC1E 7HT
| | - Varo Kirthi
- University of OxfordPain Research and Nuffield Department of Clinical NeurosciencesPain Research UnitChurchill HospitalOxfordUKOX3 7LE
| | - Mohammed Ziaei
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Martin Leyland
- Royal Berkshire Hospital NHS TrustLondon RoadReadingBerkshireUKRG1 5AN
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Impact of Low Mesopic Contrast Sensitivity Outcomes in Different Types of Modern Multifocal Intraocular Lenses. Eur J Ophthalmol 2016; 26:612-617. [DOI: 10.5301/ejo.5000777] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/20/2022]
Abstract
Purpose To investigate the low mesopic contrast sensitivity function (LMCSF) of patients implanted with different modern optical bifocal and trifocal designs of multifocal intraocular lenses (mfIOLs). Methods This prospective, comparative, nonrandomized consecutive case series included 180 eyes that underwent cataract surgery. Six groups of eyes were differentiated: group A, eyes with the diffractive AT LISA tri 839MP; group B, eyes with diffractive FineVision; group C, eyes with the bifocal Lentis Mplus-LS313; group D, eyes with the diffractive bifocal Acri.Lisa 366D; group E, eyes with the diffractive apodized Acrysof ReSTOR SN6AD1; group F, as the control group, implanted with a monofocal spherical intraocular lens. The LMCSF was evaluated with the OPTEC® 6500 device at 3 months postoperatively using a luminance of 3 cd/m2. Results No significant differences among groups were detected in LMCSF for the spatial frequencies of 1.5, 3.0, 6.0, and 12.0 cpd (1.5 cpd: F = 1.81, p = 0.13; 3.0 cpd: F = 1.14, p = 0.14; 6.0 cpd: F = 1.87, p = 0.11; 12.0 cpd: F = 1.26, p = 0.29), but significant differences were found among groups for the spatial frequency of 18 cpd (F = 2.62, p = 0.03). When comparing the groups in pairs, only statistically significant differences were observed between groups E and F for the spatial frequency of 18.0 cpd (t = 3.27, p = 0.03) with better values for group F. Conclusion No significant differences were observed in LMCSF among the different mfIOLs studied. The third focus of trifocal IOL models did not adversely affect the LMCSF. The ReSTOR SN6AD1 showed the poorest LMCSF for the highest spatial frequency analyzed when compared with the control group.
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Sadoughi MM, Einollahi B, Roshandel D, Sarimohammadli M, Feizi S. Visual and Refractive Outcomes of Phacoemulsification with Implantation of Accommodating versus Standard Monofocal Intraocular Lenses. J Ophthalmic Vis Res 2016; 10:370-4. [PMID: 27051480 PMCID: PMC4795385 DOI: 10.4103/2008-322x.176896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To compare distant and near visual function after cataract surgery with implantation of Crystalens HD or Tek-Clear as accommodating intraocular lenses (IOLs), versus SA60AT as a standard IOL. Methods: The study included 62 eyes of 58 patients divided into three groups using three different IOLs: Crystalens HD (Bausch and Lomb, NY, USA), Tek-Clear (Tekia, CA, USA) and SA60AT (Alcon, TX, USA) were implanted in 23, 14 and 25 eyes, respectively. Corrected distant visual acuity (CDVA), uncorrected and distance corrected near visual acuities (UCNVA and DCNVA), near point of accommodation (NPA), spectacle freedom and patient satisfaction were assessed six months postoperatively and compared between the three groups. Results: After 6 months, all patients showed significant improvement in CDVA with no significant difference among the study groups. However, UCNVA and DCNVA were significantly better in patients implanted with accommodating IOLs. NPA was closest in the Crystalens HD group, followed by Tek-Clear and monofocal SA60AT (P < 0.001). Patients with accommodating IOLs were more likely to become spectacle free and satisfied with their near vision as compared to subjects receiving a monofocal IOL. Conclusions: Accommodating IOLs (Crystalens HD and Tek-Clear) effectively reduce the necessity for spectacles after cataract surgery.
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Affiliation(s)
| | - Bahram Einollahi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Danial Roshandel
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sepehr Feizi
- Ocular Tissue Engineering Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Rosen E, Alió JL, Dick BH, Dell S, Slade S. Efficacy and safety of multifocal intraocular lenses following cataract and refractive lens exchange: Metaanalysis of peer-reviewed publications. J Cataract Refract Surg 2016; 42:310-28. [DOI: 10.1016/j.jcrs.2016.01.014] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/27/2015] [Accepted: 09/01/2015] [Indexed: 10/22/2022]
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Kim JS, Jung JW, Lee JM, Seo KY, Kim EK, Kim TI. Clinical Outcomes Following Implantation of Diffractive Multifocal Intraocular Lenses With Varying Add Powers. Am J Ophthalmol 2015. [PMID: 26209232 DOI: 10.1016/j.ajo.2015.07.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare clinical outcomes after implantation of TECNIS diffractive multifocal intraocular lenses (IOLs) with different add powers. DESIGN Prospective, comparative, interventional case series. METHODS Subjects underwent cataract extraction and diffractive multifocal IOL implant. Subjects had an additional add power of +2.75 diopters (D) (Group 1, 23 eyes), +3.25 D (Group 2, 21 eyes), or +4.00 D (Group 3, 21 eyes). Evaluations were performed 1 and 3 months following cataract surgery, including measurement of monocular uncorrected distance visual acuity (UDVA), refractive error (manifest refraction [MR]), and monocular uncorrected near visual acuity (UNVA) at 33, 40, and 50 cm. At 3 months, internal aberrations and contrast sensitivity were evaluated and subjects completed a questionnaire on outcomes satisfaction, visual symptoms, and spectacle use. RESULTS Sixty-five eyes (43 subjects) were included. After surgery, no significant differences between groups were observed in UDVA and MR values. UNVA at 33 cm was best in Group 3 (1 month: P = .032; 3 months: P = .031). Three months after surgery, UNVA was best in Group 1 at 50 cm (P = .017). No significant differences in internal aberration and contrast sensitivity were observed between groups and surgical satisfaction was worst in Group 3 (P = .001). A total of 87.0%, 85.7%, and 76.9% had spectacle independence in Groups 1, 2, and 3, respectively (P = .080). CONCLUSIONS TECNIS diffractive multifocal IOLs with lower add powers provide good vision over longer working distances and excellent distant vision. Subjects with lower add power had greater satisfaction, more spectacle independence, and fewer visual symptoms than those with +4.00 D add.
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Xu X, Zhu MM, Zou HD. Refractive Versus Diffractive Multifocal Intraocular Lenses in Cataract Surgery: A Meta-analysis of Randomized Controlled Trials. J Refract Surg 2014; 30:634-44. [PMID: 25250421 DOI: 10.3928/1081597x-20140814-04] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Packer M. Multifocal intraocular lens technology: biomaterial, optical design and review of clinical outcomes. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/eop.11.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schmickler S, Bautista CP, Goes F, Shah S, Wolffsohn JS. Clinical evaluation of a multifocal aspheric diffractive intraocular lens. Br J Ophthalmol 2013; 97:1560-4. [PMID: 24123903 DOI: 10.1136/bjophthalmol-2013-304010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To evaluate the performance of an aspheric diffractive multifocal acrylic intraocular lens (IOL), ZMB00 1-Piece Tecnis. SETTING Five sites across Europe. METHODS Fifty-two patients with cataracts (average age 68.5±10.5 years, 35 female) were bilaterally implanted with the aspheric diffractive multifocal IOL after completing a questionnaire regarding their optical visual symptoms, use of visual correction and their visual satisfaction. The questionnaire was completed again 4-6 months after surgery along with measures of uncorrected and best-corrected distance and near visual acuity, under photopic and mesopic lighting, reading ability, defocus curve testing and ocular examination for adverse events. RESULTS The residual refractive error was 0.01±0.47D with 56% of eyes within ±0.25D and 97% within ±1.0D. Uncorrected visual acuity was 0.02±0.10logMAR at distance and 0.15±0.30 logMAR at near, only reducing to 0.07±0.10logMAR at distance and 0.21±0.25logMAR at near in mesopic conditions.The defocus curve showed a near addition between 2.5-3.0 D allowing a reading acuity of 0.08±0.13 logMAR, with a range of clear vision <0.3 logMAR of ∼4.0 D. The average reading speed was 121.4±30.8 words per minute. Spectacle independence was 100% for distance and 88% for near, with high levels of satisfaction reported. Overall rating of vision without glasses could be explained (r=0.760) by preoperative best-corrected distance acuity, postoperative reading acuity and postoperative uncorrected distance acuity in photopic conditions (p<0.001). Only two minor adverse events occurred. CONCLUSIONS The ZMB00 1-Piece Tecnis multifocal IOL provides a good visual outcome at distance and near with minimal adverse effects.
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Yamauchi T, Tabuchi H, Takase K, Ohsugi H, Ohara Z, Kiuchi Y. Comparison of visual performance of multifocal intraocular lenses with same material monofocal intraocular lenses. PLoS One 2013; 8:e68236. [PMID: 23840836 PMCID: PMC3695892 DOI: 10.1371/journal.pone.0068236] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 06/02/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the visual performance of multifocal intraocular lenses (IOLs) and monofocal IOLs made of the same material. Methods The subjects included patients implanted with either Tecnis® monofocal IOLs (ZA9003 or ZCB00) or Tecnis® multifocal IOLs (ZMA00 or ZMB00) bilaterally. We conducted a retrospective study comparing the two types of IOLs. The multifocal group included 46 patients who were implanted with Tecnis® multifocal IOLs bilaterally. The monofocal group was an age- and sex-matched control group, and included 85 patients who were implanted with Tecnis® monofocal IOLs bilaterally. Lens opacity grading, the radius of corneal curvature, corneal astigmatism, axial length and the refractive status were measured preoperatively. Pupil size, ocular aberrometry, distance, intermediate and near visual acuity, contrast sensitivity with and without glare and the responses to a quality-of-vision questionnaire were evaluated pre- and postoperatively. Results The uncorrected near visual acuity was significantly better in the multifocal group, whereas both the corrected intermediate and near visual acuity were better in the monofocal group. Contrast sensitivity (with and without glare) was significantly better in the monofocal group. The rate of spectacle dependency was significantly lower in the multifocal group. There were no significant differences between the two groups regarding most items of the postoperative quality-of-vision questionnaire (VFQ-25), with the exception that the patients in the monofocal group reported fewer problems with nighttime driving. Conclusions The multifocal IOLs used in this study reduced spectacle dependency more so than monofocal IOLs and did not compromise the subjective visual function, with the exception of nighttime driving.
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Comparison of Far and near Contrast Sensitivity in Patients Symmetrically Implanted with Multifocal and Monofocal Iols. Eur J Ophthalmol 2013; 24:44-52. [DOI: 10.5301/ejo.5000335] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2013] [Indexed: 11/20/2022]
Abstract
Purpose A prospective, randomized, double-masked, clinical trial was designed to evaluate distance and near contrast sensitivity (CS) in patients symmetrically, and randomly, implanted with 4 different multifocal intraocular lens (MIOL) designs (ReSTOR SN6AD1, ReSTOR SN60D3, ReZoom NXG, and Tecnis ZMA00) and a monofocal control group (Tecnis ZA9003), 6 months after cataract intervention. Methods Photopic, mesopic, and mesopic with glare distance CS, as well as photopic near CS, was evaluated with the CSV-1000 CS test and the Vistech VCTS 6000 system, respectively, in a group of 180 patients attending the ophthalmology department of Sant Pau Hospital, Barcelona, for cataract intervention and lens implantation. Results Statistically and clinically significant differences were found between the monofocal and multifocal lens groups at all spatial frequencies and illumination conditions, both during distance and near CS evaluation (all p<0.05), with the monofocal lens offering the best performance in all cases. Contrast sensitivity was similarly compromised in all MIOL models at distance, although MIOLs with diffractive optics and aspheric profiles showed a non–statistically significant trend to perform better in mesopic conditions. Near CS was lower for refractive, distance dominant lens designs, particularly at medium to high spatial frequencies. Conclusions The present results, which reflect intraocular lens (IOL) characteristics in optics, profile, and add power, may contribute to help surgeons decide on the type of IOL most suitable for each patient by taking into consideration the individual needs for critical distance and near vision, both in terms of visual acuity and contrast sensitivity.
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Ye PP, Li X, Yao K. Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses: a prospective comparison. Int J Ophthalmol 2013; 6:300-6. [PMID: 23826522 DOI: 10.3980/j.issn.2222-3959.2013.03.08] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 04/22/2013] [Indexed: 11/02/2022] Open
Abstract
AIM To evaluate the visual function after bilateral implantation of aspheric diffractive multifocal Tecnis ZMA00, aspheric monofocal ZA9003 versus spherical monofocal Akreos Adapt intraocular lenses (IOLs). METHODS Tecnis ZMA00, Tecnis ZA9003 or Akreos Adapt IOLs were bilaterally implanted in 180 eyes from 90 patients. The following parameters were assessed 3 months postoperatively: monocular and binocular uncorrected visual acuity (UCVA) and distance-corrected visual acuity (DCVA) for distance, intermediate and near, spherical aberration (SA), contrast and glare sensitivity, near point refractive power, uncorrected and best-corrected near stereoscopic acuity (NSA). Patient satisfaction was assessed by a questionnaire. RESULTS Three months postoperatively, the monocular and binocular UCVA and DCVA at near of Tecnis ZMA00 were significantly better than other two groups. The mean SA for 5.0mm optical zone in Tecnis ZMA00 and Tecnis ZA9003 was significantly lower than that in Akreos Adapt. Mean contrast sensitivity and glare sensitivity were better for Tecnis ZA9003 group than for other two groups. Patients with Tecnis ZMA00 had higher monocular and binocular near point refractive power and uncorrected NSA than monofocal groups. The patients in Tecnis ZMA00 had higher mean values for halo compared with other two groups. CONCLUSION Tecnis ZMA00 provided better near VA and uncorrected NSA and higher near point refractive power than monofocal IOLs and patients were spectacle independent. The IOLs with Tecnis aspheric design improved contrast and glare sensitivity. Patients with Tecnis ZMA00 reported more disturbances on visual phenomena of halo.
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Affiliation(s)
- Pan-Pan Ye
- Eye Center, the Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 3100009, Zhejiang Province, China
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Visual performance after bilateral implantation of a new diffractive aspheric multifocal intraocular lens with a 3.5 D addition. Eur J Ophthalmol 2013; 24:35-43. [PMID: 23787450 DOI: 10.5301/ejo.5000315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2013] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate visual performance after implantation of a new diffractive aspheric multifocal intraocular lens (MIOL) with a +3.50 D addition power. METHODS A total of 24 cataract patients were bilaterally implanted with the Diffractiva-aA MIOL in 2 ophthalmologic centers and followed for 6 months. Postoperative evaluations included visual acuities (VA) at various distances, defocus testing, contrast sensitivity (CS) measurements, and patient satisfaction questionnaire. RESULTS Six months postoperatively, binocular uncorrected VA (mean ± SD; logMAR) was 0.00 ± 0.05 (≈ 20/20) for distance, 0.06 ± 0.13 (≈ 20/23) for intermediate (1 m), and 0.00 ± 0.05 (≈ 20/20) for near (40 cm). All patients achieved uncorrected VA of 20/25 or better for distance and near, and 20/40 or better at 1 m. Monocular and binocular defocus curves showed 2 peaks of maximum VA at the distance focus (0.0 D) and the near focus (-2.5 D) and a good range of intermediate vision with the lowest mean acuity being at -1.5 D defocus. Photopic and mesopic CS were within the standard normal range. The majority of patients (n = 22; 91.7%) were spectacle independent; 8.3% (n = 2) reported wearing glasses occasionally for very small print (1 patient) or for watching television (1 patient). Overall, all patients were "very satisfied" (n = 22; 91.7%) or "satisfied" (n = 2; 8.3%) with the procedure. CONCLUSIONS The new Diffractiva-aA MIOL provided a full range of vision from near to far generating highly satisfied, spectacle independent patients with only minimal visual disturbances at night.
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de Vries NE, Nuijts RM. Multifocal intraocular lenses in cataract surgery: Literature review of benefits and side effects. J Cataract Refract Surg 2013; 39:268-78. [DOI: 10.1016/j.jcrs.2012.12.002] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 06/18/2012] [Accepted: 06/19/2012] [Indexed: 11/30/2022]
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Park YL, Hwang GY, Joo CK. Comparative Study of Clinical Outcomes Between 2 Types of Multifocal Aspheric Intraocular Lenses. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.8.1199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yu Li Park
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Gyu Yeon Hwang
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
| | - Choun Ki Joo
- Department of Ophthalmology and Visual Science, The Catholic University of Korea School of Medicine, Seoul, Korea
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Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev 2012:CD003169. [PMID: 22972061 DOI: 10.1002/14651858.cd003169.pub3] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Good unaided distance visual acuity is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs. OBJECTIVES The objective of this review was to assess the effects of multifocal IOLs, including effects on visual acuity, subjective visual satisfaction, spectacle dependence, glare and contrast sensitivity, compared to standard monofocal lenses in people undergoing cataract surgery. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 2), MEDLINE (January 1946 to March 2012), EMBASE (January 1980 to March 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 6 March 2012. We searched the reference lists of relevant articles and contacted investigators of included studies and manufacturers of multifocal IOLs for information about additional published and unpublished studies. SELECTION CRITERIA All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. DATA COLLECTION AND ANALYSIS Two authors collected data and assessed trial quality. Where possible, we pooled data from the individual studies using a random-effects model, otherwise we tabulated data. MAIN RESULTS Sixteen completed trials (1608 participants) and two ongoing trials were identified. All included trials compared multifocal and monofocal lenses but there was considerable variety in the make and model of lenses implanted. Overall we considered the trials at risk of performance and detection bias because it was difficult to mask patients and outcome assessors. It was also difficult to assess the role of reporting bias. There was moderate quality evidence that similar distance acuity is achieved with both types of lenses (pooled risk ratio (RR) for unaided visual acuity worse than 6/6: 0.98, 95% confidence interval (CI) 0.91 to 1.05). There was also evidence that people with multifocal lenses had better near vision but methodological and statistical heterogeneity meant that we did not calculate a pooled estimate for effect on near vision. Total freedom from use of glasses was achieved more frequently with multifocal than monofocal IOLs. Adverse subjective visual phenomena, particularly haloes, or rings around lights, were more prevalent and more troublesome in participants with the multifocal IOL and there was evidence of reduced contrast sensitivity with the multifocal lenses. AUTHORS' CONCLUSIONS Multifocal IOLs are effective at improving near vision relative to monofocal IOLs. Whether that improvement outweighs the adverse effects of multifocal IOLs will vary between patients. Motivation to achieve spectacle independence is likely to be the deciding factor.
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Affiliation(s)
- Daniel Calladine
- Eye Department at West Wing, John Radcliffe Hospital, Oxford, UK.
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Visual and optical performance with the ReZoom multifocal intraocular lens. Eur J Ophthalmol 2012; 22:356-62. [PMID: 21928262 DOI: 10.5301/ejo.5000030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE This study evaluated visual acuity, contrast sensitivity, and wavefront aberrations after refractive multifocal intraocular lens (IOL) implantation. METHODS A prospective study comprising 174 eyes of 87 patients who had bilateral implantation of a multifocal IOL was carried out. A control group of 100 eyes of 50 age-matched patients with a monofocal IOL was used for comparison. Uncorrected and corrected distance and near visual acuity, contrast sensitivity (CS), and wavefront analysis (Hartmann-Shack) was performed 6 months after surgery. Contrast sensitivity was tested for distance and near under mesopic (2 cd/m2) and photopic conditions (90 cd/m2). RESULTS Distance photopic CS was not significantly different from the monofocal group, while distant mesopic CS and near photopic and mesopic CS were significantly lower. Mean aberration root mean square (RMS) values for the multifocal IOL group were 0.229 ± 0.103 µm for coma, 0.137 ± 0.067 µm for spherical aberration (SA), and 0.301 ± 0.133 µm for higher order aberrations (HOAs). Strehl ratio averaged 0.096 ± 0.045. CONCLUSIONS Distant visual performance with the multifocal IOL was excellent under photopic conditions, but was reduced under mesopic levels. Near vision showed suboptimal results in both photopic and mesopic conditions. Coma, SA, and HOAs with the multifocal IOL were higher than those reported previously, with a lower Strehl ratio.
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Pepose JS, Wang D, Altmann GE. Comparison of through-focus image sharpness across five presbyopia-correcting intraocular lenses. Am J Ophthalmol 2012; 154:20-28.e1. [PMID: 22464368 DOI: 10.1016/j.ajo.2012.01.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 01/12/2012] [Accepted: 01/13/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess through-focus polychromatic image sharpness of 5 FDA-approved presbyopia-correcting intraocular lenses (IOLs) through a range of object vergences and pupil diameters using an image sharpness algorithm. DESIGN Laboratory investigation. METHODS A 1951 USAF resolution target was imaged through Crystalens AO (AO), Crystalens HD (HD), aspheric ReSTOR +4 (R4), aspheric ReSTOR +3 (R3), and Tecnis Multifocal Acrylic (TMF) IOL in a model eye and captured digitally for each combination of pupil diameter and object vergence. The sharpness of each digital image was objectively scored using a 2-dimensional gradient function. RESULTS AO had the best distance image sharpness for all pupil diameters and was superior to the HD. With a 5-mm pupil, the R4 distance image sharpness was similar to the HD and at 6 mm the TMF was superior to the HD, R3, and R4. The R3 moved the near focal point farther from the patient compared to the R4, but did not improve image sharpness at intermediate distances and showed worse distance and near image sharpness. Consistent with apodization, the ReSTOR IOLs displayed better distance and poorer near image sharpness as pupil diameter increased. TMF showed consistent distance and near image sharpness across pupil diameters and the best near image sharpness for all pupil diameters. CONCLUSIONS Differing IOL design strategies to increase depth of field are associated with quantifiable differences in image sharpness at varying vergences and pupil sizes. Objective comparison of the imaging properties of specific presbyopia-correcting IOLs in relation to patient's pupil sizes can be useful in selecting the most appropriate IOL for each patient.
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Affiliation(s)
- Jay S Pepose
- Pepose Vision Institute, and the Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63017, USA.
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Muñoz G, Albarrán-Diego C, Javaloy J, Sakla HF, Cerviño A. Combining Zonal Refractive and Diffractive Aspheric Multifocal Intraocular Lenses. J Refract Surg 2012; 28:174-81. [DOI: 10.3928/1081597x-20120215-02] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Accepted: 01/05/2012] [Indexed: 11/20/2022]
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Kim P, Plugfelder S, Slomovic AR. Top 5 pearls to consider when implanting advanced-technology IOLs in patients with ocular surface disease. Int Ophthalmol Clin 2012; 52:51-58. [PMID: 22395627 DOI: 10.1097/iio.0b013e31824b4504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Peter Kim
- Department of Ophthalmology, Baylor College of Medicine, 6565 Fannin NC 205, Houston, TX 77035, USA
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Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens. J Cataract Refract Surg 2011; 37:2043-52. [DOI: 10.1016/j.jcrs.2011.05.045] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 05/17/2011] [Accepted: 05/19/2011] [Indexed: 11/22/2022]
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Kim MJ, Zheleznyak L, Macrae S, Tchah H, Yoon G. Objective evaluation of through-focus optical performance of presbyopia-correcting intraocular lenses using an optical bench system. J Cataract Refract Surg 2011; 37:1305-12. [PMID: 21700107 DOI: 10.1016/j.jcrs.2011.03.033] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Revised: 03/16/2011] [Accepted: 03/23/2011] [Indexed: 11/18/2022]
Abstract
PURPOSE TO evaluate spherical aberration and through-focus optical performances of 5 presbyopia-correcting and 2 monofocal intraocular lenses (IOLs). SETTING Flaum Eye Institute, University of Rochester, Rochester, New York, USA. DESIGN Experimental study. METHODS Five presbyopia-correcting IOLs (Restor +4D SN6AD3, Restor +3D SN6AD1, Rezoom NXG1, Tecnis multifocal ZM900, Crystalens HD500) were tested using an optical bench system consisting of a model eye, a high-resolution Hartmann-Shack wavefront sensor, and an image-capturing device. Two monofocal IOLs (Sofport AO LI60AOV, Acrysof SN60AT) were measured for comparison. No accommodation was simulated. The spherical aberration profiles of each IOL were measured using the wavefront sensor. Through-focus performance was evaluated by calculating cross-correlation coefficients and comparing the likenesses of captured images of a resolution target and a perfect reference image. RESULTS With a 5.0 mm entrance pupil, the SN6AD3, SN6AD1, ZM900, NXG1, and HD500 IOLs had spherical aberration of -0.18 μm, -0.14 μm, -0.15 μm, -0.07 μm, and -0.01 μm, respectively. Distance image quality was poorer with multifocal and accommodating IOLs than with monofocal IOLs. All multifocal IOLs had effective distance and near image quality but had a loss in intermediate image quality. The HD 500 accommodating IOL had decreased distance image quality and slightly increased depth of focus compared with the monofocal IOLs because of the bispheric design. CONCLUSIONS The presbyopia-correcting IOLs had different optical characteristics, including spherical aberration profile and through-focus performance. An accurate understanding of the optical characteristics of individual IOLs is essential to selecting the best presbyopia-correcting IOL and thus improving cataract surgery outcomes. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Myoung Joon Kim
- Flaum Eye Institute, University of Rochester, Rochester, New York, USA.
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