Comparison of Bilateral Reading Performance Among Two Presbyopia-Correcting Intraocular Lenses

Changes in cataract and refractive surgery practice patterns among JSCRS members over the past 20 years

PURPOSE

To evaluate changes in cataract and refractive surgery practice patterns among members of the Japanese Society of Cataract and Refractive Surgery (JSCRS) over the past 20 years.

STUDY DESIGN

Questionnaire survey study.

SUBJECTS AND METHODS

Clinical surveys were conducted annually between February and April from 2004 to 2023. Survey questions covered various areas, including cataract surgical techniques, anesthesia, endophthalmitis prophylaxis, toric and presbyopia-correcting intraocular lenses (IOLs), complications, and refractive surgery.

RESULTS

The highest (n=554 [36.8%]) and lowest (n=316 [19.1%]) numbers of responses were collected in 2012 and 2016, respectively. In perioperative management, the intraoperative use of polyvinyl alcohol-iodine solution and topical antibiotic prescription 3 days before surgery has increased. The use of intracameral injection at the end of surgery has also significantly increased, although it has not been established as common practice. In anesthesia, there is a clear polarization between the use of topical drops and tenon injection. The use of toric IOLs and presbyopia-correcting IOLs has significantly increased from 2010 to 2023. In the latter, the use of trifocal IOLs has particularly increased. Regarding IOL power calculations, the Barrett True K and the Barrett Universal II formulas are rapidly gaining popularity for application with and without post-laser vision correction, respectively. In refractive surgery, phakic IOLs and corneal refractive therapy have attracted considerable interest, followed by laser in situ keratomileusis.

CONCLUSIONS

Evaluation of annual clinical survey data over the past two decades provided valuable insights into the shifting practice patterns and clinical opinions among JSCRS members.

Clinical outcomes of a toric continuous range of vision presbyopia-correcting intraocular lens

PURPOSE

To evaluate the clinical outcomes of the toric version of a presbyopia-correcting intraocular lens (IOL) based on the combination of a diffractive-based extended depth-of-focus (EDOF) pattern and a diffractive multifocal platform.

SETTING

Miranza COI Bilbao, Bilbao, Spain.

DESIGN

Prospective case series.

METHODS

35 patients (51 to 84 years) with corneal astigmatism ranging from 0.75 to 2.19 diopters (D) undergoing bilateral cataract surgery with implantation of the Synergy Toric II IOL were evaluated during a 3-month follow-up. Visual acuity, refraction, defocus curve, and patient-reported outcomes with the Catquest-9SF questionnaire were analyzed. A vectorial analysis was used to analyze the accuracy of astigmatic correction.

RESULTS

Mean 3-month monocular postoperative uncorrected distance, intermediate (80 cm) and near (40 cm) visual acuities were 0.06 ± 0.11 logMAR, 0.13 ± 0.12 logMAR, and 0.13 ± 0.09 logMAR, respectively. Mean monocular distance-corrected intermediate (80 cm) and near visual acuity (40 cm) were 0.11 ± 0.12 logMAR and 0.10 ± 0.10 logMAR, respectively. Mean binocular defocus curve showed visual acuities of 0.10 logMAR or better for defocus levels from +0.50 to -2.50 D. Residual cylinder was within ±0.50 D in 97.0% of eyes. The surgically induced astigmatism prediction error ranged between -0.49 D and 0.50 D, with a mean value of 0.04 ± 0.16 D. Mean absolute IOL rotation was 3.79 ± 2.94 degrees. Significant improvements were found in all Rasch-calibrated scores obtained with Catquest-9SF ( P < .001).

CONCLUSIONS

The implantation of the toric presbyopia-correcting IOL evaluated provides an efficacious astigmatic correction while providing a fully restoration of the visual function across different distances.

Refractive and Visual Outcomes Using a Trifocal, Diffractive, Hydrophobic Intraocular Lens in Japanese Eyes

Purpose

To report the refractive and visual outcomes after implantation of a trifocal, diffractive, hydrophobic intraocular lens (IOL) in Japanese eyes following cataract surgery.

Methods

A total of 45 eyes implanted with FineVision HP IOLs (Beaver-Visitec International, Inc. USA) were enrolled in this retrospective study. The clinical outcomes assessed after 3-months were refraction and monocular logarithm of the minimum angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA) at 40 cm.

Results

97.78% of the eyes were within ±0.50D of spherical equivalent and all of them were within ±1.00D (mean: -0.00±0.22 D, with 75.56% within ±0.13D), while 91.11% of the eyes had ≤0.50D residual astigmatism and all of them had ≤1.00D (mean: -0.08±0.24D, with 88.89% ≤0.25D). UDVA and CDVA showed mean values of -0.05±0.07 logMAR and -0.07±0.06 logMAR, respectively. 86.67% and 95.56% of the eyes had ≥20/20 UDVA and CDVA, respectively, with 100% achieving ≥20/25 for both UDVA and CDVA. At 80 cm, the mean monocular logMAR UIVA and DCIVA were 0.18±0.14 and 0.14±0.14, and at 66 cm the values were 0.20±0.15 and 0.19±0.15, respectively. At 80 cm 20% of the eyes had ≥20/25 DCIVA and 60% had ≥20/32 DCIVA. These values changed to 15.56% and 40% of the eyes at 66 cm. In terms of near vision, the mean monocular logMAR UNVA and DCNVA were 0.04±0.10 and 0.03±0.10, respectively. 53.33% of the eyes had ≥20/20 UNVA and DCNVA, with 86.67% achieving ≥20/25 UNVA and DCNVA.

Conclusion

The FineVision HP trifocal diffractive IOL provided accurate refractive outcomes with good visual acuity at different distances in Japanese eyes.

Visual and Refractive Outcomes of a New Hydrophobic Trifocal Toric Intraocular Lens

Purpose

To evaluate the visual outcomes and efficacy of astigmatism correction using a new hydrophobic trifocal toric intraocular lens (IOL).

Methods

This study involved 62 eyes implanted with the FineVision HP Toric IOL. The visual and refractive outcomes were assessed preoperatively and 6 weeks after the surgery. Specifically, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA) at 80 and 60 cm and uncorrected near visual acuity at (UNVA) at 40 cm were evaluated. The rotational stability of the lens was also assessed.

Results

Sixty-one eyes (98.39%) were within ±1.00D and 55 eyes (88.71%) were within ±0.50 D of spherical equivalent, with a mean value of 0.09±0.39 D. 51 (82.26%) and 61 (98.39%) eyes had a UDVA of ≥20/20 and ≥20/25, respectively, and for CDVA these values were as follows: 59 (95.16%) and 62 eyes (100%), respectively. The mean UDVA and CDVA were 0.01±0.06 and -0.01±0.04logMAR, respectively. Greater than or equal to unaided 20/20 vision was achieved at 40 cm in 42 (67.74%), UIVA at 60 cm in 42 (67.74%) and 50 eyes (80.65%) at 80 cm. Those achieving ≥20/25 were 56 (90.32%, 40 cm), 59 (95.16%, 60 cm), and 62 eyes (100%, 80 cm). Postoperative mean values were 0.04±0.07, 0.03±0.07, and 0.00±0.07logMAR for UCNVA, UIVA at 60 cm, and UIVA at 80 cm, respectively. The mean rotation of the IOL was 5.8 degrees.

Conclusion

This hydrophobic trifocal toric IOL provides good refractive outcomes with excellent visual acuity across multiple distances, providing a full range of focus.

Comparative Analysis of the Clinical Outcomes of Two Toric Presbyopia-Correcting Intraocular Lenses

INTRODUCTION

To evaluate and compare the clinical outcomes of two toric presbyopia-correcting intraocular lenses (IOLs).

METHODS

Non-randomized prospective comparative study including 86 eyes of 51 patients (age 43-83 years) that underwent cataract surgery with implantation of one of the following two IOLs: TECNIS Toric Synergy (Johnson & Johnson Vision) (Synergy group) or AT LISA tri toric 939MP (Carl Zeiss Meditec) (ATLISA group). Visual and refractive outcomes were evaluated during a 6-month follow-up.

RESULTS

At 6 months after surgery, all eyes achieved uncorrected distance visual acuity 20/25 or better in both groups, whereas 96.2% and 100% of eyes achieved uncorrected near visual acuity (UNVA) 20/25 or better in the ATLISA and Synergy groups, respectively. All eyes achieved postoperative mesopic UNVA 20/30 or better in both IOL groups; 96.2% and 100% of eyes had a manifest cylinder ≤ 0.50 D at 6 months in ATLISA and Synergy groups, respectively. Mean magnitude of error was 0.04 ± 0.20 and - 0.04 ± 0.09 D in ATLISA and Synergy groups, respectively (p = 0.05). In the defocus curve, significant differences were found between IOL groups for most of distance-corrected visual acuities, except those corresponding to defocus of 0 D (p = 0.268) and - 1 D (p = 0.361).

CONCLUSIONS

The two toric presbyopia-correcting IOLs evaluated provide an efficacious astigmatic correction combined with a successful distance, intermediate and near visual rehabilitation. The visual performance seems to be better for most visual demands with the TECNIS Toric Synergy IOL, especially for distances closer than 40 cm.

Long-term Clinical Outcomes After Bilateral Implantation of Two Trifocal Diffractive IOLs

PURPOSE

To show clinical outcomes after bilateral implantation of either a hydrophobic FineVision POD F GF or a hydro-philic FineVision POD F intraocular lens (IOL) (Beaver-Visitec International, Inc).

METHODS

A total of 110 patients with cataract were randomized to receive either POD F GF or POD F IOLs and followed up for 2 years. The measurements included refraction, monocular and binocular uncorrected and corrected distance (UDVA and CDVA), intermediate (UIVA and DCIVA), and near (UNVA and DCNVA) visual acuities, defocus curve, photopic and mesopic contrast sensitivity, photic phenomena, and patient-reported outcomes.

RESULTS

The mean spherical equivalent was similar in both groups and stable across visits (< 0.25 diopters [D]). At 2 years, 81.8% and 90.5% of eyes were within ±0.50 D in the POD F GF and POD F IOL groups, respectively (100% for ±1.00 D in both groups). At 2 years, 100% and 90.5% of the patients presented a binocular CDVA of 20/25 or better; 93.9% and 85.7% of patients a DCIVA of 20/25 or better and 87.5% and 70% of patients a DCNVA of 20/25 or better, for the POD F GF and POD F IOL groups, respectively. The defocus curve showed continuous visual acuity, being 20/32 or better in both groups over a 4.50 D range. Both groups presented good contrast sensitivity for photopic and mesopic conditions, and the size and intensity of halo and glare phenomena were similar between the two. Both groups also included a high percentage of patients who reported that they had stopped wearing glasses and greater than 80% satisfaction and recommendation levels.

CONCLUSIONS

This study showed comparable long-term visual and refractive outcomes of both IOL models after cataract surgery. [J Refract Surg. 2023;39(12):798-807.].

Visual Outcomes, Quality of Vision, Patient Satisfaction and Spectacle Independence After Bilateral Implantation of the Synergy™ Intraocular Lens

Purpose

To evaluate vision, visual quality, patient satisfaction and spectacle independence after bilateral implantation of the TECNIS Synergy™ intraocular lens.

Setting

Two clinical practices in the USA.

Design

Ambispective unmasked non-randomized clinical trial.

Methods

Patients with a history of uneventful bilateral femtosecond laser assisted cataract surgery with the study IOL implanted, targeted for emmetropia, at least 3 months prior to the study visit were enrolled. Monocular and binocular visual acuity (VA) were measured at distance, intermediate and near, along with binocular mesopic VA. Low contrast binocular VA and reading speed in mesopic and photopic conditions were also measured. Patient satisfaction, spectacle independence, visual symptoms, and functional vision questionnaires were completed.

Results

Results from 52 subjects were available for analysis. Mean binocular unaided visual acuity was ~0.1 logMAR (20/20) from distance to 33 cm, with 81% of subjects having 0.2 logMAR (20/25) vision or better at all test distances and 92% reporting never needing glasses at any distance. Average reading speed at 40 cm was only 10 words/minute slower in dim light (p = 0.03). Mesopic and low contrast acuity appeared good. Halos were the most frequent and bothersome visual disturbances, with the greatest effect on driving at night. Eighty-eight percent of subjects reported being "completely" or "mostly" satisfied with their overall unaided vision.

Conclusion

This hybrid technology IOL provided a range of binocular visual acuity from distance to 33 cm and good functional vision, even in dim light. Patients should be advised of the likelihood of visual disturbances, particularly halos.

Long Term Clinical Outcomes of Hydrophilic and Hydrophobic Versions of a Trifocal IOL with the Same Optical Design

Purpose

To show the visual and refractive outcomes in Asian eyes with cataract when bilaterally implanted with either a hydrophobic FineVision POD F GF or a hydrophilic FineVision POD F intraocular lens (IOL).

Methods

Forty-six patients were randomized to receive POD F GF or POD F IOLs. Visual and refractive outcomes were assessed up to 24 months post-surgery. Measurements included uncorrected-distance visual acuity, corrected-distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA), distance-corrected near visual acuity (DCNVA), refraction, defocus curve, photopic and mesopic contrast sensitivity, and patient-reported outcomes.

Results

Mean spherical equivalent was close to emmetropia for both groups and stable across postoperative visits. Overall, 97.73% and 100% of eyes in the POD F GF IOL group and 95.65% and 100%, of eyes in the POD F IOL group were within ±1.00D of the target refraction at 12 and 24 months, respectively. All patients showed a CDVA of ≥20/25 at 12- and 24-months post-surgery. In both groups, 24 months post-surgery 91% of patients presented a DCIVA of ≥20/25 and 83.3% of patients had a DCNVA of ≥20/25. Defocus curve showed continuous visual acuity, being 20/32 or better in both groups over a 4.00D range between 1.00D and -3.00/-3.50D. Both groups showed good contrast sensitivity values for photopic and mesopic conditions. Overall, 86.4%, 86.4%, and 72.7% of patients implanted with the POD F GF IOL reported not wearing glasses at all for distance, intermediate, and near vision, respectively. These values were 81.8%, 86.4%, and 90.9% for patients implanted with the POD F IOL. Both groups of patients reported similar satisfaction percentages (100% very satisfied/satisfied) and would recommend the procedure (100% definitively yes/probably yes).

Conclusion

This study demonstrates good visual and refractive outcomes for both the FineVision POD F GF and the FineVision POD F IOLs when implanted in Asian eyes.

Clinical Evaluation of Reading Performance in Refractive Lens Exchange With a Diffractive Continuous-Range-of-Vision Intraocular Lens

PURPOSE

Evaluation of reading performance with a novel presbyopia correcting intraocular lens (IOL) in refractive lens exchange using an electronic reading desk.

DESIGN

Prospective interventional before-and-after clinical study.

METHODS

In total, 56 eyes of 28 patients were included. Bilateral implantation of the TECNIS Synergy IOL (Johnson & Johnson Surgical Vision) during a bilateral delayed sequential refractive lens exchange procedure. Uncorrected and distance corrected reading acuity, reading distance, reading speed, and the smallest print size that could be read effectively at a set (40 cm/80 cm) and subjectively chosen near and intermediate distance were assessed using the Salzburg Reading Desk preoperatively and 6 months after surgery.

RESULTS

Uncorrected near reading acuity increased from 0.61 ± 0.16 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.05 ± 0.09 logMAR postoperatively at the set near distance (40 cm) and from 0.60 ± 0.11 logMAR to 0.07 ± 0.08 logMAR at the subjectively preferred distance (39.6 ± 5.3 cm and 37.7 ± 4.3 cm). Uncorrected intermediate reading acuity was 0.39 ± 0.19 logMAR preoperatively and 0.08 ± 0.07 logMAR postoperatively at the set intermediate distance (80 cm) and 0.43 ± 0.21 logMAR preoperatively and 0.07 ± 0.08 logMAR postoperatively at the preferred intermediate distance (73.5 ± 9.5 cm and 73.3 ± 5.9 cm).

CONCLUSIONS

Uncorrected intermediate and near reading function considerably improved after bilateral implantation of the TECNIS Synergy IOL. Patients preferred a closer near and intermediate distance to the set distances. However, reading function was comparable for the set and subjectively preferred distances.