Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses: a prospective comparison

Visual performance after the deterioration of retinal image quality: induced forward scattering using Bangerter foils and fog filters

We induced and evaluated different levels of retinal-image degradation using Bangerter foils and fog filters. We found increased straylight and an important deterioration in visual performance, assessed by means of visual acuity, contrast threshold, and visual discrimination capacity. Bangerter foils induced forward scattering levels comparable to those observed in mature to severe cataracts, with an important impact of halos and starbursts. Fog filters induced lower levels of intraocular scattering, although luminous veils and circular halos were reported. The visual disturbance index positively correlated with intraocular scattering and straylight. Our results show retinal-image quality has an important influence on night-vision performance.

Effect of the kappa angle on depth of focus after implantation of the TECNIS Symfony intraocular lens

PURPOSE

To evaluate the clinical effect of TECNIS Symfony intraocular lens (IOL) implantation and identify the effect of kappa angle on the depth of focus (DOF) after implantation.

METHODS

This prospective clinical study included consecutive patients who underwent cataract surgery and TECNIS Symfony IOL implantation at the Daqing Oilfield General Hospital from January 2019 to September 2019. Patients were divided into three groups according to the preoperative kappa angle (r): A (0 < r ≤ 0.2), B (0.2 < r ≤ 0.4), and C (r > 0.4). Uncorrected visual acuity was performed preoperatively and at 7 days, 1 month, and 3 months postoperatively. Synthetical optometry, higher-order aberrations, and defocus examinations were performed at 3 months postoperatively. Single-factor analysis of variance and Spearman correlation coefficient were used for data analysis.

RESULTS

The uncorrected visual acuity values of the three groups were significantly improved postoperatively, compared with preoperative values (p < 0.001). Three months postoperatively, the best-corrected visual acuity values of the three groups were 0.11 ± 0.02 logarithm of the minimum angle of resolution (logMAR), 0.09 ± 0.03 logMAR, and 0.11 ± 0.03 logMAR, respectively. Spherical equivalent (SE) values were 0.37 ± 0.08 D, 0.41 ± 0.06 D, and 0.42 ± 0.06 D, respectively. Best-corrected visual acuity and SE did not significantly differ among the three groups (F = 1.254, p = 0.135; F = 0.849, p = 0.228). There was no significant difference in SE between the three groups (F = 1.658, p = 0.312). Moreover, higher-order aberrations did not significantly differ among the three groups (p > 0.05). The kappa angle was negatively correlated with the postoperative DOF (r = -4.341, p = 0.026). Three months postoperatively, 54.55% of patients exhibited DOF ≥ 3 D, while 92.42% of patients exhibited DOF ≥ 2 D. The ranges of DOF in the three groups were 3.18 ± 0.27 D, 2.83 ± 0.80 D, and 2.57 ± 0.89 D, respectively; the difference among the three groups was statistically significant (F = 5.689, p = 0.037).

CONCLUSION

Most patients achieved full-range vision after TECNIS Symfony IOL implantation, but the DOF narrowed for those with an excessively large kappa angle, which indicates a need for careful selection.

A clinical study to assess feasibility, acceptance, and outcome of multifocal intraocular lens in patients with bilateral immature cataract at a tertiary eye care institute

Purpose

: To assess feasibility, acceptability, and outcome of multifocal intraocular lenses (IOL) in patients with bilateral immature cataract.

Methods

1691 patients with bilateral immature cataract were included in the study. The feasibility of these IOLs was calculated by studying ocular parameters using Visionix VX120 and subjective characteristics. A prospective study was then conducted in 148 eyes of 74 patients in which multifocal IOLs were implanted. Their visual outcome was assessed using LogMAR for distance and Snellen's chart for near vision, contrast sensitivity by Pelli-Robson chart, and satisfaction using visual function-7 questionnaire.

Results

Considering ocular and subjective characteristics, it was feasible to implant the lens in 920 patients (54.40%) and the acceptability rate was 8.04%, most common reason for decreased acceptability was cost (85%) of IOL. The median distance uncorrected visual acuity (UCVA) at day 7 and at 30 days was LogMAR 0.2 (0.1-0.3) and 0.15 (0.1-0.2), respectively, which was statistically significant compared to preoperative distance UCVA (P < 0.001). The median near UCVA at day 7 and 30 days was N6 for both and statistically significant (P < 0.001) compared to preoperative near UCVA. 77.02% patients had distance UCVA of LogMAR (0.0-0.2) and 91.8% had near UCVA of N6-N8 at 30 days. The contrast sensitivity was decreased in all patients.

Conclusion

Appropriately selected patients can achieve spectacle independence and good visual satisfaction which begins with proper patient education, lifestyle and personality dynamics, and individualized weighing of benefits and side effects of multifocal IOLs.

Spectacle Independence And Patient Satisfaction With Pseudophakic Mini-Monovision Using Aberration-Free Intraocular Lens

Purpose

To assess spectacle independence and patient satisfaction with pseudophakic mini-monovision in patients undergoing routine bilateral cataract surgery with implantation of an aspherical aberration-free intraocular lens (Akreos AO, Bausch and Lomb, USA).

Methods

This study was a retrospective analysis that included 60 eyes of 30 consecutive patients between 2016 and 2018. The included patients had undergone sequential bilateral routine phacoemulsification after choosing the mini-monovision option. Test for ocular dominance was done using a sighting test. Emmetropia was aimed at in the dominant eye, while in the non-dominant eye the aim was myopia between -1 D and -1.5 D. The main outcome parameters were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and data reported from a questionnaire given to the patients at 3 months postoperative visit.

Results

The study included 60 eyes of 30 consecutive patients. The mean binocular UDVA was 0.09 ± 0.07 logMAR. Twenty-eight patients (93%) had binocular UDVA of 0.2 logMAR or better. The mean binocular uncorrected intermediate distance visual acuity (at 65 cm) was 0.16 ± 0.12 logMAR. Twenty-six patients (87%) had binocular uncorrected intermediate distance visual acuity of 0.2 logMAR or better. The mean binocular UNVA (at 35 cm) was 0.30 ± 0.21 logMAR. Fourteen patients (47%) had binocular UNVA of 0.2 logMAR or better. The patients score in the questionnaire was significantly higher in far and intermediate vision than near vision (p = 0.022). The patients score was significantly higher in day vision than night vision (p = 0.031). The mean overall patient satisfaction was good (9.1 ± 1.54). Twenty-eight patients (93%) reported high spectacle independence for far vision (score 8, 9, or 10).

Conclusion

Pseudophakic mini-monovision shows good results for spectacle independence and high patient satisfaction. It is a safe and inexpensive option after bilateral cataract surgery for correcting distance and intermediate vision. However, it might show lower results with near and night vision which is generally acceptable. Using aberration-free monofocal IOL allows for the residual normal positive corneal aberration that may augment the effect of monovision.

Comparison of visual outcomes after bilateral implantation of two intraocular lenses with distinct diffractive optics

Purpose

The aim of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of an extended depth of focus intraocular lens, J&J Vision Tecnis Symfony^® ZXR00 (Group A) and bilateral implantation of a diffractive trifocal intraocular lens, Alcon Acrysof IQ PanOptix^® TNFT00 (Group B).

Methods

This prospective, nonrandomized, comparative study of consecutive cases assessed 52 eyes of 26 patients operated on by the same surgeon (WTH) and binocularly implanted with multifocal intraocular lenses between May 2016 and July 2018. Binocular visual acuity for far, intermediate and near was tested in all cases. Ophthalmological evaluation included the measurement of binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA) at 40 cm, uncorrected intermediate visual acuity (UIVA) at 70 cm, monocular visual defocus curve and the quality of life (QoL) questionnaire, National Eye Institute Visual Functioning Questionnaire - 25 ( NEI-VFQ 25).

Results

Postoperative UDVA was 0.00 and 0.09 logMAR (P<0.001), UIVA was 0.20 and 0.39 logMAR (P<0.001) and UNVA was 0.16 and -0.01 logMAR (P<0.001) in groups A and B, respectively; postoperative CDVA was -0.05 and 0.06 logMAR (P<0.001) in groups A and B, respectively.

Conclusion

Both groups reported good subjective quality of vision regarding long, intermediate and short distances. Group A had a better performance for binocular UDVA, UIVA at 70 cm and CDVA, while regarding the monocular defocus curve, Group A outperformed Group B for long distances. Furthermore, Group B surpassed it in the short to very short distances, between the range of ≥2.00 D to 5.00 D of vergence. While Group A had a better performance regarding the vergences between 0.00 and 1.00 D (P<0.05) and at the vergence of +2.50 D (P=0.007). Group B outran Group A for UNVA at 40 cm.

Comparison of visual outcomes after bilateral implantation of a diffractive trifocal intraocular lens and blended implantation of an extended depth of focus intraocular lens with a diffractive bifocal intraocular lens

Purpose

The purpose of this study was to compare the visual outcomes and subjective visual quality between bilateral implantation of a diffractive trifocal intraocular lens, Alcon Acrysof IQ^® PanOptix^® TNFT00 (group A), and blended implantation of an extended depth of focus lens, J&J Tecnis Symfony^® ZXR00 with a diffractive bifocal intraocular lens, J&J Vision Tecnis^® ZMB00 (group B).

Methods

This prospective, nonrandomized, consecutive, comparative study included the assessment of 40 eyes in 20 patients implanted with multifocal intraocular lens. Exclusion criteria were existence of any corneal, retina, or optic nerve disease, previous eye surgery, illiteracy, previous refractive surgery, high axial myopia, expected postoperative corneal astigmatism of >1.00 cylindrical diopter (D), and intraoperative or postoperative complications. Binocular visual acuity was tested in all cases. Ophthalmological evaluation included the measurement of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), and uncorrected intermediate visual acuity (UIVA), with the analysis of contrast sensitivity (CS), and visual defocus curve.

Results

Postoperative UDVA was 0.01 and −0.096 logMAR (p<0.01) in groups A and B, respectively; postoperative CDVA was −0.07 and −0.16 logMAR (p<0.01) in groups A and B, respectively; UIVA was 0.14 and 0.20 logMAR (p<0.01) in groups A and B, respectively; UNVA was −0.03 and 0.11 logMAR (p<0.01) in groups A and B, respectively. Under photopic conditions group B had better CS at low frequencies with and without glare.

Conclusion

Both groups promoted good quality of vision for long, intermediate, and short distances. Group B exhibited a better performance for very short distances and for intermediate and long distances ≥−1.50 D of vergence. Group A exhibited a better performance for UIVA at 60 cm and for UNVA at 40 cm.

Visual acuity and patient satisfaction at varied distances and lighting conditions after implantation of an aspheric diffractive multifocal one-piece intraocular lens

PURPOSE

The aim of the study is to evaluate the visual acuity and patient satisfaction at varied distances under photopic and mesopic lighting conditions in patients bilaterally implanted with aspheric diffractive multifocal one-piece intraocular lenses.

METHODS

In this retrospective-prospective study, 16 patients with a mean age of 66.2±9.2 years (range: 50-81 years) who had undergone bilateral phacoemulsification surgery with implantation of a Tecnis multifocal one-piece intraocular lens (ZMB00) were evaluated. Monocular and binocular uncorrected and distance-corrected visual acuities were measured at distance (20 ft), intermediate (70-80 cm), and near (35-40 cm) under photopic (85 cd/m(2)) and mesopic (3 cd/m(2)) lighting conditions and were compared using the paired t-test. All patients also completed a subjective questionnaire.

RESULTS

At a mean follow-up of 9.5±3.9 months, distance, near, and intermediate visual acuity improved significantly from preoperative acuity. Under photopic and mesopic conditions, 93.8% and 62.5% of patients, respectively, had binocular uncorrected intermediate visual acuity of 20/40 or better, and 62.5% and 31.3% of patients had binocular uncorrected near visual acuity of 20/20 or better. All patients were satisfied with their overall vision without using glasses and/or contact lenses when compared with before surgery. A total of 87.5% of patients reported no glare and 68.8% of patients reported no halos around lights at night.

CONCLUSION

Tecnis multifocal one-piece intraocular lenses provide good distance, intermediate, and near visual acuity under photopic as well as mesopic lighting conditions. High levels of spectacle independence with low levels of photic phenomenon were achieved, resulting in excellent patient satisfaction.

Visual outcomes and patient satisfaction after refractive lens exchange with a single-piece diffractive multifocal intraocular lens

Purpose. To report visual outcomes and patient satisfaction after unilateral or bilateral refractive lens exchange (RLE) with a single-piece bifocal diffractive multifocal intraocular lens (MIOL). Methods. All patients underwent RLE with the ZMB00 MIOL (Abbott Medical Optics). Patient charts were reviewed to evaluate the distance, intermediate, and near visual acuity (VA), contrast sensitivity, extent of visual symptoms (0-5), satisfaction (1-5), and rate of spectacle independence between unilateral and bilateral RLE group. Results. Forty-seven eyes of 28 patients were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were 0.01 ± 0.12 (standard deviation), 0.27 ± 0.18, and 0.15 ± 0.11, respectively. No eyes lost >1 line of corrected distance VA. Monocular contrast sensitivity remained at normal level. Median scores of halos, night glare, and starbursts for 27 patients were 2.0, 3.0, and 0.0, respectively. Median score of satisfaction was 4.0. There were no differences in visual symptom scores or satisfaction between unilateral and bilateral group (P > 0.05). Eighty percent of 25 patients reported total spectacle freedom, with similar rate between bilateral (82%) and unilateral group (75%) (P = 1.000). Conclusions. RLE with the bifocal diffractive MIOL was safe in presbyopic patients and resulted in a high rate of spectacle independence.