Visual outcomes of binocular implantation of a new extended depth of focus intraocular lens

Refraction and defocus curves in eyes with monofocal and multifocal intraocular lenses

Several clinical techniques have been described to evaluate visual performance and optical quality with intraocular lenses (IOL). However, subjective refraction remains one of the most important methods for assessing post-surgery results, taking decisions about retreatments, advanced spectacle prescription and the refinement of the constant for the formula used in the IOL power calculation. Beyond clinical refraction, defocus curve measurement has been described as a complementary tool for assessing visual performance and taking clinical decisions. However, to date, there are no clinical guidelines or evidence-based protocols published in the scientific literature recommended for pseudophakic patients implanted with either monofocal or multifocal IOLs. This narrative review highlights the importance of clinical refraction in pseudophakic eyes, its utility in the decision of different types of IOL implantation, and describes a clinical refraction protocol for eyes implanted with monofocal and multifocal IOLs.

Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia

Background

Enhanced depth-of- focus intraocular lenses (EDOF IOL) have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses. The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision.

Methods

The study included 15 patients (29 eyes as one was amblyopic) with bilateral implantation of LUXSMART EDOF IOL (Bausch & Lomb) with a targeted myopia (between -0.25 and -0.50D) in both eyes. Monocular corrected and uncorrected visual acuity for far, intermediate and near as well as refractive outcomes were evaluated at 1, 3, 6 and 12 months after the surgery. Additionally, binocular visual acuity, contrast sensitivity and defocus curve were measured at the final follow-up visit. At 12 months' visit patients completed a questionnaire evaluating patient satisfaction, spectacle independence and presence of dysphotopsias.

Results

Binocular uncorrected visual acuities at 12 month's visit were 0.13 ​± ​0.16, 0.06 ​± ​0.08, 0.07 ​± ​0.09 and 0.15 ​± ​0.09 logMAR for far distance, 80 ​cm, 66 ​cm and 40 ​cm respectively. Corrected binocular visual acuities at 12 months were 0.00 ​± ​0.00, 0.05 ​± ​0.07, 0.05 ​± ​0.06, 0.13 ​± ​0.16 respectively for distance, 80 ​cm, 66 ​cm and 40 ​cm. Automated refraction spherical equivalent at 12 months' visit stood at -0.70 ​± ​0.48D, which was 0.46D less than calculated biometric target, however spherical equivalent of subjective refraction at 12 months equaled -0.49 ​± ​0.46D, which was closer to preoperative biometric target. Defocus curve had gentle shape without peaks typical for monofocal IOLs. Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78 ​± ​0.16 logMAR without correction and 1.81 ​± ​0.13 logMAR with correction. Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3% of patients. Burdensome dysphotopsias were not reported in any case.

Conclusions

EDOF IOLs targeted bilaterally at low myopia can provide excellent near and intermediate visual acuity and independence of any optical correction in majority of cases. This approach can be used in selected patients who are focused on stationary activities.

Latest Development in Extended Depth-of-Focus Intraocular Lenses: An Update

In recent years, there has been an overwhelming influx of different types of intraocular lenses (IOLs) as treatment for presbyopia. The extended depth-of-focus (EDOF) technology creates a single elongated focal point to enhance depth of focus, in contrast to the multiple foci of multifocal (MF) lenses. In this way, the EDOF lenses aim to reduce photic phenomena, glare, and halos, which have been reported in MF IOLs. A potential disadvantage of this is a blur due to decreased retinal image quality when the amount of the aberrations is increased excessively. Multifocality and EDOF characteristics are not exclusive of each other. Frequently, EDOF IOLs are combined with MF optical designs, a bifocal IOL may exhibit EDOF characteristics, likewise an aspheric monofocal IOL or a diffractive or refractive trifocal IOL. Thus, EDOF lenses are commonly subjected to confusion. A wide range of different types of EDOF lenses are available on the market to surgeons. In this practical update, we aim to clarify what is a true EDOF lens, classify the different types of the EDOF lenses based on their optical principle and review their recently reported outcomes. Comprehensive patient examination and selection, combined with knowledge of the most updated options and adequate patient counseling, can avoid dissatisfaction and yield the desired outcomes.

COMPARISON OF REFRACTIVE AND VISUAL OUTCOMES OF THREE PRESBYOPIA-CORRECTING INTRAOCULAR LENSES

PURPOSE

To evaluate and compare the clinical outcomes after cataract surgery with implantation of three different types of trifocal diffractive intraocular lenses (IOLs).

SETTING

Hospital da Luz, Lisbon, Portugal.

DESIGN

Prospective comparative case series.

METHODS

180 eyes of 90 patients undergoing phacoemulsification cataract surgery with implantation of one of these trifocal IOLs were enrolled: Tecnis Synergy (J&J Vision) (Synergy group, 30 patients), Acrysof PanOptix (Alcon) (PanOptix group, 30 patients), and POD F (PhysIOL) (Finevision group, 30 patients). The outcomes in terms of distance, intermediate and near visual acuity (VA), refraction, defocus curve, photic phenomena and spectacle independence were evaluated at 3-months follow-up.

RESULTS

No significant differences were found between groups in monocular distance-corrected intermediate (Synergy 0.04±0.11, PanOptix 0.05±0.09, Finevision 0.08±0.10; p=0.107) and near VA (0.01±0.08, 0.01±0.06, 0.04±0.10; p=0.186). Likewise, no significant differences among groups were found in binocular uncorrected distance (p=0.572), near (p=0.929) and intermediate VA (p=0.327). In contrast, significant differences between groups were found in the visual acuity for the vergence demands of -0.50, -1.00, -2.00, -3.50 and -4.00 D (p≤0.045). No significant differences among groups were found either in the frequency, severity and bothersomeness of different disturbing visual symptoms, including glare and haloes (p≥0.129). More than 96% of patients in all groups did not require the use of spectacles at any distance after surgery.

CONCLUSIONS

The three trifocal IOLs evaluated provide an effective visual rehabilitation with minimal incidence of photic phenomena. A trend to obtain a wider range of functional focus was observed with the Tecnis Synergy IOL.

Clinical Outcomes with a Novel Extended Depth of Focus Presbyopia-Correcting Intraocular Lens: Pilot Study

Purpose

To evaluate the clinical outcomes of cataract surgery with implantation of a novel model of extended depth of focus (EDOF) intraocular lens (IOL).

Methods

Pilot case series enrolling a total of 27 eyes of 16 patients (49 to 84 years) undergoing uncomplicated phacoemulsification cataract surgery with implantation of the EDOF IOL Synthesis PLUS (Cutting Edge, Montpellier, France). Near (UNVA, uncorrected near visual acuity; DCNVA, distance-corrected near visual acuity) and distance visual acuity (uncorrected and corrected distance visual acuity, UDVA and CDVA), monocular defocus curve and refractive outcomes were evaluated during a 3-month follow-up.

Results

Mean postoperative UDVA, UNVA and DCNVA were 0.11±0.17, 0.14±0.22 and 0.37±0.36 logMAR, respectively. A total of 84.6%, 91.7%, and 96.3% of eyes achieved postoperative UDVA, UNVA and CDVA of 0.20 logMAR or better. A total of 78.6% of eyes achieved postoperative DCNVA of 0.30 logMAR or better. Mean postoperative spherical equivalent was −0.76±0.53 D. The distance-corrected visual acuity was maintained on average over a value of 0.30 logMAR for the range of defocus levels between +1.00 and −1.50 D.

Conclusion

The implantation of the Synthesis plus EDOF IOL after cataract surgery seems to provide functional levels of distance, intermediate and near visual acuity. The near visual performance with this new IOL might be significantly enhanced using a micro-monovision approach. The results of this pilot study should be confirmed in future clinical trials.