Intraocular lens correction of presbyopia

Comparative efficacy and safety of all kinds of intraocular lenses in presbyopia-correcting cataract surgery: a systematic review and meta-analysis

PURPOSE

To assess the efficacy and safety of various intraocular lenses (IOLs), including standard monofocal, bifocal, trifocal, extended depth of focus (EDOF), and enhanced monofocal IOLs, post-cataract surgery through a network meta-analysis.

METHODS

A systematic search of PubMed, Cochrane Library, and Web of Science was conducted to identify relevant studies from the past 5 years. Parameters such as binocular visual acuities, spectacle independence, contrast sensitivity (CS), and optical quality were used to evaluate efficacy and safety. Data from the selected studies were analyzed using Review Manager 5.4 and STATA 17.0 software.

RESULTS

Twenty-eight Randomized Controlled Trials (RCTs) comprising 2465 subjects were included. Trifocal IOLs exhibited superior uncorrected near visual acuity (UNVA) compared to monofocal IOLs (MD: -0.35; 95% CI: -0.48, -0.22). Both trifocal (AcrySof IQ PanOptix IOLs group MD: -0.13; 95% CI: -0.21, -0.06) and EDOF IOLs (MD: -0.13; 95% CI: -0.17, -0.09) showed better uncorrected intermediate visual acuity (UIVA) than monofocal IOLs. Trifocal IOLs ranked highest in spectacle independence at various distances (AT LISAtri 839MP group: SUCRA 97.5% for distance, 80.7% for intermediate; AcrySof IQ PanOptix group: SUCRA 83.0% for near).

CONCLUSIONS

For cataract patients who want to treat presbyopia, trifocal IOLs demonstrated better visual acuity and spectacle independence at near distances. Different types of trifocal IOL characteristics differ. EDOF and enhanced monofocal IOLs have improved visual quality at intermediate distances.Therefore, It is very important to select the appropriate IOLs based on the lens characteristics and patient needs.

Comparison of Early Vision Quality of SBL-2 and SBL-3 Segmented Refractive Lens

PURPOSE

To compare objective quality of vision in patients undergoing phacoemulsification with implantation of a bilateral segmented multifocal intraocular lens (SMIOL).

METHODS

A retro-prospective study included 110 eyes of 55 patients who underwent cataract surgery with bilateral SMIOL implantation. Patients were divided according to the type of implanted intraocular lens into group 1 (SBL-2, 62 eyes) and group 2 (SBL-3, 48 eyes). Postoperatively, monocular and binocular uncorrected distance visual acuity (UCDVA), corrected distance visual acuity (BCDVA), uncorrected intermediate visual acuity (UCIVA, at 66 cm), uncorrected near visual acuity (UCNVA, at 40 cm), corrected near visual acuity (BCNVA) and defocus curve were measured and evaluated. The follow-up period was 6 months.

RESULTS

Mean UCDVA in group 1 (SBL-2) was 0.010 ±0.15 LogMAR monocularly, 0.01 ±0.10 LogMAR binocularly, and in group 2 (SBL-3) was 0.02 ±0.11 LogMAR monocularly and -0.07 ±0.09 LogMAR binocularly. Binocular defocus curves showed that the SBL-3 group performed better than the SBL-2 lens at a vergence of -1.50 D corresponding to 66 cm (center distance), averaging 0.03 ±0.11 LogMAR, while the SBL-2 group averaged 0.12 ±0.14 LogMAR (p = 0.01). The -2.50 D vergence characterizing near vision (40 cm) was achieved by the SBL-2 lens in our study at 0.33 ±0.15 LogMAR and by the SBL-3 lens at 0.00 ±0.11 LogMAR (p = 0.00).

CONCLUSION

Both SMIOLs provided very good vision at all tested distances 6 months postoperatively. The SBL-2 lens performed better in UCIVA, while the SBL-3 lens excelled in UCDVA and UCNVA.

2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management

ABSTRACT

Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.

Defocus Curve and Satisfaction of Patients with Presbyopia After LASIK Using the Differential Modulation of Binocular Longitudinal Spherical Aberration

Purpose

To investigate the visual acuity and satisfaction of patients after Zhang & Zheng's corneal laser-enhanced accommodation refraction Q (ZZ-CLEAR-Q) surgery utilizing differential modulation of binocular longitudinal spherical aberration and determine its clinical significance.

Patients and Methods

This prospective observational study enrolled a consecutive cohort of patients with presbyopia who underwent ZZ-CLEAR-Q surgery between December 2020 and January 2023. The study assessed visual acuity, distance-corrected defocus curve, satisfaction, Q factor, manifest spherical equivalent, and primary spherical aberration, among others, at 3 months postoperatively. Additionally, the study conducted a binocular comparison to analyze the clinical significance of setting the different longitudinal spherical aberrations.

Results

A total of 232 eyes of 116 patients were included. The binocular uncorrected distance visual acuity was 20/20 for all patients. At 3 months postoperatively, the binocular uncorrected near visual acuity was Jaeger 1 for 96% of the patients and Jaeger 2 for 100% of the patients. Furthermore, 93.1% of the patients expressed satisfaction. The monocular distance-corrected defocus curve revealed that the dominant eyes had significantly better visual acuity at 0 D (P<0.001), while the non-dominant eyes had significantly better visual acuity across various defocus levels except 0 and -0.50 D (All P<0.05). At 3 months, there were no significant differences between the expected and achieved manifest spherical equivalents, corneal Q factor values, and ocular primary spherical aberration values of both groups.

Conclusion

Patients with presbyopia who underwent ZZ-CLEAR-Q surgery were likely to achieve normal uncorrected visual acuity and be satisfied. The increased depth of field has clinical significance for assisting near vision.

IRIS® Registry (Intelligent Research In Sight) Analysis of the Incidence of Monovision in Cataract Patients with Bilateral Monofocal Intraocular Lens Implantation

Purpose

To determine the incidence of pseudophakic monovision among patients bilaterally implanted with monofocal intraocular lenses (IOLs) and to characterize the distribution of myopic offsets achieved.

Patients and Methods

This retrospective database study included data on patients receiving care from ophthalmologists who contributed to the Academy IRIS® (Intelligent Research In Sight) Registry. Anonymized data were collected, including patient age, ethnicity, procedure data (CPT code, date, laterality), and postoperative manifest refractive spherical equivalent (MRSE) in both eyes implanted with monofocal or monofocal toric IOLs. No data regarding IOL manufacturer, model, or power were collected. One primary outcome measure was the percentage of patients achieving monovision (defined as emmetropia within ±0.25 diopters [D] in one eye and a myopic offset of ≥0.50 D in the fellow eye) among all patients receiving bilateral monofocal IOLs at the time of cataract surgery between January 1, 2016, and September 1, 2019, with at least 90 days of follow-up. Other primary outcomes included the distribution and frequency of myopic offsets (anisometropia) between eyes.

Results

Of the 16,765 people receiving bilateral monofocal IOLs within the study period, 4796 (28.6%) achieved emmetropia in at least one eye, as defined by an MRSE within ± 0.25 D. The incidence of monovision among these patients was 34.2% (1638/4796). One-quarter (24.7%; 405/1638) of patients who achieved monovision had a myopic offset between 0.50 and 0.74 D, with more than one-third (35.2%; 576/1638) falling within 0.75-1.24 D and 18.0% within 1.25-1.74 D. A myopic offset ≥1.75 D was observed in 22.1% (362/1638) of patients who achieved monovision.

Conclusion

Pseudophakic monovision for presbyopia correction was achieved in ~34% of patients in the IRIS Registry bilaterally implanted with monofocal IOLs, with myopic offsets typically ranging from 0.5 to 1.24 D.

Clinical outcomes with an aspheric monofocal and a new enhanced monofocal intraocular lens with modified optical profile

PURPOSE

This study aimed to evaluate and compare the clinical outcomes obtained after cataract surgery with an aspheric monofocal intraocular lens (IOL) and an enhanced IOL with a modified optical profile.

METHODS

Randomised clinical trial enrolling 70 patients (age, 52-87 years) undergoing cataract surgery. Two groups were created according to the type of IOL implanted: Vivinex iSert from Hoya Surgical Optics (Vivinex group, 35 patients) and Tecnis Eyhance ICB00 from Johnson & Johnson Vision (Eyhance group, 35 patients). Uncorrected (UDVA) and corrected distance visual acuity (CDVA), uncorrected (UIVA) and distance-corrected intermediate visual acuity (DCIVA), refraction, and self-perceived visual function (Catquest-9SF) were evaluated during a 3-month follow-up.

RESULTS

No significant differences were found between IOL groups in UDVA and CDVA (p ≥ 0.093). In contrast, monocular and binocular UIVA and DCIVA were significantly better in the Eyhance group at 1 (p ≤ 0.015) and 3 months postoperatively (p ≤ 0.002). Postoperative DCIVA 20/25 or better was obtained in 71.4% and 20.0% of patients in Eyhance and Vivinex groups, respectively. Differences in postoperative Rasch calibrated Catquest scores between Eyhance and Vivinex groups did not reach statistical significance (p ≥ 0.102). However, significant correlations were only found between the change in UIVA and Catquest scores (0.364 ≤ r ≤ 0.444, p ≤ 0.041) in the Eyhance group.

CONCLUSIONS

The modified monofocal IOL evaluated provides better intermediate visual function in comparison with a standard aspheric monofocal IOL, but the impact of this benefit on the self-perceived level of vision achieved after surgery according to the patient seemed to be limited.

Enhancing Intermediate Vision in Patients Affected by Epiretinal Membrane Treated by Phaco-Vitrectomy

BACKGROUND

The aim of this research was to see if a refractive enhanced monofocal IOL (Eyhance IOL, IOL Abbott Medical Optics, Inc., Santa Ana, CA, USA) can provide better intermediate vision in patients undergoing phaco-vitrectomy due to cataract and epiretinal macular membrane (ERM).

METHODS

A nonrandomized prospective observational comparative study enrolled patients affected by cataract and ERM undergoing phaco-vitrectomy. A follow up of 6 months was established. Corrected and uncorrected visual acuity of both monocular and binocular types were assessed regarding intermediate and far distances. The CATQUEST 9-SF questionnaire was administered preoperatively and at the last follow-up.

RESULTS

Twenty-three eyes of twenty-three patients were enrolled, with 11 in the enhanced monofocal group. The uncorrected and corrected distance visual acuity after 6 months was not statistically different. Both monocular and binocular uncorrected intermediate visual acuity after 6 months were higher in the enhanced monofocal group (p < 0.001). The corrected intermediate visual acuity after 6 months was higher in the enhanced monofocal group (p = 0.01). The CATQUEST-9SF questionnaire showed significant differences in the variation between the preoperative condition and six-month postoperative results (p < 0.001).

CONCLUSIONS

This refractive enhanced monofocal IOL can provide better intermediate vision compared to a standard monofocal IOL in patients undergoing phaco-vitrectomy due to cataracts and ERM. Further studies are necessary to confirm these results.

ESCRS Clinical Trends Survey 2016-2021: 6-year assessment of practice patterns among society delegates

PURPOSE

To evaluate clinical opinions and practice patterns of delegates to the ESCRS.

SETTING

Clinical Trends Surveys were administered during annual ESCRS congresses held between 2016 and 2021, and data collected online and in-person.

DESIGN

Survey questions addressed several specialty areas, including cataract surgery, presbyopia-correcting and toric intraocular lenses (IOLs), ocular surface disease, and glaucoma.

METHODS

Survey results were compared and analyzed across 6 years. 4 main profile questions were used for cross-tabulation analyses of questions pertaining to refractive surgery-practice location, years in practice, primary surgery setting, and average annual volume of cataract surgery.

RESULTS

The highest number of responses (3019) was collected in 2019, with the lowest (569) received in 2020. The use of presbyopia-correcting and toric IOLs has increased significantly from 2016 to 2021, with certain respondent segments using them more frequently than others. Although optical biometry remains the preferred method for obtaining preoperative measurements, the use of tomography (Scheimpflug) has significantly increased. In 2021, 61.1% and 44.9% of respondents always performed preoperative checks of the ocular surface before refractive and cataract surgery, respectively. The number of respondents who perform glaucoma surgery has significantly decreased over the years, with an increasing number of delegates reporting having only a medical glaucoma practice. On average, 5.4% of patients with cataract and glaucoma underwent combined minimally invasive glaucoma surgery and cataract procedures in 2021.

CONCLUSIONS

Evaluation of the Clinical Trends Survey data provides valuable insights into the shifting practice patterns and clinical opinions of ESCRS delegates.

Defocus Curve of Emerging Presbyopic Patients

Purpose

To create a defocus curve of emerging presbyopic patients of various age groups.

Setting

Single site private practice in Sioux Falls, South Dakota.

Design

This was a non-randomized, prospective study. All subjects were enrolled from healthy volunteers.

Methods

Subjects aged 37-9, 40-42, 43-45 and 46-48 that have 20/20 best-corrected distance visual acuity (BCDVA) were included. Binocular visual acuity at different defocus steps ranging from +0.5 D to -3 D was measured in each age group. Defocus curves were generated from the mean logMAR visual acuities at each defocus step, by age group.

Results

Of the 60 subjects, 23.3% of subjects were between the ages of 37-39, 26.7% were between the ages of 40-42, 25% of subjects were between ages 43-45, and 25% were between the ages of 46-48. Visual acuity significantly decreased from plano to -3 D defocus steps in all groups (p < 0.0002, p = 0, p = 0 and p = 0). The 46-48-year-old group had worse visual acuity compared to the other three groups from the -1.0 to -2.0 D defocus steps (p = 0.037, p = 0.022 and 0.017, respectively). Starting at a near point of 40cm, the 37-39 group had the best logMAR vision and the 46-48 group had the worst vision (p = 0.001).

Conclusion

The defocus curves of emerging presbyopic individuals demonstrate a decreasing visual acuity at near defocus steps that decreases with age. Defocus curves at different age ranges can help doctors explain various presbyopia treatment options in terms of near point capabilities at various ages.

Vitrectomy Improves Contrast Sensitivity in Multifocal Pseudophakia With Vision Degrading Myodesopsia

PURPOSE

Multifocal intraocular lenses (MFIOL) are associated with degradation in contrast sensitivity function (CSF); yet the contribution of vitreous is not known, nor is the benefit of vitrectomy.

DESIGN

Prospective, nonrandomized clinical study.

METHODS

A total of 180 eyes of 180 patients (55 MFIOL, 60 monofocal intraocular lenses [MIOL], 65 phakic) with symptomatic vitreous opacities were enrolled. Vitreous structure was assessed with quantitative ultrasonography (QUS). Vision was evaluated with visual acuity and CSF measurements.

RESULTS

Vitreous echodensity was the same in all lens cohorts, yet CSF was worse in MFIOL eyes (P < .001). In 86 patients who elected vitrectomy, there was 68% greater vitreous echodensity and 31% worse CSF than in observation controls (P < .0001 for each). Preoperatively, CSF was 25% worse in MFIOL than in MIOL (P = .014). Postoperatively, vitreous echodensity decreased by 55%, 51%, and 52%, whereas CSF improved by 37% 48% in and 43% in MFIOL, MIOL, and phakic eyes, respectively (P < .0001 for each). NEI Visual Function Questionnaire analyses showed improved visual well-being.

CONCLUSIONS

Patients with vision degrading myodesopsia who elected vitrectomy had greater vitreous echodensity and worse CSF than controls, but no other differences in age, sex, or myopia. MFIOL eyes had worse CSF than MIOL and phakic eyes, very possibly due to combined effects of the MFIOL and vitreous opacification. Limited vitrectomy reduced vitreous echodensity and improved CSF in all eyes. All patients with CSF-degrading vitreous opacities benefited from limited vitrectomy, including those with MFIOL. As MFIOL eyes had 37% improvement in CSF, patients with MFIOL and vision degrading myodesopsia merit consideration of vitrectomy.

Geometric-phase intraocular lenses with multifocality

We demonstrate a new type of multifocal and extended depth of focus (EDOF) intraocular lenses (IOLs) embedding μm-thin geometric phase (GP) lens layers. As an emerging approach for lens phase design, the GP modulated IOLs outperform conventional diffractive IOLs in multifocality while completely avoiding the clinically undesirable demand for additional surface patterns to standard monofocal IOL designs. The number of foci and light splitting ratio of the GP IOLs are adjusted by changing the number of stacked GP layers and the thickness of each layer. Bifocal and trifocal GP IOLs are fabricated by radial alignment of anisotropic orientation in UV-curable liquid crystal polymers. After characterizing the defocus image and modulation transfer function of the GP IOLs, it is expected that GP IOLs will alleviate the most common problems associated with multifocal and EDOF IOLs, blurred vision and photic phenomena caused by light scattering and posterior capsule opacification.

Clinical outcomes of new multifocal intraocular lenses with hydroxyethyl methacrylate and comparative results of contrast sensitivity, objective scatter, and subjective photic phenomena

Background

We investigate the performance of new hydrophobic diffractive multifocal intraocular lenses (IOL) with hydroxyethyl methacrylate (HEMA) and compare their optical quality, contrast sensitivity, and subjective photic phenomena.

Methods

Medical records of patients who underwent routine simple cataract surgery and insertion of an existing multifocal IOL (TFNT, TF group) or a new multifocal IOL (CNWT, CN group) were retrospectively reviewed. Clinical data was collected 2 months postoperatively and included optical quality analysis system (OQAS) indices, contrast sensitivity, and subjective degrees of photic phenomena.

Results

One hundred thirty-five eyes of 135 patients were included (CN group, 71; TF group, 64). There was no significant difference between the two groups in the visual acuity and defocus curve. The indices of OQAS did not show a significant difference between groups. Contrast sensitivity was significantly better in the CN group at all degrees, including the area under the log contrast sensitivity function (p = 0.01). The subjective photic phenomena survey showed better results for the CN group, with the proportion of patients reporting no photic phenomena as 9.9% and 3.1% in the CN and TF groups, respectively. The proportion of patients who reported severe photic phenomena was 11.3% in the CN group and 25.0% in the TF group. Although the follow-up period was only 2 months, glistening, surface scattering, and posterior capsule opacity were not observed in any patient.

Conclusions

The new multifocal IOL with HEMA is safe, and provides stable visual acuity as well as superior contrast sensitivity and lower subjective photic phenomena, over the prior IOL.

Evaluation of Visual and Patient-Reported Outcomes, Spectacle Dependence after Bilateral Implantation with a Non-Diffractive Extended Depth of Focus Intraocular Lens Compared to Other Intraocular Lenses

Purpose: To evaluate postoperative outcomes, spectacle dependance and the occurrence of the photic phenomena in patients after cataract surgery following the implantation of a non-diffractive extended depth of focus (EDOF) intraocular lens was compared to monofocal and multifocal lenses. Methods: We enrolled patients with bilateral cataracts who wanted to reduce their dependence on glasses in the study. They were followed for 6 months. The study group in which the EDOF lens was implanted consisted of 70 eyes in 35 patients. The control groups consisted of: 52 eyes in 26 patients in whom a multifocal was implanted and 52 eyes in 26 patients with implanted monofocal lens. After a total of 2 weeks, 2 months and 6 months post-surgery the following were evaluated: uncorrected and corrected visual acuity at 4 m, 80 cm, 40 cm, manifest refraction expressed as mean refractive spherical equivalent (MRSE), contrast sensitivity, intraocular pressure. A questionnaire on independence from ocular correction, the occurrence of photic phenomena, and patient satisfaction was also completed. Results: Monocular and binocular visual acuity and MRSE 6 months after the procedure were compared between three groups. All of the main analyses, except for comparisons of uncorrected distance visual acuity (both monocular and binocular) level, were significant. Contrast sensitivity was lower among patients with multifocal lens than among patients with EDOF lens. Halo and glare after 6 months were seen more often among patients with multifocal lens than among patients with the other lens (65% of eyes with multifocal lens vs. 6% of eyes with EDOF lens and 0% of eyes with monofocal lens). Glasses were needed by 35% of patients with EDOF lens, and by 96% of patients with monofocal lens and in none of the patients with multifocal lens. Conclusions: Most patients qualify for the implantation of a non-diffractive EDOF lens. Post-operative visual acuity improves at any distance. The best monocular visual acuity for intermediate distances is provided by an EDOF lens, and for near distance by a multifocal lens. The EDOF lens definitely increases independence from spectacle correction compared to monofocal lenses; however, the greatest degree of independence from spectacles is provided by multifocal lenses. The incidence of photic phenomena is slightly higher than that of a monofocal lens, and much lower for a multifocal lens.

PresbyPRK vs presbyLASIK using the SUPRACOR algorithm and micromonovision in presbyopic hyperopic patients: visual and refractive results at 12 months

PURPOSE

To compare the visual outcome and refractive results between presbyopic photorefractive keratectomy (presbyPRK) and presbyopic laser in situ keratomileusis (presbyLASIK) in presbyopic hyperopic patients using micromonovision and the SUPRACOR algorithm.

SETTING

Percy Military Hospital and private Laser Victor Hugo Center, France.

DESIGN

Observational retrospective nonrandomized.

METHODS

Twenty-three patients who had undergone presbyPRK or presbyLASIK were included and followed up for 12-months. Far and near visual acuity without correction in monocular and binocular, measurement of distance visual acuity with correction in monocular, evaluation of spherical equivalent (SE), aberrometry, and patient satisfaction were measured and analyzed in this study.

RESULTS

The study included 26 eyes of 13 patients in the presbyLASIK group and 20 eyes of 10 patients in the presbyPRK group. The mean age was 55.43 ± 4.6 years. Uncorrected binocular distance visual acuity was 0.030 ± 0.05 logMAR in the presbyLASIK group and 0 logMAR in the presbyPRK group (P = .066). Binocular near visual acuity without correction was 0.21 ± 0.11 logMAR in the presbyLASIK group and 0.30 ± 0.15 logMAR in the presbyPRK group (P = .0398). For the dominant eyes, the SE was -0.08 ± 0.48 diopters (D) in the presbyLASIK group and 0.16 ± 0.82 D in the presbyPRK group (P = .3995). For nondominant eyes, the SE was -0.44 ± 0.50 D in the presbyLASIK group and 0.12 ± 0.65 D in the presbyPRK group (P = .0254).

CONCLUSIONS

PresbyPRK and presbyLASIK were comparable in efficacy, stability, predictability, and safety. PresbyPRK could be a safe and effective surgical alternative for the hyperopic presbyopic patient.

Visual Performances of a New Extended Depth-of-Focus Intraocular Lens with a Refractive Design: A Prospective Study After Bilateral Implantation

Purpose

The aim of the present study was to evaluate the visual outcome of a new extended depth-of-focus (EDOF) intraocular lens (IOL) after bilateral implantation. A qualitative and quantitative analysis was performed and data were compared with those given by other studies regarding multifocal IOLs, which have the same purpose of giving spectacle independence to the patients.

Methods

The study enrolled 40 eyes of 20 patients who underwent cataract surgery with bilateral implantation of an EDOF IOL (Evolve Soleko, Rome, Italy). The mean age was 74.5±9 years (range 59-83ys). Refractive outcomes and contrast sensitivity were evaluated preoperatively and at 6-month follow-up. We also examined reading speed, glare, halos, difficulties in the night driving, the requirement for spectacles, and overall satisfaction with vision. Two questionnaires were administered for this purpose.

Results

At 6 months, the percentage of eyes within ±0.50 diopters (D) from emmetropia was 82.5%. Of all patients, 90% were satisfied with their vision. The percentage of spectacle-free for near and distance vision patients was 70% and 95%, respectively. A postoperative binocular uncorrected 60cm intermediate visual acuity (UI60VA) of 0.2 logMAR or better was achieved in 92% of patients. Contrast sensitivity significantly improved postoperatively (p<0.001) and mean reading speed was good.

Conclusion

This new EDOF IOL seems to provide an effective alternative to patients who desire a spectacle-free lifestyle postoperatively. These lenses can supply a satisfactory distance, intermediate and near vision, and retain good contrast sensitivity, with most patients reporting excellent satisfaction.

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.

Use of presbyopia-correcting intraocular lenses in patients with prior corneal refractive surgery

PURPOSE OF REVIEW

Corneal refractive surgery has achieved spectacle-free vision for millions of patients, but this aging population is now developing cataracts. Many of these patients may wish to avoid reliance on glasses after cataract surgery. Presbyopia-correcting intraocular lenses (IOLs) offer a solution, but corneal changes after refractive surgery may compound higher order aberrations and dysphotopic symptoms associated with these IOLs. This review aims to discuss potential factors that could aid in determining suitable postkeratorefractive candidates for presbyopia-correcting IOLs.

RECENT FINDINGS

Studies investigating which preoperative measures influence outcomes are lacking. The few studies that have examined presbyopia-correcting IOLs in postkeratorefractive patients report that satisfactory outcomes are possible. However, recommendations for preoperative thresholds appear limited to expert opinion and studies involving virgin corneas.

SUMMARY

As the number of presbyopia-correcting IOLs and postkeratorefractive patients grows, continued investigation into relevant preoperative factors and appropriate IOLs is required to make evidence-based decisions. The current literature shows that with rigorous counseling and appropriate patient selection, presbyopia-correcting IOLs can provide postkeratorefractive patients with satisfactory results and spectacle independence. In addition, the development of postoperative modifiable IOLs may prove to be the preferred option.

Multifocal and Extended Depth-of-Focus Intraocular Lenses in 2020

Ophthalmic surgeons have been overwhelmed by the influx of multifocal intraocular lens (IOL) options in recent years, with close to 100 IOLs on the market in 2020. This practical and technical update on a representative group of established as well as newly launched multifocal IOLs on the market focuses on multifocal IOLs, including extended depth-of-focus lenses. We also describe the optical basis of lens platforms used and thorough preoperative planning to aid decision making. This allows the surgeon the knowledge base to deliver the required relative customized spectacle independence with the least photic phenomenon and loss of contrast possible while achieving high individual patient satisfaction. Data of reviewed IOLs displayed in tabular format include mean monocular uncorrected distance, intermediate, and near visual acuities (logarithm of the minimum angle of resolution), with standard deviations and ranges where available. The range of vision targeted, pupil dependence, toric availability, as well as type of optical platform, are provided as a practical guide to demystify existing terminology on the market that may create interest around a seemingly new design that is actually not novel at all. Halos and glare experienced, levels of patient satisfaction, and spectacle independence achieved also are summarized. A wide range of multifocal IOLs options are available on the market to surgeons. Comprehensive patient selection and examination, combined with knowledge of the most recent options and adequate patient counseling, including neuroadaptation, can avoid dissatisfaction. Many recently available IOLs are awaiting formal results, but the methods by which we label and compare these types of IOLs must also be standardized.