Visual performance after bilateral implantation of a new diffractive aspheric multifocal intraocular lens with a 3.5 D addition

Biometric factors associated with the postoperative visual performance of a multifocal intraocular lens

Purpose

To identify the biometric factors associated with postoperative visual performance after uneventful phacoemulsification with multifocal intraocular lens (MIOL) implantation.

Methods

In this retrospective cohort study, 72 eyes of 72 patients implanted with the HumanOptics Diff-aAY MIOL were included. Preoperative examination data including the white-to-white distance (WTW), anterior chamber depth (ACD), axial length and corneal astigmatism were gathered through the electronic medical records. One month postoperatively, the pupil parameters, corneal aberrations, corneal astigmatism, IOL tilts and IOL decentrations were measured using an OPD-Scan III aberrometer. Postoperative visual performance parameters were recorded as the visual acuity, depth of focus, modulation transfer function (MTF) and point spread function (PSF) values, area under log contrast sensitivity function (AULCSF), retinal straylight and visual function questionnaire scores. Univariate and multivariate linear regression analyses were then performed to evaluate the associations between the potential biometric factors and postoperative visual outcomes.

Results

Younger age predicted greater MTF and PSF values, better AULCSF and better retinal straylight (P < 0.05). A lower corneal trefoil predicted better MTF and PSF values (P < 0.05). Smaller IOL decentration predicted better distance-corrected near visual acuity, greater AULCSF and better retinal straylight (P < 0.05). A less negative spherical equivalent (SE) predicted better MTF values (P = 0.017), while a more negative SE predicted better Visual Function Index-14 (VF-14) questionnaire scores and satisfaction scores (P < 0.05). A higher IOL power predicted better best corrected distance visual acuity (P = 0.005). Lower preoperative corneal astigmatism predicted greater MTF values (P = 0.020). Lower postoperative corneal astigmatism, smaller corneal high-order aberrations (HOAs), smaller photopic pupil size, larger WTW and deeper ACD predicted a better AULCSF (P < 0.05).

Conclusions

IOL decentration, IOL power, age, preoperative and postoperative corneal astigmatism, SE, photopic pupil size, corneal trefoil, WTW, ACD and corneal HOAs were significantly associated with postoperative visual performance. These findings might aid in patient selection prior to MIOL implantation.

The impact of corneal higher-order aberrations on dynamic visual acuity post cataract surgery

Purpose

To explore the influence of corneal higher-order aberrations (HOAs) on dynamic visual acuity (DVA) post cataract surgery.

Methods

A total of 27 patients with 45 eyes following cataract surgery were included in this study. The postoperative monocular object-moving DVA at the velocity of 20, 40, and 80 degrees per second (dps) were examined at 1 month. The total corneal HOAs were measured with Scheimpflug-based corneal topography. The correlation between postoperative DVA and HOAs was analyzed.

Results

Significant difference was shown among DVA at different velocities (P < 0.001). The 20 dps DVA was significantly better than 40 (P < 0.001) and 80 (P < 0.001) dps DVA. No significant difference was observed between 40 and 80 dps DVA (P = 0.420). The vertical coma and the root mean square (RMS) of coma (RMScoma) were statistically correlated with 80 dps DVA (P < 0.05). The vertical trefoil, RMStrefoil and total RMSHOA were statistically correlated with 40 and 80 dps DVA (P < 0.05). The spherical aberration was not significantly associated with postoperative DVA (P > 0.05 for all velocites). The multivariate linear regression model revealed that age was a significant influential factor for 20 dps DVA (P = 0.002), and RMStrefoil (4 mm) and age were significantly associated with 40 and 80 dps DVA (P ≤ 0.01).

Conclusion

The research demonstrated that larger corneal HOAs, especially coma and trefoil aberrations were significantly associated with worse high-speed DVA, but not spherical aberration post cataract surgery.

Evaluation of extended depth-of-focus hydrophobic intraocular lens with an optic concept based on combination of high-order aberrations

Background

Extended depth-of-focus (EDOF) intraocular lenses (IOLs) provide a continuous range of uncorrected vision at different distances.

Objective

To assess visual acuity, refractive outcomes, and patient satisfaction after cataract surgery using the LuxSmart EDOF IOL (Bausch+Lomb).

Design

A two-center, prospective observational clinical study.

Methods

This study includes patients who have undergone bilateral phacoemulsification with bilateral implantation of the LuxSmart EDOF IOL, with the aim of achieving emmetropia. Visual acuity (VA) and subjective refraction were obtained in all patients preoperatively and at 1 week, 1 month, 3 months, and 6 months postoperatively. Subjective measures were obtained using the Catquest-9SF questionnaire and the Patient-Reported Spectacle Independence Questionnaire (PRSIQ). Contrast sensitivity and a glare assessment were undertaken postoperatively. Safety outcomes were additionally assessed.

Results

Sixty eyes from thirty patients were recruited for this study. The mean spherical equivalent was 1.04 ± 1.67 D preoperatively and -0.30 ± 0.46 D at 6 months. Monocular uncorrected distance VA was 0.57 ± 0.32 (logMAR) preoperatively and 0.09 ± 0.12 (logMAR) at 6 months. Mean 6-month monocular uncorrected VA was 0.11 ± 0.13, 0.12 ± 0.15, and 0.31 ± 0.15 (logMAR) at 80, 66, and 40 cm, respectively. More than 90% of patients were either fairly or very satisfied with their vision. There was one case of suspected vitreomacular traction postoperatively.

Conclusion

The LuxSmart EDOF IOL offers good refractive, VA, and safety outcomes. The single elongated focal point designed to enhance the DOF shows good results for VA and patient satisfaction.

Defocus curves: Focusing on factors influencing assessment

ABSTRACT

Defocus curve assessment is used to emulate defocus over a range of distances and is a valuable tool that is used to differentiate the performance of presbyopia-correcting intraocular lenses. However, defocus curves are limited by a lack of standardization, and multiple factors can impact their generation and interpretation. This review discusses key factors that influence the assessment of defocus curves, including pupil size, level of contrast, sphere versus cylinder defocus, viewing distance, monocular versus binocular assessment, use of Snellen versus logarithm of the minimum angle of resolution charts, and diopter range and step size. There are also different methods to analyze defocus curves, including the direct comparison method, range-of-focus analysis, and area under the curve analysis, which can impact result interpretation. A good understanding of these factors and standardization of the methodology are important to ensure optimal cross-study comparisons.

Long-term performance of a diffractive-refractive trifocal IOL with centralized diffractive rings: 5-year prospective clinical trial

PURPOSE

To report the 5-year visual, refractive, and patient-reported outcomes following implantation of a trifocal intraocular lens (IOL) during cataract surgery.

SETTING

Csolnoky Ferenc University Hospital, Veszprém, Hungary.

DESIGN

Prospective, longitudinal, single-center, interventional study.

METHODS

100 eyes of 50 patients underwent bilateral implantation of a trifocal IOL during cataract surgery. Preoperative corrected distance (CDVA) and postoperative uncorrected distance visual acuity (UDVA), CDVA, uncorrected (UIVA) and corrected (CIVA) intermediate and uncorrected (UNVA) and corrected (CNVA) near visual acuity were collected. All subjects were seen at day 1, 1 month, 3 months, 6 months, 12 months, and 24 months, and at year 5. Contrast sensitivity, slitlamp photography, and quality of vision questionnaire were performed at months 3, 6, 12, and 24 and at year 5. Of these 50 patients, 41 completed their 5-year follow-up.

RESULTS

At year 5, 74 eyes of 37 patients were analyzed. The mean postoperative UDVA was 0.02 ± 0.10 (logMAR). The mean CDVA was -0.04 ± 0.07. The mean UIVA was 0.04 ± 0.09. The mean CIVA was 0.00 ± 0.08. The mean UNVA was 0.09 ± 0.09. The mean CNVA was 0.05 ± 0.07. Mesopic and photopic contrast sensitivity values were in the upper third range of the age-matched normal values.

CONCLUSIONS

5-year prospective study data showed that bilateral implantation of a diffractive-refractive trifocal IOL with centralized diffractive rings provided good functional vision at all distances. There was high level of spectacle independence and patient satisfaction with minimal levels of dysphotopsia.

Comparison of an aspheric monofocal intraocular lens with the new generation monofocal lens using defocus curve

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.

Comparison of Post-Cataract Surgery Visual Outcomes and Quality of Life in Patients Bilaterally Implanted with Multifocal Intraocular Lenses

Introduction

The present study compared visual outcomes in eyes with bilateral implantation of two multifocal intraocular lenses (MFIOLs)—the Eyecryl™ ACTV diffractive multifocal IOL (group 1) and AcrySof^® IQ ReSTOR^® multifocal IOL (group 2).

Methods

This was a prospective, two-group observational longitudinal study of 118 eyes from 59 patients conducted at Laxmi Eye Institute, Panvel, India. We evaluated the patients at 1, 3, and 6 months. We assessed visual acuity, contrast sensitivity, higher-order aberrations, reading speed, defocus curve, stereopsis, quality of life (QOL), and adverse events in these participants.

Results

The median (interquartile range) best-corrected distance visual acuity was 0.18 (0, 0.18) in group 1 and 0.18 (0, 0.18) in group 2 at 1, 3, and 6 months; the difference was not statistically significant (p = 0.48). The binocular defocus curve in both groups showed two peaks at 0.0 to −0.5 D and at −2.5 D. The mean (95% confidence interval) critical print size was significantly different between groups 1 and 2 at low illumination (0.918 [0.905, 0.931] vs 1.154 [1.128, 1.180]; p = 0.004). Contrast sensitivity was significantly better in group 1 under mesopic conditions but not under scotopic conditions. Though total QOL did not differ significantly between groups, the psychosocial quality of life was significantly better in group 1. About 23% of patients in group 2 reported unwanted images, compared with 0% in group 1 (p = 0.01).

Conclusion

We found that the Eyecryl and AcrySof groups were comparable for best-corrected visual acuity, photopic contrast sensitivity, defocus curve, reading parameters, stereopsis, and quality of vision. However, the Eyecryl group had better mesopic contrast and a lower proportion of unwanted images. Psychosocial quality of life was significantly better in the Eyecryl group; however, satisfaction was similar between groups. The cost of one of the lenses is less than the other. Thus, individuals with limited resources may opt for the Eyecryl™ ACTV, with similar visual outcomes.

Lens-based surgical correction of presbyopia. Where are we in 2020?

INTRODUCTION

Presbyopia is the progressive and irreversible loss of accommodation due to aging. It is one of the main causes of loss of quality of life in people from 45 years of age, due to the, often novel, dependence on spectacles. The eagerness to correct it by ophthalmologists impulsed by the desire of millions of people who suffer from it, has become one of the main drivers for the development of intraocular lens (IOL) technology over the last twenty years.

MATERIAL AND METHODS

This review briefly presents the different alternatives that have allowed us to improve the crystalline lens surgical approach of presbyopia; from monofocal lenses and monovision technique, accommodative, refractive, and diffractive multifocal lenses, and finally the most recent extended depth of focus/field lenses known as EDOFs.

RESULTS

Each IOL has its advantages, limitations and disadvantages. Furthermore, there is no single lens that suits the needs of all patients.

CONCLUSIONS

It is necessary to know the variety of lenses available, and to have an in-depth understanding of their optical properties, as well as the impact that these will have later on their clinical performance and on the visual quality of the patients. This should help us to select the best alternative for each of them.

[Current Review: Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses]

Presbyopia and cataract patients' wish to be increasingly independent of spectacles after surgery and this is one of the main drivers for the development of multifocal intraocular lenses (MIOL) and extended depth of focus (EDOF) intraocular lenses (IOL). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract refractive surgeons to help address this need. There is not one single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOL and EDOF IOL, their optics, and their impact on our patients' quality of vision have to be fully understood if we have to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOL/EDOF IOL, in order to help surgeons find an appropriate solution for each of their individual patients.

Clinical outcomes of a new diffractive multifocal intraocular lens

AIM

To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL) with +3.00 addition power.

METHODS

This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK) multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE)], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ)-25 questionnaire] were retrieved from electronic medical records and analyzed.

RESULTS

Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82) were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D) and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10%) visual acuity remained stable (P=0.54) through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12.

CONCLUSION

The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.

Multifocal Intraocular Lenses and Extended Depth of Focus Intraocular Lenses

Presbyopia and cataract patients' desire for increased spectacle independence after surgery is one of the main drivers for the development of multifocal intraocular lenses (MIOLs) and extended depth of focus (EDOF) intraocular lenses (IOLs). As education, biometry, diagnostics, surgical techniques, and MIOL/EDOF IOL designs have improved over the past decade, an increasing number of cataract surgeons have become cataract-refractive surgeons to help address this need. There is not 1 single MIOL/EDOF IOL, however, that suits all patients' needs. The wide variety of MIOLs and EDOF IOLs, their optics, and their respective impact on our patients' quality of vision have to be fully understood to choose the appropriate IOL for each individual; MIOL/EDOF IOL surgery has to be customized. This review article looks at the different optical aspects and clinical consequences of MIOLs/EDOF IOLs to help surgeons find an appropriate solution for each of their individual patients.

[Clinical results of a multifocal pseudophakic additional lens]

BACKGROUND

In order to meet the patients wish for compensation of presbyopia in a flexible way, even in cases of an already pseudophacic eye, sulcus-fixated additional intraocular lenses (IOL) have been developed as an alternative to multifocal IOLs (MIOL) in the capsular bag. This allows subsequent application of multifocal optics. Furthermore, these additional lenses offer a relatively simple opportunity for postoperative refractive fine tuning or, in cases of incompatibility, a minimally invasive explantation of the multifocal part of the optical system.

PURPOSE

The objective of our work was the examination of a diffractive multifocal additional IOL and its functional characteristics.

MATERIAL AND METHODS

In a prospective, monocentric trial 32 eyes of 21 patients had cataract surgery with implantation of a monofocal IOL into the capsular bag and simultaneous implantation of a multifocal additional IOL into the sulcus. The visual acuity was tested at different distances 6 weeks and 3 months postoperatively. At the 3 month follow-up contrast sensitivity and defocus curves were additionally assessed. Patients with bilateral implantation filled in a questionnaire to assess their subjective satisfaction of postoperative visual quality.

RESULTS

All eyes had an uneventful postoperative course. At both follow-ups an uncorrected distance and near visual acuity (VA) of 0.2 LogMAR or better was achieved. In intermediate vision 29 out of 32 eyes after 6 weeks and 31 out of 32 eyes after 3 months reached an uncorrected VA of 0.2 LogMAR or better. The defocus curves showed a typical two-peaked shape. At intermediate distance (-1.5 D of defocus) the median VA was 0.35 LogMAR. Contrast sensitivity testing showed results in the upper region of the standard range of age-matched, healthy patients.

DISCUSSION

The examined type of diffractive additional IOL achieved good to very good functional results, which are comparable to corresponding IOLs in the capsular bag. Multifocal additional IOLs can be considered as a useful extension of refractive surgical alternatives for the compensation of presbyopia. The possibility to implant the multifocal optic part independently of the primary surgery, the minimal invasivity of the procedure and the likewise time-independent reversibility can be pointed out as special qualities of these IOL.

Visual and optical performances of multifocal intraocular lenses with three different near additions: 6-month follow-up

Purpose :

To compare the visual and optical outcomes of four multifocal intraocular lenses (IOLs) with three different near additions of +3.00 diopters (D), +3.75 D and +4.00 D.

Methods :

In this prospective study, 133 eyes of 88 patients were implanted with one of the following IOLs: AcrySof^® ReSTOR^® SN6AD1 (+3.00 D) for Group A, Acriva^UD Reviol BB MF 613 or BB MFM 611 (+3.75 D) for Group B, and AcrySof^® ReSTOR^® SN6AD3 (+4.00 D) for Group C. The visual acuity, refraction, intraocular pressure, tomography and corneal endothelial cell density (ECD) were compared between the three groups preoperatively and at 6 month postoperatively. Defocus curve, contrast sensitivity and higher order aberrations (HOAs) at 6 month postoperative visit were measured and compared.

Results :

There were no statistically significant differences in distance visual acuity, refraction, intraocular pressure or ECD among the three groups after 6 months (P > 0.05). The photopic contrast sensitivity in Group C was statistically better than in Group A (P < 0.05). The scotopic ocular aberration in Group B was statistically greater compared to that in Group A (P < 0.05). The highest near-visual peaks were -0.06 logMAR at a -2.50 D (40 cm) in Group A, -0.07 logMAR at -3.00D (33 cm) in Group B, and -0.06 logMAR at -3.50 D (29 cm) in Group C. Statistically significant differences in near and intermediate visual acuities were observed among the three groups at -2.00 D (50 cm), -2.50 D (40 cm), -3.50 D (29 cm) and -4.00 D (25 cm) (P < 0.01).

Conclusion :

AcrySof^® ReSTOR^® SN6AD1 IOLs (+3.00 D) and SN6AD3 (+4.00 D) IOLs provided the best intermediate and near vision, respectively. Both intermediate and near vision were comparatively better in the eyes with Acriva^UD Reviol BB MFM 611 IOLs or BB MF 613 IOLs (+3.75 D).