Extended Depth-of-Focus Intraocular Lens Implantation in Patients with Age-Related Macular Degeneration: A Pilot Study

Purpose

To assess visual outcomes of the implantation of a non-diffractive extended depth of focus (EDOF) intraocular lens (IOL) in patients with age-related macular degeneration (AMD).

Setting

Ophthalmology practice, Sydney, Australia.

Design

Retrospective chart review.

Methods

Patients with AMD undergoing cataract surgery and receiving non-diffractive EDOF AcrySof IQ Vivity IOL implantation over a 2-year period were identified. Corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA; 50 cm), contrast sensitivity, central foveal thickness, VF-14 questionnaire results, and quality of life where available were analyzed.

Results

A total of 28 sequential patients (51 eyes) were included in this pilot study (46% male, mean age 77.4 years). Of 27 eyes that had late AMD, 17 (63%) had wet AMD. Mean patient preoperative CDVA was logMAR 0.32±0.29. Postoperative monocular CDVA and DCNVA were logMAR 0.20±0.25 and N9±5 (range N5-N36), respectively. Eyes achieving postoperative CDVA of Snellen 6/5-6/12 (n=42, 82%), 6/15-6/24 (n=7, 14%), and greater than 6/24 (n=2, 4%) achieved a mean DCNVA of N8 (range N5-N10), N13 (range N10-N18), and N27 (range N18-N36), respectively. Eyes achieving CDVA of Snellen 6/5-6/12 showed contrast sensitivity within the normal range. On postoperative VF-14 questionnaire, patients with CDVA of Snellen 6/5-6/12 reported minimal visual impairment, while patients with CDVA greater than 6/15 reported mild impairment. A majority of patients (96%, n=27) were satisfied with the improvement in quality of life postoperatively. No intraoperative complications were reported.

Conclusion

The EDOF AcrySof IQ Vivity IOL provides improved near vision proportional to distance vision in patients with early AMD.

Clinical Outcomes and Quality of Vision Associated with Bilateral Implantation of a Wavefront Shaping Presbyopia Correcting Intraocular Lens

Purpose

To provide normative visual acuity and quality of vision data related to bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens (IOL).

Patients and Methods

This was a non-interventional research study of the refraction, visual acuity (VA) and quality of vision achieved after bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens between 3 months and 12 months post-surgery. The manifest refraction, and uncorrected and distance corrected VA at near, intermediate and distance (40 cm, 50 cm, 66cm, 4 m) were tested. Binocular mesopic VA at 4m and uncorrected photopic low contrast (25%) VA at 4 m were also tested, the latter with and without a glare source. A patient reported outcome questionnaire was administered. Defocus curve testing with and without simulated myopia in the non-dominant eye was also tested (reported elsewhere).

Results

Forty subjects completed the study. There was no statistically significant difference between the uncorrected and distance corrected VA at any distance. Mean logMAR binocular VAs were (−0.07 ± 0.07) at 4 m, (0.00 ± 0.07) at 66 cm and (0.07 ± 0.11) at 40 cm. Uncorrected photopic low contrast VA was statistically significantly better without glare (0.09 ± 0.10) compared to with glare (0.44 ± 0.21, p < 0.01). Reported glare, halos and starbursts were “not at all” Or “a little” bothersome for more than 95% of subjects. Hazy vision and blurred vision were reported most often.

Conclusion

The Vivity IOL provided patients with good distance and intermediate vision, and functional near vision with low reported bother from glare, halos, or starbursts.

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The Effect of Spectacle-Induced Low Myopia in the Non-Dominant Eye on the Binocular Defocus Curve with a Non-Diffractive Extended Vision Intraocular Lens

Purpose

To quantify the changes in the binocular defocus curve associated with the Vivity™ non-diffractive extended vision intraocular lens when the dominant eye was targeted for emmetropia and the non-dominant eye was artificially targeted for slight myopia using spectacles.

Patients and Methods

This was a non-interventional research study of the corrected binocular defocus curve associated with binocular emmetropia (Setting A) and with emmetropia in the dominant eye and two different levels of myopia simulated in the non-dominant eye (−0.50 D, Setting B and −1.00 D, Setting C). Subjects were patients implanted with the AcrySof^® IQ Vivity^® intraocular lens in both eyes 3 to 12 months previously. Using the defocus data, the percentage of subjects with a continuous 2.5 D range of vision (distance to 40 cm) was calculated for various levels of minimum visual acuity (VA).

Results

Forty subjects were enrolled. The mean spherical equivalent refraction was −0.06 D ± 0.36 D, with 0.37 D ± 0.29 D of refractive cylinder. There was no statistically significant difference in the mean VA at −0.25 D or at −0.50 D vergences between the test Settings, but there was a statistically significant difference at all other vergences. Differences were particularly noticeable at −2.00 D, −2.50 D and −3.00 D, where higher myopia in the non-dominant eye yielded better binocular VA. A 2.5 D range of functional vision (20/25) was achieved by 38% of subjects at Setting A, 68% of subjects at Setting B and 85% of subjects at Setting C. At setting C, all but one subject (39/40, 97.5%) had a 2.5 D range of vision with a VA of 20/32 or better.

Conclusion

Significant gains in binocular near vision, with only a nominal effect on distance vision, can be achieved with the Vivity IOL by leaving the non-dominant eye of patients with 0.50 D or 1.00 D of myopia.

Non-Diffractive Bessel Beams for Ultrafast Laser Scanning Platform and Proof-Of-Concept Side-Wall Polishing of Additively Manufactured Parts

We report the potential use of non-diffractive Bessel beam for ultrafast laser processing in additive manufacturing environments, its integration into a fast scanning platform, and proof-of-concept side-wall polishing of stainless steel-based additively fabricated parts. We demonstrate two key advantages of the zeroth-order Bessel beam: the significantly long non-diffractive length for large tolerance of sample positioning and the unique self-reconstruction property for un-disrupted beam access, despite the obstruction of metallic powders in the additive manufacturing environment. The integration of Bessel beam scanning platform is constructed by finely adapting the Bessel beam into a Galvano scanner. The beam sustained its good profile within the scan field of 35 × 35 mm2. As a proof of concept, the platform showcases its advanced capacity by largely reducing the side-wall surface roughness of an additively as-fabricated workpiece from Ra 10 μm down to 1 μm. Therefore, the demonstrated Bessel-Scanner configuration possesses great potential for integrating in a hybrid additive manufacturing apparatus.