Clinical Outcomes of a Bi-Aspheric Trifocal Diffractive Intraocular Lens

Purpose

To assess refractive and visual outcomes post-cataract surgery with bilateral implantation of a bi-aspheric diffractive trifocal intraocular lens (IOL).

Methods

A total of 24 patients who underwent bilateral implantation with the Asqelio Trifocal IOL TFLIO130C were evaluated at the 6 months postoperative mark. Key outcome measures included refractive error, photopic monocular and binocular uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and corrected intermediate visual acuity (UIVA, CDIVA) at 60 cm, and uncorrected and corrected near visual acuity (UNVA, CDNVA) at 40 cm. Additionally, monocular and binocular CDNVA were assessed under mesopic conditions. Monocular and binocular defocus curves, and binocular contrast sensitivity under photopic and mesopic conditions, with and without glare, were measured. Catquest-9SF and visual symptoms questionnaires were also administered.

Results

Postoperative average values of binocular logMAR photopic CDVA, photopic CDIVA, photopic CDNVA and mesopic CDNVA were -0.01±0.06, 0.03±0.09, 0.02±0.05 and 0.19±0.13, respectively. About 100% of patients showed cumulative CDVA and CDNVA ≥20/25, and CDIVA ≥20/32. The average absolute depth-of-focus was about 4.50D. The average postoperative spherical equivalent was 0.05±0.30D and 100% and 93.75% eyes were within ±1.00D and ±0.50D, respectively. Contrast sensitivity was either within or above normal levels under both photopic and mesopic conditions, both with and without glare, except for 12 cpd under mesopic conditions with glare where the mean falls just below the normal range. Questionnaires revealed that 87.5% of patients were either satisfied or very satisfied with their vision after the surgery, and higher percentages for no difficulty in performing different activities, ranging from 70.83% to 95.83%, were reported.

Conclusion

This study demonstrates that the bi-aspheric diffractive trifocal IOL yields very good visual performance across distances, fostering high satisfaction levels and minimal difficulties in daily activities.

Clinical outcomes of trifocal toric intraocular lenses

The purpose of this report is to summarize the visual and refractive outcomes of patients with trifocal toric intraocular lens (IOL) implants. A peer-reviewed literature search in different databases was carried out to identify clinical publications reporting outcomes of patients with this type of implant. The analysis considered information on the sample of eyes, type and power of the trifocal toric IOLs, biometric preoperative data, postoperative refraction, rotational stability, visual acuity at different distances and other analyses undertaken, such as contrast sensitivity or quality of vision questionnaires. 20 clinical studies, encompassing a total of 1404 eyes implanted with three commercially available trifocal toric IOLs, were included in this review. The analysis assessed the outcomes reported for the AT LISA tri toric 939MP IOL, involving 3 articles and 313 eyes; the FineVision toric POD FT IOL, with 7 articles studying 370 eyes, and the AcrySof IQ PanOptix toric IOL, involving 11 articles and 721 eyes. Our assessment of the outcomes of the various studies indicates that the efficacy of the refractive correction (both sphere and cylinder) and visual acuity at different distances was similar between the IOL models. The same was found for the patients' quality of vision and satisfaction levels, in addition to photic phenomena reported. The outcomes summarized in this report lead us to conclude that the use of trifocal toric IOLs allows complete visual restoration over a wide range of distances.

Refractive and Visual Outcomes of a Monofocal Non-Constant Aberration Aspheric Intraocular Lens

Purpose

To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new monofocal non-constant aberration aspheric intraocular lens (IOL).

Methods

Ninety eyes of 86 patients who underwent implantation the CT LUCIA 621P IOL (Carl Zeiss Meditec AG) were retrospectively analyzed in this study. Main outcome measures were refractive error and monocular corrected distance visual acuity (CDVA) and monocular uncorrected distance visual acuity (UDVA) values. Patients were evaluated at 1-month post-surgery and intra- and post-operative complications were recorded.

Results

Eighty percent of the eyes showed a CDVA of 20/25 or better before surgery. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.64±0.22 and 0.89±0.13, respectively. All eyes showed the same or better difference between UDVA and CDVA. In relation to the postoperative spherical equivalent, the highest percentage of eyes, 31.11%, was for the range between −0.50 and −0.14D followed by 22.22% for the ±0.13D range. Ninety percent of the eyes were within ±1.00 D and 73.33% of eyes within ±0.50 D. The mean postoperative spherical equivalent was −0.18±0.55D. 37.78% and 76.67% of the eyes showed a value ≤0.50 D and ≤1.00D, respectively, being the mean postoperative refractive cylinder −0.81±0.50D. No adverse events were reported in whole sample intra and postoperatively.

Conclusion

The present study shows that cataract surgery with an monofocal non-constant aberration aspheric IOL implantation resulted in good visual performance and refractive outcomes. This lens may be considered as a valid choice for patients in a standard-routine cataract surgery practice.

Agreement of predicted intraocular lens power using swept-source optical coherence tomography and partial coherence interferometry

PURPOSE

To analyze the agreement of the predicted intraocular lens (IOL) power obtained with ANTERION, IOLMaster 700 and Pentacam AXL biometers.

METHODS

We calculated the monofocal and trifocal IOL power using the SRK/T, Haigis, Barrett Universal II and Hoffer Q formulas for 106 eyes. IOL power agreement between devices was evaluated using the Bland-Altman method.

RESULTS

We found significant differences between biometers comparisons (p < 0.001). ANTERION and IOLMaster 700 did not produce significant IOL power differences (p > 0.05), with the same outcomes for medium- and long-eyes. No significant differences were found using the SRK/T, Haigis, or Hoffer Q formulas for short-eyes (p > 0.1). However, Barrett Universal II formula produced significant differences (p < 0.05) and these differences lay between the ANTERION and Pentacam AXL. ANTERION versus IOLMaster 700 comparison showed limits of agreement (LoA) varying from 1.1071D in SRK/T monofocal medium-eyes to 1.6828D in Hoffer Q trifocal all-eyes. The largest LoA (about 3.0D) was found for short-eyes when comparing the Pentacam AXL with the other two devices.

CONCLUSIONS

These devices provided statistically significant but clinically insignificant mean differences in predicted IOL power. However, wide LoA values suggest that for specific eyes these outcomes could be clinically significant.

Enhanced Monofocal Extended Depth of Focus IOL With a Diffractive Surface Design

PURPOSE

To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new enhanced monofocal extended depth of focus (EDOF) intraocular lens (IOL).

METHODS

Fifty eyes of 25 consecutive patients who underwent implantation of the xact Mono-EDoF IOL (Santen Pharmaceutical Co, Ltd) were enrolled in this study. Main outcome measures were refractive error and monocular corrected (CDVA) and uncorrected (UDVA) distance visual acuity values. Monocular visual acuity at different vergences (defocus curve) was obtained. Patients were evaluated at 12 months postoperatively.

RESULTS

At 1 year of follow-up, all eyes showed a postoperative spherical equivalent within ±1.00 diopters (D) and 95% of eyes within ±0.50 D. The mean postoperative spherical equivalent was -0.15 ± 0.28 D. A total of 88% and 100% of eyes showed UDVA and CDVA of 20/25 or better, respectively. The mean values of UDVA and CDVA (Snellen decimal) were 0.94 ± 0.09 (range: 0.70 to 1.00) and 0.99 ± 0.03 (range: 0.79 to 1.00), respectively. Defocus curve showed good visual acuity at distance and intermediate distances with a depth of focus value of 1.25 D. No visual disturbances were reported in the whole sample during the entire follow-up.

CONCLUSIONS

The current study shows that this EDOF IOL provides good visual performance at far and intermediate distances. The lens may be considered for patients interested in reducing spectacle independence at intermediate distances. [J Refract Surg. 2021;37(9):595-600.].

Agreement between intraoperative anterior segment spectral-domain OCT and 2 swept-source OCT biometers

Purpose: To evaluate the agreement of different biometric parameters obtained using intraoperative spectral-domain optical coherence tomography (SD-OCT) and two swept-source optical coherence tomography (SS-OCT) based biometers.Methods: 102 eyes were assessed using the intraoperative SD-OCT integrated into the Catalys femtosecond-laser, and the IOLMaster 700 and Anterion SS-OCT-based-biometers. Central corneal thickness (CCT), anterior chamber depth (ACD), white-to-white (WTW), and lens thickness (LT) were measured.Results: There were statistically significant differences for CCT, ACD, WTW and LT between devices (p < 0.001). The mean difference for ACD ranged from -0.067 to -0.250 mm, with the largest mean difference being between the IOLMaster 700 and Catalys. CCT mean differences ranged from 7 to 32 µm, with the largest mean difference being between the Anterion and Catalys. For WTW, the comparison between the IOLMaster 700 vs Catalys showed the largest mean difference (0.38 mm). However, the mean differences for LT from all three devices were quite similar, ranging from -0.02 to -0.08 mm.Conclusions: SS-OCT biometers showed good agreement for ACD, CCT, WTW and LT. The SD-OCT showed ACD, CCT and WTW values that do not seem to be interchangeable with the SS-OCT biometers; however, this device did show excellent agreement in the case of LT.

Optical and visual quality assessment of an extended depth-of-focus intraocular lens based on spherical aberration of different sign

PURPOSE

To assess the optical quality and the visual performance of patients implanted with an extended depth-of-focus (EDOF) intraocular lens (IOL).

METHODS

Thirty-eight eyes underwent implantation of the Mini WELL Ready EDOF IOL and were evaluated at 3-months postsurgery. Higher-order aberrations (HOAs) and modular transfer function (MTF) were measured at 3- and 5-mm pupils. Binocular uncorrected-distance visual acuity (UDVA) and corrected-distance visual acuity (CDVA), uncorrected-distance intermediate visual acuity (UIVA) and corrected-distance intermediate visual acuity (CDIVA) at 80 cm, and uncorrected-distance near visual acuity (UNVA) and corrected-distance near visual acuity (CDNVA) at 40 cm were obtained. Postoperative refraction, binocular defocus curve, halometry and subjective ad hoc patients' questionnaire were also evaluated.

RESULTS

HOAs were 0.171 ± 0.046 µm and 0.406 ± 0.137 µm at 3 and 5 mm, respectively. MTFs decreased as the spatial frequency increased being comparable for both pupils. 92.10% of eyes were within ± 1.00D, and the mean postoperative spherical equivalent was - 0.25 ± 0.65D. Mean UDVA, UIVA and UNVA were 0.06 ± 0.12, 0.05 ± 0.10 and 0.26 ± 0.28 logMAR, respectively. Mean CDVA, CDIVA and CDNVA were - 0.01 ± 0.08, 0.06 ± 0.11 and 0.24 ± 0.12 logMAR, respectively. Defocus curve showed a continuous range of vision, especially at intermediate distances. Mean discrimination index was 0.79 ± 0.04. Questionnaire revealed that about 79% of patients reported a high or moderately high satisfaction with the procedure, and about 95% of patients would undergo the same procedure again.

CONCLUSIONS

The Mini WELL Ready EDOF IOL provided good optical and visual quality with high level of patient satisfaction and seems to be a valuable option to provide unaided vision at different distances minimizing visual disturbances.

Angle-to-angle and spur-to-spur distance analysis with high-resolution optical coherence tomography

Background

To measure angle-to-angle (ATA) and spur-to-spur (STS) distances along six meridians using high-resolution swept-source optical coherence tomography (SS-OCT) and to compare those values with horizontal white-to-white (WTW) distance.

Methods

68 eyes from 68 patients were quantitatively assessed with the Anterion SS-OCT (Heidelberg Engineering, Heidelberg, Germany). ATA and STS distances were measured with the SS-OCT’s B-Scan in six cross-sectional images corresponding to the vertical (6–12 o’clock), 1–7 o’clock, 2–8 o’clock, horizontal (3–9 o’clock), 4–10 o’clock and 5–11 o’clock meridians. WTW was measured horizontally with the device’s infrared camera. A Pearson correlation analysis was carried out to compare ATA and STS distances with WTW.

Results

The largest values were found for the vertical meridian and the shortest for the 2–8 o’clock meridian, both for ATA and STS distances. No statistically significant differences were found between WTW, ATA and STS along the horizontal meridian (p > 0.1). However, ATA and STS showed statistically significant differences elsewhere, except for the horizontal and the 2–8 o’clock meridians (p > 0.05). Moreover, we found that ATA and STS varied significantly depending on the meridian being assessed, except for ATA at 4–10 versus 3–9 o’clock and for STS at 4–10 versus 3–9 o’clock and at 3–9 versus 2–8 o’clock (p > 0.1). R² values ranged from 0.49 to 0.75 for ATA and STS at the different meridians, showing the best correlation at 3–9 o’clock meridian (0.64 and 0.75, respectively) and the worst at 6–12 o’clock meridian (R² = 0.49 for both ATA and STS).

Conclusions

ATA and STS distances vary radially, thus showing that the anterior chamber is vertically oval. Therefore, it is advisable to measure these two distances along the meridian to be used.

Comparison of a new Scheimpflug imaging combined with partial coherence interferometry biometer and a low-coherence reflectometry biometer

PURPOSE

To evaluate the repeatability of a new biometer using Scheimpflug technology combined with partial coherence interferometry (PCI) (Pentacam AXL) and its agreement with a device based on optical low-coherence reflectometry (OLCR), the Allegro Biograph.

SETTING

Oftalvist Centro Integral Ocular Jerez, Jerez de la Frontera, Spain.

DESIGN

Evaluation of a diagnostic test.

METHODS

The mean keratometry (K), central corneal thickness (CCT), anterior chamber depth (ACD), and axial length (AL) were measured with the 2 devices 3 times by the same examiner in 2 groups (patients with cataract and patients without cataract). The repeatability was determined using the within-subject standard deviation, test-retest repeatability, coefficient of variation, and intraclass correlation coefficient. The correlation was evaluated with the Pearson coefficient and interchangeability with the Bland-Altman plot.

RESULTS

Eighty eyes (40 eyes in each group) of 80 patients were analyzed. Significant differences were found between the Scheimpflug-PCI device and the OLCR device for mean K in the normal group (P < .001) and for CCT in the normal group (P < .05) and the cataract group (P < .001). There were no differences between devices in ACD and AL in either group. The repeatability between devices was similar. Although a significant correlation between devices was found for all measurements (all P < .001), wide limits of agreement were found in both groups for all biometric parameters.

CONCLUSIONS

The Scheimpflug-PCI and OLCR devices showed excellent intravisit repeatability and high correlation for mean K, CCT, ACD, and AL in healthy and cataractous eyes. No differences were found in AL; however, the 2 devices might not be interchangeable.