A Comparative Clinical Study of 0.50% Versus 0.75% Pilocarpine Eye Drops for Improving Visual Performance in Presbyopia.

To evaluate clinical outcomes delivered by a new hybrid presbyopia-correcting intraocular lens (IOL): TECNIS Synergy ZFR00V IOL model (Johnson & Johnson Vision). Hospital da Luz Lisboa, Lisbon, Portugal. Prospective observational study. Patients undergoing bilateral IOL implantation were included. Visual acuity (VA) was measured for far distance, intermediate (66 cm), and near (40 cm) vision under both photopic and mesopic conditions. In addition, at the 3-month follow-up visit, the defocus curve was obtained for binocular vision, and questionnaires were administered to measure spectacle independence and level of satisfaction ( quality of vision and Catquest-SF9) with the surgical outcomes. 54 eyes of 27 patients were included. At the 3-month follow-up, under photopic conditions, VA values were as follows: corrected distance VA (CDVA) = -0.02 ± 0.07, distance-corrected intermediate VA = 0.03 ± 0.11, and distance-corrected near VA (DCNVA) = 0.00 ± 0.08, whereas under mesopic conditions, VA values were as follows: CDVA = -0.01 ± 0.05 and DCNVA = 0.07 ± 0.09. The binocular defocus curve revealed that mean VA was better than 0.30 logMAR within the +1.00 to -4.00 diopters (D) interval, and better than 0.10 logMAR between +0.50 and -3.00 D. All patients achieved distance vision spectacle freedom, whereas 3.7% of them said they used them in certain intermediate or near vision situations. As much as 88% of the patients reported being fairly satisfied or very satisfied. The TECNIS Synergy ZFR00V IOL model used for cataract surgery is capable of restoring visual function while providing very good intermediate and near vision, under both photopic and mesopic conditions, resulting in a high level of patient satisfaction.

Aspheric Multifocal Intraocular Lens

To investigate the influence of pupil size on visual acuity after KAMRA inlay (AcuFocus, Inc., Irvine, CA) implantation. Five hundred eighty-four presbyopic eyes of 584 patients who underwent LASIK were evaluated. Uncorrected near visual acuity (UNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and corrected near visual acuity (CNVA) were measured. Two groups were classified: small pupil (pupil diameter < 6 mm) and large pupil (pupil diameter ≥ 6 mm) for both mesopic (pupil diameter < 4 mm) and photopic (pupil diameter ≥ 4 mm) pupil size parameters. The follow-up period was 6 months. There were no significant differences in UNVA (P = .98) and CNVA (P = .16) between the mesopic pupil size groups; however, there were significant differences in UDVA (P = .023) and CDVA (P = .039). There was a weak correlation between pupil size and UDVA of the large mesopic pupil size group (rs = 0.129, P = .04). There were no significant differences in UNVA (P = .78), CNVA (P = .92), UDVA (P = .19), and CDVA (P = .60) for the photopic pupil size groups. Pupil size does not have an influence on the resultant visual acuity after KAMRA inlay implantation. No correlation was found between preoperative and postoperative pupil size and visual acuity for the mesopic pupil groups.

Purpose: To report the visual outcomes following bilateral implantation of a new trifocal intraocular lens (IOL) in patients with age-related cataracts.Methods: This prospective, noncomparative, multicenter study assessed 126 patients undergoing cataract extraction followed by AT ELANA 841P IOL implantation. At 4–6 months postoperatively, refractive error and predictability, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and binocular contrast sensitivity were measured. The binocular defocus curve was evaluated at 3 months postoperatively.Results: Postoperatively, most of the eyes (84.9%) were within ±0.5 D of spherical equivalent (SE) refraction and almost all eyes (98.9%) within ±1.0 D, with a mean SE value of −0.11 ± 0.37 D. Mean monocular CDVA was −0.06 ± 0.08 logMAR and UDVA was −0.01 ± 0.10 logMAR. Mean monocular uncorrected (UIVA and UNVA) and distance-corrected visual acuities (DCIVA and DCNVA) were 0.1 logMAR or better at intermediate (80 cm) and near (40 cm) distances. In the mean defocus curve, a continuous range of 0.1 logMAR or better vision from distance to near was observed. Percentages of eyes achieving CDVA, DCIVA, and DCNVA of 0.1 logMAR or better were 97.2%, 59.1% and 59.1%, respectively. Uncorrected visual acuity of 0.1 logMAR or better was achieved in 88.9% of the eyes at far, 57.1% at intermediate, and 44.4% at near distances. Contrast sensitivity was in the normal range of a phakic population at all spatial frequencies in all light conditions tested, photopic with glare and mesopic with and without glare.Conclusion: Implantation of the new AT ELANA 841P IOL following cataract extraction is safe and effective. Visual acuities at all distances, refractive outcomes, and contrast sensitivity were favorable at 4–6 months postoperatively, providing patients with satisfactory far, intermediate, and near vision.Trial registration: ClinicalTrials.gov identifier: NCT06247683

To report the refractive and visual outcomes after implantation of a trifocal, diffractive, hydrophobic intraocular lens (IOL) in Japanese eyes following cataract surgery. A total of 45 eyes implanted with FineVision HP IOLs (Beaver-Visitec International, Inc. USA) were enrolled in this retrospective study. The clinical outcomes assessed after 3-months were refraction and monocular logarithm of the minimum angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA) at 40 cm. 97.78% of the eyes were within ±0.50D of spherical equivalent and all of them were within ±1.00D (mean: -0.00±0.22 D, with 75.56% within ±0.13D), while 91.11% of the eyes had ≤0.50D residual astigmatism and all of them had ≤1.00D (mean: -0.08±0.24D, with 88.89% ≤0.25D). UDVA and CDVA showed mean values of -0.05±0.07 logMAR and -0.07±0.06 logMAR, respectively. 86.67% and 95.56% of the eyes had ≥20/20 UDVA and CDVA, respectively, with 100% achieving ≥20/25 for both UDVA and CDVA. At 80 cm, the mean monocular logMAR UIVA and DCIVA were 0.18±0.14 and 0.14±0.14, and at 66 cm the values were 0.20±0.15 and 0.19±0.15, respectively. At 80 cm 20% of the eyes had ≥20/25 DCIVA and 60% had ≥20/32 DCIVA. These values changed to 15.56% and 40% of the eyes at 66 cm. In terms of near vision, the mean monocular logMAR UNVA and DCNVA were 0.04±0.10 and 0.03±0.10, respectively. 53.33% of the eyes had ≥20/20 UNVA and DCNVA, with 86.67% achieving ≥20/25 UNVA and DCNVA. The FineVision HP trifocal diffractive IOL provided accurate refractive outcomes with good visual acuity at different distances in Japanese eyes.

Introduction: To assess refractive and visual outcomes in pediatric patients who underwent cataract extraction and implantation with a nondiffractive extended-depth-of-focus (ND-EDOF; Alcon Vivity) intraocular lens (IOL). Patient and Clinical Findings: 4 eyes of 3 pediatric patients underwent cataract extraction and implantation of the ND-EDOF. The 1- and 6-month postoperative manifest refractive error and corrected distance visual acuity (CDVA), distance corrected intermediate visual acuity (DCIVA), and distance corrected near visual acuity (DCNVA) were ascertained by chart review. Diagnosis, Intervention, and Outcomes: The mean ± SD age was 12 ± 2.45 years. The mean predicted postoperative spherical equivalent (SE) was 0.77 ± 0.82 diopter (D). 1 month postoperatively, the mean actual SE, uncorrected distance visual acuity (UDVA), CDVA, DCIVA, and DCNVA were 0.59 ± 0.21 D, 0.22 ± 0.05 (≈20/33), 0.05 ± 0.14 (≈20/22), 0.38 ± 0.14 (≈20/48), and 0.58 ± 0.23 (≈20/76) logMAR, respectively. 6 months postoperatively, the mean SE, UVDA, CDVA, DCIVA, and DCNVA were 0.50 ± 0.31 D, 0.20 ± 0.11 (≈20/32), 0.11 ± 0.14 (≈20/26), 0.28 ± 0.13 (≈20/38), and 0.54 ± 0.21 (≈20/69), respectively. Conclusions: Successful implantation of the ND-EDOF IOL in 4 eyes of 3 pediatric patients is reported. This lens might provide improved uncorrected visual acuity when targeted for hyperopia and increased pseudoaccommodation as the eye grows with age, as compared with a monofocal. Further work is needed to investigate the contrast sensitivity and incidence of photopsias with this IOL in this unique group of patients.

PurposeExtended depth of focus intraocular (EDOF) IOLs form a bridge between single- and multifocal IOL design. This study aimed to compare clinical outcomes obtained after implanting two different optical designs of EDOF IOLs: the Mini Well Ready (SIFI Medtech, Catania, Italy) and Tecnis Symfony (Abbott Laboratories, Illinois, USA).MethodsThe retrospective observational study included 61 patients (122 eyes) who underwent bilateral implantation of the Mini Well Ready IOL (32 patients) or the Tecnis Symfony IOL (29 patients). The following preoperative and postoperative parameters were evaluated: spherical equivalent, anterior astigmatism, pupil size, monocular and binocular uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), monocular and binocular uncorrected intermediate visual acuity (UIVA) and distance-corrected intermediate visual acuity (DCIVA), monocular and binocular uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA). In the 6 months postoperative period, defocus curve, contrast sensitivity, photopic phenomena, and posterior capsule opacification were assessed.ResultsThe patients receiving the Tecnis Symfony had slightly better monocular and binocular UDVA and CDVA than with the Mini Well Ready IOL, the differences were not statistically significant. Whereas the UIVA, DCIVA, UNVA, DCNVA, UNVA and DCNVA values were higher in the Mini Well Ready group, the differences were not significant. There were no significant between-group differences regarding the defocus curve for the vast majority of tested vergences. Dysphotopsias postoperatively were assessed at 6 months.ConclusionPatients receiving both the Mini Well Ready and Symfony IOLs had excellent visual acuity outcomes and spectacle independence.

To evaluate visual outcomes at different distances (near, intermediate, and far), depth of focus, optical quality, quantitative dysphotopsia, and patient satisfaction in two groups. The extended depth of focus (EDOF) only group (n = 40 eyes) was implanted bilaterally with an EDOF intraocular lens (IOL) and the mixed group (n = 40 eyes) was implanted with the same EDOF IOL in the dominant eye and a trifocal IOL in the fellow eye. At the 3-month postoperative visit, refractive outcomes and monocular and binocular uncorrected (UDVA) and corrected (CDVA) distance visual acuities for far UDVA, CDVA, distance-corrected intermediate visual acuity (DCIVA) at 80 cm, uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA) at 40 cm, and binocular defocus curve were evaluated. The mean spherical equivalent (SE) 3 months postoperatively was -0.16 ± 0.41 diopters (D) in the EDOF only group and -0.39 ± 0.63 D in the mixed group. In the EDOF only group, binocular visual acuities were: UDVA = -0.04 ± 0.07 logMAR (20/18); CDVA = -0.04 ± 0.06 logMAR (20/18); DCIVA (80 cm) = 0.07 ± 0.19 logMAR (20/23); DCNVA (40 cm) = 0.32 ± 0.15 logMAR (20/42); and UNVA (40 cm) = 0.24 ± 0.17 logMAR (20/35). In the mixed group, binocular visual acuities were: UDVA = 0.03 ± 0.09 logMAR (20/21) (P = .08); CDVA = -0.01 ± 0.07 logMAR (20/20) (P = .25); DCIVA (80 cm) = 0.24 ± 0.23 logMAR (20/35) (P = .08); DCNVA (40 cm) = 0.19 ± 0.07 logMAR (20/31) (P = .03); and UNVA (40 cm) = 0.18 ± 0.10 logMAR (20/30) (P = .37). Effective restoration of visual acuity was demonstrated in both groups, with high levels of visual quality and patient satisfaction. Better results in near visual acuity were demonstrated in the mixed group. [J Refract Surg. 2019;35(7):408-416.].

Objective To compare the short-term postoperative quality of vision of segmental refractive multifocal intraocular lens (MIOL) SBL-3 and aspheric-surface monofocal intraocular lens Akreos Adapt AO. Methods 26 cases of age-related cataract (35 eyes) after phacoemulsification cataract extraction combined with IOL implantation were collected from June of 2017 to January of 2018 in the Peking University First Hospital. There were 15 eyes in SBL-3 group, and 20 eyes in AO group according to the different types of IOL implanted. At 1 month after operation the following parameters of the two groups were assessed: uncorrected distant visual acuity(UDVA), uncorrected intermediate visual acuity(UIVA), uncorrected near visual acuity(UNVA), corrected distant visual acuity(CDVA), corrected near visual acuity (CNVA), distance-corrected intermediate visual acuity(DCIVA), distance-corrected near visual acuity(DCNVA). And analyze total higher order aberrations (ocular, corneal, internal), spherical aberration, point spread function for 4mm and 6mm optical zone. Defocusing curve of SBL-3 group was also drawn at 1 month postoperatively. The two groups of patients, UDVA, CDVA, CNVA, UIVA, UNVA, DCIVA, DCNVA and visual quality were expressed as mean standard deviation (±s), and were compared with non parametric Mann-Whimey U test. Results At 1 month after operation, the UIVA, UNVA, DCIVA and DCNVA in SBL-3 group [(0.32±0.08), (0.44±0.18), (0.30±0.10), (0.33±0.11)] were all better than that of the eyes in AO group [(0.25±0.10), (0.27±0.09), (0.20±0.07), (0.21±0.10)] (Z=-2.26, -3.13, -1.84, -2.17; P>0.05). But there were no statistical differences between two groups in UDVA, CDVA and CNVA(Z=-0.99, 0, -1.84; P>0.05). The visual quality assessment showed that the difference of eyeball difference between the two groups with the pupil diameter of 4 mm was not statistically significant (Z=-1.50, -1.04, -0.82; P>0.05), and the difference of eyeball difference between the two groups with 6 mm pupil diameter was not statistically significant (Z=-0.12, -1.93, -1.16; P>0.05). The total higher order aberrations of ocular for 4mm and 6mm optical zone in SBL-3 group [(0.45±0.12), (1.41±0.21)] were better than that in AO group [(0.26±0.12), (0.82±0.13)] (Z=-3.45, -3.24; P<0.05). But there were no statistical differences between two groups in spherical aberration. The point spread function in SBL-3 group (0.05±0.02) was lower than that in AO group (0.11±0.07) (Z=-2.60, P<0.05). There is a peak appeared at 0 D and the defocusing curve was smooth within -1.0 D and -3.0 D but was steep within -3.0 D and -5.0 D. Conclusions The objective visual quality of Adapt AO is better than that of SBL-3 lens, but the application of SBL-3 lens in medium and near vision is better than that of Adapt AO lens. The peak of the defocus curve of SBL-3 lens appeared at 0 D, and the curve in -1.0 D to -3.0 D was stable, and the decrease was not obvious. This study also needs to expand the sample size and observe its efficacy and safety in the long term. Key words: Segmental refractive; Multifocal; Intraocular lens; Quality of vision; Defocusing curve

Purpose:To evaluate the efficacy and safety of 1.25% pilocarpine compared to placebo for the treatment of presbyopia.Methods:This multicenter, randomized, double-masked clinical trial compared pilocarpine 1.25% to placebo in presbyopic individuals aged 45–55 years, meeting standard near vision impairment criteria. Participants were randomized 1:1 using a computer-generated sequence, with identical, unmarked bottles ensuring masking. Distance-corrected near visual acuity (DCNVA) and distance-corrected intermediate visual acuity (DCIVA) were assessed under mesopic and photopic conditions across multiple visits (days 1, 3, 7, 14, and 30). The primary outcome was a ≥ 3-line gain in mesopic, high-contrast, binocular DCNVA at day 30, hour 3. Secondary outcomes included photopic and intermediate vision improvements.Results:A total of 234 participants (mean age 49 ± 3 years, 57% male) were randomized equally. By day 3, pilocarpine demonstrated a significant half-line improvement in high-contrast, binocular mesopic DCNVA (0.47 ± 0.1 vs. 0.51 ± 0.1 logMAR, P = 0.03), progressing to 1.3 lines by day 30 (0.37 ± 0.1 vs. 0.50 ± 0.1, P < 0.001). Nearly 50% achieved a two-line gain (n = 54 [46%] vs. 10 [8%], P = 0.001), and one-third gained three lines (n = 36 [31%)] vs. 5 [4%], P < 0.001). Pilocarpine’s effect was cumulative, with each visit’s baseline DCNVA surpassing prior measurements (P < 0.001). Photopic DCNVA followed a similar trend (0.31 ± 0.1 vs. 0.43 ± 0.1 logMAR, P = 0.02 at day 30, hour 3). Intermediate DCIVA showed a modest half-line improvement by day 30. No adverse drug reactions or ophthalmic side effects were observed during the study.Conclusion:Pilocarpine 1.25% effectively improves near vision in presbyopia, with sustained benefits up to day 30 and potential long-term adaptability.

PurposeTo determine the visual performance and patient reported outcomes after bilateral implantation of an enhanced monofocal intraocular lens (IOL) (RayOne EMV RAO200E) targeted for emmetropia or modest monovision.Patients and MethodsThis was a prospective, single-centre, comparative, interventional study. Patients were divided into two groups and targeted for bilateral emmetropia or modest monovision (−1.50 D in the near eye). Manifest refraction, monocular uncorrected and corrected distance visual acuity (UDVA and CDVA), uncorrected and distance-corrected intermediate visual acuity (UIVA and DCIVA), uncorrected and distance-corrected near visual acuity (UNVA and DCNVA), and monocular and binocular defocus curves under photopic and mesopic conditions were measured at 1-month post-surgery. The Catquest 9-SF questionnaire was administered to assess patient reported visual outcomes and quality of life.Results60 patients were enrolled. For the emmetropia group (n = 30), the mean logMAR UDVA, UIVA and UNVA were 0.16±0.13, 0.35±0.12 and 0.50±0.15. In the monovision group (n = 30), the values for the distance eyes were 0.13±0.11, 0.40±0.11 and 0.56±0.13; and for the near eyes 0.41±0.21, 0.27±0.16 and 0.34±0.13. Binocular defocus curves showed similar distance visual acuity but better visual acuity in the monovision group from –1.00 D to –4.00 D and −1.00 D to –3.50 D defocus under photopic and mesopic conditions respectively (p < 0.05). The defocus range (logMAR 0.2 or better) was 1.3 D for the bilateral emmetropia group and 2.5 D for the monovision group. 90% (emmetropia group) and 96% (monovision group) of patients were very or fairly satisfied with their vision, with the monovision group reporting better performance for intermediate and near tasks.ConclusionPatients targeted for bilateral emmetropia achieved good functional intermediate vision, while those with modest monovision experienced enhanced intermediate and near vision. Overall, patients reported high satisfaction and good visual performance when implanted with the enhanced monofocal IOL.

To analyze the refractive and visual outcomes following cataract surgery and implantation of a new hydrophobic trifocal toric intraocular lens (IOL) in Japanese eyes with different degrees of corneal astigmatism. A total of 66 eyes from 39 patients implanted with a FineVision HP Toric IOL (Beaver-Visitec International Inc) were analyzed retrospectively. The main outcome measures considered were refraction, monocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA) and distance-corrected near visual acuity (DCNVA) at 40 cm. Eyes were evaluated at three months post-surgery. Sixty-five eyes (98.48%) were within ±0.50D of spherical equivalent, and all were within ±1.00D (mean: 0.00±0.21D). Moreover, 63 eyes (95.45%) had ≤0.50D of residual astigmatism, and all had ≤1.00D (mean: -0.08±0.23D). Similarly, 58 (87.88%) and 60 eyes (90.91%) had ≥20/20 UDVA and CDVA, respectively, with 65 (98.48%) and 66 eyes (100%) achieving ≥20/25 UDVA and CDVA, respectively. In addition, 28 (42.42%) and 23 eyes (34.85%) had ≥20/25 DCIVA at 80 and 66 cm, respectively, with 49 (74.24%) and 52 eyes (78.79%) achieving ≥20/32 DCIVA at 80 and 66 cm, respectively. Finally, 39 (59.09%) and 40 eyes (60.61%) had ≥20/20 UNVA and DCNVA, respectively, with 58 (87.88%) and 59 eyes (89.39%) achieving ≥20/25 UNVA and DCNVA, respectively. Our study shows that implantation of the new hydrophobic FineVision HP Toric IOL results in accurate refractive outcomes, with good visual acuity at different distances, in Japanese eyes.

Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens

Prospective study of the Acri.LISA bifocal intraocular lens

Symmetric bilateral implantation of a distance-dominant diffractive bifocal intraocular lens