Abstract
PurposeThe AT LARA 829MP is a next-generation extended depth of focus (EDOF) intraocular lens (IOL) providing continuous vision over a range of distances. The aim of this prospective multi-centre randomised trial was to compare two EDOF IOLs and one monofocal IOL.MethodsCataract patients between 50 and 80 years were randomised for bilateral implantation with either the AT LARA 829MP (EDOF), the TECNIS Symfony (EDOF) or the CT ASPHINA 409MP (monofocal). Follow-up was at 1 to 2 weeks, 1 month and 4 to 6 months.ResultsA total of 211 patients were randomised and included in the final analysis. Monocular depth of focus was significantly better for AT LARA 829MP eyes compared with that for TECNIS Symfony at all thresholds (p = 0.024, 0.001 and 0.006, for 0.1, 0.2 and 0.3 logMAR respectively) with no significant difference for binocular depth of focus. LARA eyes had significantly better monocular depth of focus at all levels compared with ASPHINA eyes (all p < 0.0001), while there was no significant difference between Symfony and ASPHINA eyes at 0.1 logMAR and 0.2 logMAR. Both EDOF IOLs were significantly better than the monofocal ASPHINA at all levels for binocular depth of focus (LARA: all p < 0.0001; Symfony: all p = 0.002). Distance visual acuity was similar for all IOLs at 6 months; intermediate and near visual acuity were significantly better for the EDOF IOLs than for the monofocal (p < 0.0001). Refraction improved in all groups relative to baseline. Contrast sensitivity was higher with the CT ASPHINA 409MP but both EDOF lenses had a better spectacle independence rate. At 6 months, all IOLs were well centred with no cases of tilt. No general safety issues were raised for any of the groups.ConclusionThe two EDOF intraocular lenses investigated provided good visual outcomes with comparable visual acuity at all distances. The AT LARA 829MP provided the widest monocular depth of focus at 0.1 and 0.2 logMAR, with a clear superiority compared with the monofocal IOL. TECNIS Symfony was superior to the monofocal control at 0.3 logMAR. Spectacle independence and patient satisfaction were comparable.Trial registrationTrial registered on https://clinicaltrials.gov/ under the identification NCT03172351 (date of registration 1 June May 2017).
Highlights
MethodsThere is an increasing expectation by patients for spectaclefree vision following cataract surgery
The primary endpoint of the study was to evaluate the monocular depth of focus of the two extended depth of focus (EDOF) lenses versus the monofocal CT ASPHINA 409MP intraocular lens (IOL)
The two key secondary objectives were to demonstrate the superiority of both EDOF IOLs over the monofocal IOL regarding depth of focus at the same level
Summary
MethodsThere is an increasing expectation by patients for spectaclefree vision following cataract surgery. Excellent for distance vision, monofocal intraocular lenses (IOLs) generally cannot provide clear vision over a full range of distances including intermediate and near, while many patients demand improved vision for activities such as driving and use of devices such as computers and mobile phones. In the case of a trifocal lens, the simultaneous images for distance, intermediate and near, are superimposed on the retina and neural processing is employed to filter and to create a sharp vision over a wide range of distances simultaneously [1]. One eye is targeted for emmetropia and the other is targeted for near or intermediate distance. This principle is not tolerated by everyone and has to be tested prior to surgery. Due to the presence of cataract, it is not always straightforward in practice to detect which eye is dominant or whether dominance is maintained for all distances
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