Optimizing Predictive Models for Distance and Near Vision Outcomes in Presbyopic Surgery Using Machine Learning

To assess visual and refractive outcomes and patient satisfaction after bilateral sequential implantation of a primary capsular bag intraocular lens (IOL) and a supplementary sulcus-fixated trifocal IOL. All patients had bilateral implantation of a mono-focal IOL in the capsular bag followed by a supplementary trifocal IOL (Sulcoflex 703F, Rayner Intraocular Lenses Limited) in the sulcus. Patients were evaluated for monocular uncorrected and corrected distance visual acuity, binocular uncorrected and corrected distance, intermediate and near visual acuity, photopic and mesopic contrast sensitivity, defocus curves, visual symptoms, spectacle independence, and patient satisfaction at 1 and 6 months postoperatively. Forty eyes of 20 patients were evaluated. Six months after surgery, mean binocular uncorrected visual acuity was -0.07 ± 0.06 logMAR for distance vision (range: -0.2 to 0.0 logMAR), -0.03 ± 0.17 logMAR for intermediate vision (range: -0.1 to 0.6 logMAR), and 0.09 ± 0.08 logMAR for near vision (range: -0.1 to 0.2 logMAR). All patients reported full spectacle independence after 6 months and no adverse events were reported for any of the patients. Sequential implantation of a monofocal IOL in the capsular bag and a supplementary trifocal IOL in the sulcus provides a safe and effective choice for patients who desire spectacle independence after cataract surgery. [J Refract Surg. 2021;37(2):105-111.].

Purpose: To assess the primary visual disability in patients with cataract and to evaluate their preference regarding the visual outcome after surgery. Materials and Methods: 120 patients (66 males, mean age 76.3 years, mean best corrected visual acuity 5.2/10 binocularly) participated. Perception regarding the primary visual disability related to cataract and preference of visual outcome after surgery were assessed by a questionnaire. All study procedures adhered to the principles outlined in the Declaration of Helsinki for research involving human subjects, and all participants gave written informed consent before their participation. Results: 74 patients (61.6%) had difficulty in distant vision, 5 (4.2%) in near vision, 17 (14.2%) mentioned blurred vision, 14 (11.7%) difficulty in driving especially at night, 7 (5.8%) complained about monocular diplopia and 3 (2.5%) about anisometropia. All mentioned that they preferred to obtain clear distant and near vision after cataract surgery. Conclusions: There was an interesting variety in visual disability related to cataract. The difficulty in distant vision was the primary visual deficit in the majority of the patients and the preference for clear distant and near vision was the desired postoperative visual outcome.

PurposeTo compare the trifocal TFNT00 and extended depth-of-focus (EDF) ZXR00 intraocular lenses (IOLs) with respect to overall satisfaction with near and distance vision, visual acuity, dysphotopsia symptoms, spectacle dependence, and mesopic best corrected contrast sensitivity (MBCCS).Materials and MethodsThis non-randomized, retrospective, single-centre, comparative study took place at the Kensington Eye Institute in Toronto, Canada. Subjects implanted with either the TFNT00 IOL (n = 11) or ZXR00 IOL (n = 13) were assessed up to 4 years post operatively. Overall satisfaction with distance and near vision, corrected distance visual acuity, uncorrected visual acuity at distance, intermediate (60 cm) and near (40 cm) (UNVA), dysphotopsia symptoms, spectacle dependence and monocular MBCCS were evaluated.ResultsForty-eight eyes of 24 subjects (mean age 68 years, 54% female) were assessed. There was no difference in overall satisfaction; both groups had a median score of 10/10 for overall distance vision, and 7/10 and 8/10 for near vision for EDF and trifocal, respectively. MBCCS at the higher spatial frequencies was significantly better with the ZXR00 IOL. Potentially clinically relevant but not statistically significant differences were found; the trifocal group (vs the EDF group) had better binocular UNVA (20/24 vs 20/32) and less spectacle dependence at least some of the time (54% vs 85%).ConclusionThe ZXR00 may be preferred for those who want optimal contrast sensitivity in dim lighting. Consistent with previous studies, the TFNT00 trifocal IOL may be a better choice for those who want to optimize UNVA. More studies in North America are required to further investigate spectacle dependence.

To investigate the effect of age on visual outcomes after the bilateral implantation of trifocal intraocular lenses (IOLs). A total of 290 patients (580 eyes) who underwent bilateral implantation of a trifocal IOL were enrolled in this retrospective case-control study. Patients were divided into five age groups: 45 to 49, 50 to 54, 55 to 59, 60 to 64, and 65 years and older. Postoperative monocular uncorrected and corrected distance visual acuity (UDVA and CDVA, respectively), uncorrected near visual acuity (UNVA), binocular distance-corrected defocus curve, spectacle dependence for near and distance vision, and patient satisfaction scores were compared among the five groups. The 45 to 49 years group had significantly better mean UDVA (0.02 ± 0.05 logMAR) and UNVA (0.02 ± 0.04 logMAR) than the 65 years and older group (0.06 ± 0.09 and 0.09 ± 0.09 logMAR; P = .029 and P < .001; respectively). However, no significant differences were observed in the mean CDVA among the groups. Binocular visual performance of the 45 to 49 years group was better than that of the 65 years and older age group at defocuses of +1.00, +0.50, -1.00, and -3.00 D. No significant differences were observed in spectacle dependence for near and distance vision or in patient satisfaction scores among the five groups. Bilateral implantation of trifocal IOLs can provide excellent near and distance vision in both young and older patients. However, UDVA and UNVA revealed considerably worse results in the older group, although no significant difference was observed in CDVA and postoperative refractive errors by age. [J Refract Surg. 2024;40(4):e270-e277.].

Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles.

Presbyopic LASIK using the Supracor algorithm and micromonovision in presbyopic myopic patients: 12-month visual and refractive outcomes.

Intérêt d’une bascule d’asphéricité pour une plus grande multifocalité dans la chirurgie de la cataracte

Outcomes of sulcus implantation of Array multifocal intraocular lenses in second-eye cataract surgery complicated by vitreous loss

Background:Recent innovations in intraocular lens (IOL) design have introduced extended depth of focus lenses, which has shown promise in improving visual acuity at multiple distances while preserving the distance vision provided by a standard monofocal IOL. This study aimed to evaluate the visual outcomes of TECNIS Eyhance, a monofocal IOL with enhanced intermediate function, and a standard TECNIS monofocal 1-piece IOL, and to review published studies comparing the clinical performance between the TECNIS Eyhance and standard IOLs.Methods: A retrospective analysis was conducted on patients who underwent cataract extraction with bilateral implantation of either TECNIS Eyhance IOLs or TECNIS Monofocal 1-Piece IOLs. Primary outcomes included monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA), and manifest refraction. Outcomes such as glare, halos, and dry eye were also assessed. A literature review was performed to identify studies evaluating the clinical outcomes of TECNIS Eyhance and standard TECNIS monofocal IOLs.Results: In total 108 patients (216 eyes) underwent bilateral implantation with either TECNIS Eyhance (104 eyes) or TECNIS Monofocal 1-Piece (112 eyes) IOLs. The mean (standard deviation [SD]) binocular UNVA was better in the Eyhance group at 1 month (0.18 [0.13] logMAR) compared to the standard monofocal group (0.24 [0.14] logMAR; P < 0.05). A greater proportion of Eyhance patients achieved binocular UNVA of 20/25 or better (46.9% vs 21.8%; P < 0.01), and 20/32 or better (65.3% vs 45.5%; P < 0.05). However, there was no significant difference for 20/20 visual acuity (20.4% vs 18.2%; P > 0.05). No significant differences were observed in postoperative UDVA or CDVA between groups (both P > 0.05). The mean (SD) monocular UNVA showed a slight, but non-significant, advantage in the Eyhance group (0.26 [0.15] logMAR vs 0.29 [0.15] logMAR; P > 0.05). Eyhance eyes demonstrated less residual refractive cylinder at 1 month (P < 0.01), which may be attributed to a higher rate of toric IOL use (P < 0.01). Patient-reported visual symptoms did not differ between groups. Thirteen studies were identified that compared the Eyhance and standard monofocal IOLs. Across the studies analyzed, the Eyhance group showed better monocular and binocular UNVA with mean (SD) differences of - 0.10 (0.20) logMAR and - 0.10 (0.21) logMAR, respectively (both P < 0.01), as well as improved binocular uncorrected intermediate visual acuity (UIVA) (mean difference [SD]: -0.10 [0.18] logMAR; P < 0.01). These studies also showed low rates of glare and halos for both IOLs.Conclusions:Patients receiving the TECNIS Eyhance IOL had better binocular UNVA compared to those with a standard monofocal IOL, consistent with published literature. The Eyhance IOL also showed better binocular UIVA and monocular UNVA across the studies reviewed. Both enhanced and standard monofocal IOLs demonstrate excellent distance vision and have similar levels of photic phenomena. Nevertheless, the Eyhance IOL shows promising potential for improving intermediate and near vision.

BackgroundTo compare clinical outcomes and optical performance of a new monofocal with enhanced intermediate function intraocular lenses (IOLs) with that of conventional monofocal IOLs.MethodsSixty eyes of 30 patients who underwent phacoemulsification with bilateral implantation of the ICB00 (15 patients) or ZCB00 (15 patients) IOLs were enrolled. Binocular corrected distance visual acuity (CDVA), distance corrected near visual acuity (DCNVA), and distance corrected intermediate visual acuity (DCIVA) were measured at 4 weeks after surgery. Patient satisfaction for overall, near, intermediate, and distance vision were assessed. The binocular defocus curves were measured. The root mean square of modulation transfer function (MTFRMS) was measured in the optical bench study.ResultsThe mean binocular DCIVA was significantly better in the ICB00 group (0.01 logMAR) compared to the ZCB00 group (0.13 logMAR), but CDVA and DCNVA were not. The patient satisfaction for near and intermediate vision was significantly higher in the ICB00 group compared to the ZCB00. However, there was no difference in patient satisfaction for overall and distance vision between two groups. The defocus curves showed that mean visual acuity of the ICB00 group was significantly better than that of the ZCB00 group at between − 1.00 D to − 3.00 D of defocus. The ICB00 IOL had higher MTFRMS values at between − 0.50 D to − 2.00 D of defocus compared to the ZCB00 IOL.ConclusionsThe ICB00 IOL provides better binocular intermediate vision and higher satisfaction for near and intermediate vision than the ZCB00 IOL while maintaining excellent distance vision.

Comparison of a New Refractive Multifocal Intraocular Lens with an Inferior Segmental Near Add and a Diffractive Multifocal Intraocular Lens

The implantation of a diffractive multifocal lens (dMIOL) as alternative to a monofocal lens is justified if after surgery there is practically no need to wear glasses. 31 patients had an implantation of a total of 35 dMIOLs (3M 815 LE). We evaluated the visual acuity, the refractive data and the patients' attitude to wearing glasses. The average age was 67.0 +/- 11.8 years. Follow up took place after 18.7 +/- 5.4 months. The mean value of the uncorrected distance acuity was 0.59 +/- 0.17 and the corrected distance acuity 0.96 +/- 0.13. The uncorrected near acuity amounted to Jg 2.40 +/- 0.94, best distance correction was Jg 1.49 +/- 0.55. The patients still accepted an average of 0.68 +/- 0.37 dpt for the best near correction (near vision over the diffractive near focus) and thus achieved Jg 1.46 +/- 0.55. At the best distance correction plus 3.5 dpt, the near visual acuity was improved to 1.03 +/- 0.17. 54.8% of the patients indicated that they did not use glasses at all. 32.3% stated that they only used glasses for reading. 9.7% wore bifocals all the time, and 3.2% always used glasses for the distance. Regarding distance vision, the dMIOL is equivalent to monofocal lenses. Without any correction the results of the dMIOLs for the near vision are superior to monofocal lenses. Glasses can be dispensed with if the uncorrected visual acuity of the operated eye is at least 0.6 Jg 2-3 after surgery and the other eye too, does not need any correction. In case the postoperative visual acuity is worse, good visual acuity of the other eye may render glasses unnecessary. Part of the patients put up with a correctable loss of visual acuity in order not to become dependent on glasses. The need to wear glasses may be decreased considerably by implanting a dMIOL in both eyes and by avoiding postoperative refraction errors.

PurposeTo evaluate the clinical outcome in eyes with significant corneal astigmatism after cataract surgery with implantation of a new diffractive multifocal toric intraocular lens (IOL).MethodsProspective, non-randomised multicentre clinical study including...

Comparison of visual quality and subjective outcomes among 3 trifocal intraocular lenses and 1 bifocal intraocular lens

To evaluate 12-month visual and refractive outcomes, patient satisfaction, and the real-world experience following bilateral implantation of an Aspheric Trifocal Toric intraocular lens (IOL). Eligible patients underwent phacoemulsification followed by bilateral implantation of the AcrySof IQ PanOptix toric IOL (Alcon) for age-related cataract. All eyes were targeted at emmetropia using the Barrett TK Toric formula. Post-operative examinations at 6 months included binocular photopic uncorrected and corrected distance, near (40 cm) and intermediate (60 cm) visual acuity assessment, defocus curve testing (+2 to -4 D), reading performance at 40 and 66 cm with Salzburg Reading Desk (SRD), and subjective outcomes, including the IOL SAT quality of vision questionnaire for patient satisfaction and spectacle independence. Thirty patients with a mean age of 60 ± 12 years were included. Twelve months post-op, the mean binocular photopic uncorrected and corrected distance visual acuity (UDVA, CDVA), UNVA, DCNVA, UIVA, and DCIVA were -0.01 ± 0.05, -0.03 ± 0.05, 0.05 ± 0.07, 0.06 ± 0.05, 0.08 ± 0.04, and 0.09 ± 0.04 LogMAR, respectively. Reading performance evaluated at 40 cm and 66 cm showed mean reading speeds of 157.9 ± 44.9 and 159.5 ± 36.63 wpm, respectively (P = 0). Mean residual sphere, cylinder, and spherical equivalent (SE) were 0.02 ± 0.09, 0.00 ± 0.17, 0.02 ± 0.12 D, respectively. A total of 96.6% (29/30) of patients reported complete freedom from spectacles while working at all distances in all light conditions and rated their satisfaction after surgery as "very satisfied." No eye required re-rotation of toric IOL or YAG capsulotomy for posterior capsule opacification (PCO) or developed any other sight impeding complication by the end of the follow-up. In the real-world scenario, PanOptix toric IOL allowed complete visual restoration with excellent patient satisfaction and visual quality outcomes. CTRI/2020/01/022808.