AcrySof ReSTOR Research Articles

Bilateral Implantation of Multifocal Intraocular Lenses: 10-Year Follow-Up

To evaluate and compare the long-term results after bilateral implantation of different multifocal intraocular lenses (MIOLs). This retrospective comparative study included 42 patients who underwent cataract surgery with bilateral MIOL implantation. Patients were divided into 5 groups: Group 1 received a refractive ReZoom NGX1 IOL (AMO), Group 2 a diffractive Acrysof ReSTOR SA60D3 IOL (Alcon), and Group 3 a diffractive Tecnis ZM900 IOL (AMO). Group 4 and Group 5 were implanted using the mix and match approach with refractive ReZoom-diffractive ReSTOR IOL and refractive ReZoom-diffractive Tecnis ZM900 IOL, respectively. Primary outcome measures were distance, near, and intermediate distance visual acuity measured 6 months (T0) and 10 years (T1) after surgery. Secondary outcomes were defocus curves, contrast sensitivity, patients' satisfaction, and spectacle independence. All patients achieved best-corrected distance visual acuity (BCDVA) greater than 0.11 logMAR and uncorrected distance visual acuity (UCDVA) greater than 0.14 logMAR at both time points. A decrease in contrast sensitivity was evident, particularly at high spatial frequencies; at T1, Group 4 reported statistically higher values than Group 2 at 12 cycles/degree and 18 cycles/degree and statistically higher values than Group 3 at 18 cycles/degree. Great overall satisfaction was reported even in the presence of dysphotopsia. Tecnis ZM900 IOL showed the lowest incidence of posterior capsular opacification. MIOLs could provide adequate functional vision and patient satisfaction, despite the incidence of side effects, in carefully selected patients desiring spectacle independence.

The Vivity Extended Range of Vision IOL vs the PanOptix Trifocal, ReStor 2.5 Active Focus and ReStor 3.0 Multifocal Lenses: A Comparison of Patient Satisfaction, Visual Disturbances, and Spectacle Independence.

PurposeTo compare patient-reported outcomes (PROs) after intraocular lens (IOL) implantation with the AcrySof IQ Vivity IOL or Vivity Toric IOL to those achieved with other multifocal IOLs.Patients and MethodsProspective, open-label, multicenter analysis of PROs, including spectacle independence, dysphotopsia, and overall satisfaction among patients who underwent cataract surgery at least 1 month previously with bilateral Vivity or Vivity Toric lenses (n=60). Results were compared to outcomes from two similar prospective studies of bilateral AcrySof IQ PanOptix or PanOptix Toric trifocal IOLs (n = 59), blended AcrySof ReSTOR 2.5/3.0 IOLs (n=72) or bilateral ReSTOR ActiveFocus 2.5 D IOLs with a mini-monovision target [n = 95]).ResultsPatients in the Vivity cohort were significantly less likely to notice glare and halo in dim light (85% “none” or “just a little”) compared to PanOptix (69%, p<0.03), 2.5 mini-monovision (75%, p< 0.05) or 2.5/3.0 (71%, p< 0.05) patients. Complete spectacle independence for all visual activities combined (never need glasses) with Vivity was comparable to the mini-monovision and 2.5/3.0 groups (33%, 36%, and 31%, respectively) but significantly lower than in the PanOptix cohort (83%, p < 0.0001). Satisfaction was high across all groups. There were no statistically significant differences in best-corrected visual acuity, and no new safety concerns were reported.ConclusionThe AcrySof IQ Vivity extended depth of focus IOL offers an expanded range of vision and better spectacle independence than has typically been achieved with traditional monofocal IOLs, with high rates of satisfaction and a favorable dysphotopsia profile compared to diffractive multifocal IOLs.

Citation network analysis of the various types of multifocal intraocular lenses.

The implantation of multifocal intraocular lens (IOL) has increased in recent years, allowing patients to achieve good quality vision at all distances, independence from use of glasses, and consequently, an increase in quality of life. The main purpose of this study was to analyse the links between publications and authors via citation networks, as well to as identify the different research areas and determine the most cited publications. The publication search was performed through the Web of Science database, using the terms «Multifocal intraocular lens», «Bifocal intraocular lens», «Trifocal intraocular lens», «Diffractive intraocular lens», «Refractive intraocular lens», «Accommodative intraocular lens» and «Extended depth of focus intraocular lens», for a time interval from 1989 to August 2020. The software used to analyse the publications was the Citation Network Explorer. A total of 1293 publications were found, with 11,730 citations generated in the network, and 2019 had the highest number of publications of any year. The most cited publication was «European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens» by Kohnen et al., published in 2006. Four groups about different research areas in this field were found using the Clustering functionality: visual quality, IOL designs, ocular aberrations, or defocus curves. The citation network offers an objective and comprehensive analysis of the main articles on the different designs and classes of multifocal IOL.

The PanOptix Trifocal IOL vs the ReSTOR 2.5 Active Focus and ReSTOR 3.0-Add Multifocal Lenses: A Study of Patient Satisfaction, Visual Disturbances, and Uncorrected Visual Performance.

PurposeTo compare spectacle independence, patient-reported outcomes (PROs), and dysphotopsia after multifocal intraocular lens (IOL) implantation with the AcrySof PanOptix trifocal or the ReSTOR +2.5/3.0 D or ReSTOR +2.5 D mini-monovision multifocal IOL.Patients and MethodsProspective, open-label, multicenter analysis of PROs, spectacle independence, and satisfaction among patients undergoing cataract surgery who had been implanted at least 1 month previously with AcrySof IQ PanOptix or PanOptix Toric trifocal (n = 59) IOLs bilaterally. Results were compared to outcomes from a similar study with the AcrySof ReSTOR 2.5/3.0 or the ReSTOR ActiveFocus 2.5 mini-monovision lens [n = 191]).ResultsSpectacle independence was significantly higher in the PanOptix cohort, with 83% of patients “never” needing glasses for any activity versus 36% in the ReSTOR 2.5 mini-monovision and 34% in the ReSTOR 2.5/3.0 cohorts. No significant differences in patient satisfaction rates were reported between the three cohorts. Glare and halo were rated “extremely” noticeable more with the PanOptix (10%) than with the ReSTOR 2.5 mini-monovision (1%) or ReSTOR 2.5/3.0 (3%). BCVA differences were not statistically significant, and no new safety concerns were reported.ConclusionThe AcrySof PanOptix trifocal provides significantly greater spectacle independence across all measured activities than the AcrySof ReSTOR multifocal IOLs.

Effect of High-Order Aberrations and Satisfaction on Cataract Patients Implanted with Four Types of AcrySof Blue Light Filtering Intraocular Lens

Objective: The objective is to evaluate the visual acuity, high-order aberrations and satisfaction in the cataract patients with the implantation of different types of AcrySof blue light filtering intraocular lens, which would provide the clinical guidance for the selection of individualized intraocular lens. Methods: From January 2019 to December 2020, the patients with age-related cataract in Guangzhou Red Cross Hospital were equally randomized to be divided into four groups. 20 patients (20 eyes) were implanted with AcrySof (SN60WF), which was the blue light filtering single focus group; 20 patients (20 eyes) were implanted with blue light filtering aspheric multifocal intraocular lens (AcrySof ReSTOR IOL +3.0D, SN6AD1), which was the multifocal intraocular lens group; 20 patients (20 eyes) were implanted with aspheric astigmatism correction intraocular lens (Toric SN6AT), which was the astigmatism group; 20 patients (20 eyes) were implanted with blue filtering aspheric multifocal astigmatism correction intraocular lens (AcrySof ReSTOR IOL +2.5D IQ, SV25T0), which was the ART group. Three months after the operation, the patients were followed up with slit lamp to check the visual acuity, including uncorrected distance visual acuity (UCDVA), uncorrected near visual acuity (UCNVA), best corrected distance visual acuity, (BCDVA); the questionnaire surveys on the satisfaction of different intraocular lens implantation (far and near vision, glare, halo and abnormal visual symptoms); the iTrace visual function analyzer was used to check the total high-order aberrations (spherical aberration, wisdom aberration and Clover aberration) in the 3 mm pupil diameter. Results: Three months after cataract surgery, American Simplified version of questionnaire survey showed that the scores of near removing glasses in the multifocal group and the ART group were significantly better than those in the single focus group and the astigmatism group (P P > 0.05). Three months after cataract surgery, there were statistically significant differences about UCDVA, BCDVA and UCNVA among the four groups (F = 18.189, P P P > 0.05). Conclusion: Different types of AcrySof blue light filtering intraocular lens implantation could improve the far vision and satisfaction of cataract patients, without different higher-order aberrations. Multifocal intraocular lens and ART intraocular lens could significantly improve the far vision of patients and reduce the dependence on near glasses.

Postoperative Evaluation of Bilateral Reading Performance With Two Intraocular Lenses: Twelve-Month Results.

The aim of this study was to compare the bilateral reading performances within the first 12 months after the implantation of two intraocular lens (IOL) models. The patients involved in this research had bilateral phacoemulsification and implantation of the Acriva Reviol MFM 613 IOL (group 1) or AcrySof ReSTOR SN6AD1 apodized multifocal IOL (group 2). The bilateral reading performance was evaluated preoperatively and postoperatively using the MNREAD acuity charts. The reading speed, critical print size, and reading acuity were measured binocularly at 40 and 60 cm. In addition, the binocular uncorrected visual acuities (far, UDVA; intermediate, UIVA; and near, UNVA) were also measured. Each IOL model was implanted in 30 eyes (15 patients), and 30 patients were included in this study. Overall, there were no statistically significant postoperative differences in the mean UDVA, UIVA and mean (P>0.05). There were statistically significant postoperative differences in the mean reading acuity (group 1, 0.07±0.10 logMAR; group 2, 0.02±0.08 logMAR; P=0.019) at 40 cm. When tested at 60 cm, the reading acuity (0.13±0.10 logMAR and 0.21±0.11 logMAR, respectively; P=0.021) and critical print size (0.25±0.13 logMAR and 0.39±0.16 logMAR, respectively; P=0.005) were significantly better in group 1 than in group 2. Both of the IOLs achieved good visual performances. However, the Acriva Reviol MFM 613 IOL performed better than the AcrySof ReSTOR SN6AD1 at an intermediate distance, whereas the AcrySof ReSTOR SN6AD1 provided better near distance results.

Cognitive functions in patieCognitive functions in patients after cataract phacoemulsification and implantation of multifocal and monofocal intraocular lnts after cataract phacoemulsification and implantation of multifocal and monofocal intraocular lenses

Introduction: The study has to determine whether implantation of diffractive multifocal lenses during cataract phacoemulsification causes distortion of the cognitive aspects of processing perceptual information. Material and methods: 25 patients who underwent cataract phacoemulsification with the implantation of diffractive multifocal lens Acrysof Restor SN6AD1 in both eyes (multifocal group) and 26 patients with the implantation of monofocal intraocular lens Acrysof IQ SN60WF in both eyes (monofocal group) were enrolled. All patients underwent ophthalmic examination and cognitive function– Trial Making Test (Part A and Part B) and Stroop Test (Stroop Test 1 and Stroop Test 2) tests at least 6 months after cataract surgery of the other eye. Results: Mean patient age and visual acuity with correction for near and far vision did not differ between groups. Average Trail Making scores were 32.80 ± 11.86 s and 84.08 ± 33.26 s for Parts A and B, respectively, in the multifocal group, while scores in the monofocal group were 36.61 ± 13.63 s and 93.34 ± 40.49 s in Parts A and B. Stroop Test scores were 79.09 ± 17.69 s and 133.64 ± 17.60 s for Stroop Test 1 and Stroop Test 2, respectively, in the multifocal group; in the monofocal group, scores were 82.04 ± 17.51 s and 152.88 ± 65.72 s, respectively. The groups did not differ for either test. Conclusions: Differences between cognitive function tests results between patients with multifocal and monofocal intraocular lenses were not statistically significant suggesting the lack of influence of the type of lens on visual perception at least in good light conditions. Further clinical trials using more sophisticate tests in different light conditions are needed.

Multifocal intraocular lens implantation after previous hyperopic corneal refractive laser surgery

To describe the outcomes in terms of the refraction and visual acuity of multifocal intraocular lens (IOL) implantation in patients with previous hyperopic corneal refractive laser surgery. Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Retrospective case series. Results were analyzed 3months after implantation of a multifocal IOL (Acrysof Restor SN6AD1) in patients after previous corneal refractive laser surgery for hyperopia. The primary outcome measures were uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction. The secondary outcome measures were the number of laser enhancements and posterior capsule opacification (PCO) rates. Forty eyes of 40 patients were included. Sixteen eyes (40.0%) had lens extraction because of cataract, and 24 eyes (60.0%) had refractive lens exchange. The mean postoperative UDVA was 0.16 logarithm of the minimum angle of resolution (logMAR)±0.18 (SD), and the mean postoperative CDVA was 0.01±0.08 logMAR. The mean postoperative spherical equivalent was 0.04±0.92 diopter (D). Twenty-five eyes (62.5%) were within ±0.50 D of emmetropia, and 35 eyes (87.5%) were within ±1.0 D of emmetropia. Nine eyes (22.5%) had a laser enhancement because of a residual refraction error. Eleven eyes (27.5%) had a neodymium:YAG laser capsulotomy because of PCO. In general, multifocal IOL implantation after corneal refractive laser surgery for hyperopia resulted in good visual acuity and refraction. The magnitude of previous hyperopia did not influence the refractive predictability.

Multifocal intraocular lens implantation after previous corneal refractive laser surgery for myopia

To describe the refraction and visual acuity outcomes of multifocal intraocular lens (IOL) implantation in patients with previous corneal refractive laser surgery for myopia. Academic Medical Center, University of Amsterdam, Amsterdam, and Retina Total Eye Care, Driebergen, the Netherlands. Retrospective cohort study. The 3-month results after implantation of a multifocal IOL (Acrysof Restor) in patients who had corneal refractive laser surgery for myopia were analyzed. The primary outcome measures were corrected distance visual acuity, uncorrected distance visual acuity (UDVA), and refraction. The secondary outcome measures were number of laser enhancements, corneal irregularity, pre-laser magnitude of myopia, and posterior capsule opacification (PCO) rate. Seventy-seven eyes of 43 patients were included. Twenty-nine eyes had lens extraction because of cataract, and 48 eyes had a refractive lens exchange. The mean postoperative UDVA was 0.14 logarithm of minimum angle of resolution ± 0.22 (SD). The mean postoperative spherical equivalent was -0.38±0.78 diopter (D). Fifty-seven percent of eyes were within ±0.50 D of emmetropia, and 86% were within ±1.0 D. Sixteen eyes (20.8%) had laser enhancement because of residual refraction. Fourteen eyes (18.2%) had a neodymium:YAG laser capsulotomy because of PCO. Eyes with pre-laser myopia greater than 6.0 D had a less predictable outcome than eyes with pre-laser myopia less than 6.0 D (P=.026). Multifocal IOL implantation after corneal refractive laser surgery for myopia resulted in good visual acuity and refraction. Results were less predictable with myopia greater than 6.0 D.

Comparison of visual outcomes, spectacles dependence and patient satisfaction of multifocal and accommodative intraocular lenses: innovative perspectives for maximal refractive-oriented cataract surgery

BackgroundThe aim of this study was to evaluate visual outcomes for different working distances (far, 60 cm and 33 cm) and impact on vision quality of multifocal IOLs AcrySof ResTOR SN6AD1 and SN6AD3 (Alcon, Inc., Fort Worth, Texas, USA) as well as REVIEW FIL611PV multifocal and OPTOFLEX FIL618 accommodative IOLs (Soleko, Ltd., Rome, Italy) in patients undergoing bilateral phacoemulsification.MethodsIn this observational prospective study 63 patients undergoing binocular cataract surgery were divided into four groups for implantation of one of the IOLs under evaluation. Visual outcomes were evaluated at 1 day, 7 days, 1 month, 3 months and 6 months after surgery. Patients’ satisfaction and spectacle independence were evaluated with questionnaires administered at the 6-months follow-up.ResultsImprovements in visual acuity for the three working distances were statistically significant in all cases compared to the preoperative status, especially after binocular implantation. The AcrySof ReSTOR SN6AD1 multifocal IOL provided the best visual acuity results and tolerability for all working distances. While performing worse than SN6AD1, FIL611PV and FIL618 provided better uncorrected visual acuity and spectacles independence for intermediate/close-up and far distances respectively, in comparison with the SN6AD3 group.ConclusionsSN6AD1 was confirmed the best choice for all working distances. However, FIL611PV IOL may represent a valid and more cost-effective alternative, especially if surgeons intend to prioritize spectacle independence and patient autonomy at intermediate and close-up distances, in accordance to specific needs and requests.Trial registrationTrial retrospectively registered in ISRCTN Registry on 02/02/2017. TRN: ISRCTN14145737.

Outbreak of Subacute-Onset Toxic Anterior Segment Syndrome Associated with Single-Piece Acrylic Intraocular Lenses

To report the results of a clinical investigation after an outbreak of subacute-onset toxic anterior segment syndrome (TASS) after implantation of single-piece acrylic intraocular lenses (IOLs), which then were recalled voluntarily from the market. Retrospective, multicenter, observational case series. Cases reported to the manufacturer from January 2015 through March 2016 of unusual ocular inflammation after cataract surgery using AcrySof ReSTOR, ReSTOR toric, or AcrySof IQ toric SN6AT6-9 IOLs (Alcon Laboratories, Inc., Fort Worth, TX). The independent investigation committee, not Alcon, directly requested the surgeons for data on 304 eyes from 184 facilities. Consent for data collection was obtained for 201 eyes from 130 facilities. By excluding cases with infectious endophthalmitis and inconclusive cases, the investigation committee identified 147 cases of subacute-onset TASS. AcrySof ReSTOR or ReSTOR toric IOLs and AcrySof IQ toric SN6AT6-9 IOLs were implanted in 94 eyes (63.9%) and 53 eyes (36.1%), respectively. The mean onset time was 13.1±16.4 days after surgery (range, 1-88 days), with 84 eyes (57.1%) demonstrating symptoms within 7 days after surgery. Typical clinical symptoms were mild to moderate exacerbation of inflammation in the anterior chamber after an uneventful clinical course for a few days after surgery. One hundred four eyes (70.7%) were treated with medication alone, and 43 eyes (29.3%) underwent surgery, including irrigation of the anterior chamber, vitrectomy, and removal of the IOL. The mean best-corrected visual acuity (BCVA) at the final visit (-0.012±0.175 logarithm of the minimum angle of resolution [logMAR]) was significantly better than the BCVA at the onset of TASS (0.158±0.351 logMAR) and did not differ from that before inflammation developed (-0.004±0.162 logMAR). Overall treatment outcomes were favorable. A large-scale outbreak of subacute-onset TASS developed after implantation of a specific model of IOL.

Residual Astigmatism Threshold and Patient Satisfaction with Bifocal, Trifocal and Extended Range of Vision Intraocular Lenses (IOLs)

Purpose: To compare the impact of induced astigmatism with four different types of multifocal intraocular lenses (MIOLs). Method: Prospective, comparative, interventional, mono-centered study, including 80 eyes of patients with implantation of four different MIOLs: AcrySof ReSTOR +2.5 D (20 eyes), AcrySof ReSTOR +3.0 D (20 eyes), AcrySof Panoptix (20 eyes) (Alcon Laboratories, Inc., Fort Worth, TX, USA), and Tecnis Symfony ZRX00 (Abbott Medical Optics, Santa Ana, USA) (20 eyes). Patients were followed up for 3 months after surgery. Major parameters were uncorrected (UDVA) and corrected (CDVA) distance visual acuity, subjective refraction and patient satisfaction. Results: Differences between IOLs with regard to the impact of the cylinder sign and axis on visual acuity and patient satisfaction were not significant. With mild added negative cylinder, AcrySof ReSTOR +2.5 D and Tecnis Symfony IOLs maintained the baseline visual acuity, while it was mildly reduced with AcrySof ReSTOR +3.0 D and Panoptix IOLs. With moderate induced cylinder, the Tecnis Symfony IOL maintained good visual acuity and patient associated satisfaction. Panoptix IOL was the IOL most affected by the induced astigmatism with regard to dissatisfaction and visual acuity. The highest tolerance to the astigmatic distortion and blurriness induced with a -1.50 D cylinder was obtained with the Tecnis Symfony IOL. Tecnis Symfony IOL showed less dissatisfaction and less reduction of visual acuity than the other MIOLs. Conclusion: Simulated residual cylinders after the implantation of the Tecnis Symfony IOL up to 1.0 D have a very mild and not clinically relevant impact on visual acuity or patient satisfaction. The ERV IOL showed a better tolerance to unexpected postoperative residual errors than diffractive bifocal and trifocal IOLs.

Comparison of visual function and patient satisfaction with AcrySof ReSTORSN6AD1 multifocal intraocular compared to monofocal intraocular lenses 5

Aim. To compare visual function and satisfaction in patients after implantation of AcrySof ReSTOR SN6AD1 multifocal intraocular lens (IOL), AcrySof SA60AТ spherical monofocal IOL, or Akreos АО aspheric monofocal IOL during cataract surgery.&#x0D; Materials. Overall, 34 patients received SN6AD1 multifocal (group 1, 48 eyes), 19 patients received Akreos АО monofocal aspheric (group 2, 30 eyes), and 13 patients received AcrySof SA60AТ monofocal spherical (group 3, 18 eyes) IOL. Patients with multifocal IOL were closely matched for age, sex, and ocular findings with patients who had monofocal IOL implantation. Six months postoperatively, uncorrected/corrected distance visual acuity (UDVA/CDVA), uncorrected intermediate (60 cm) and near (35 cm) visual acuity (UNVA), defocus curve, contrast sensitivity, and a quality-of-life questionnaire were evaluated. Furthermore, independence from glasses and presence of optical phenomena were assessed.&#x0D; Results. Patients in group 2 had statistically significant increase in UDVA than that in group 1 (p = 0.037). There was no significant difference in the mean uncorrected intermediate and best corrected distance visual acuities between the groups. UNVA was better in group 1 than that in groups 2 and 3 (p 0.0001). Photopic contrast sensitivity for high spatial frequencies was better in groups 2 and 3. Glare was reported in 5.9% of patients in group 1. Halos occurred in 32.4% of patients in group 1. No one reported undesirable visual symptoms in groups 2 and 3.&#x0D; Conclusion. Multifocal IOLs provided higher spectacle independence and satisfactory functional vision over a broad range of distances but were associated with increased subjective visual symptoms and reduced photopic contrast sensitivity for high spatial frequencies and distance visual quality compared with monofocal IOLs.

Häufigkeit, Ursachen und Verlauf von Explantationen multifokaler Intraokularlinsen

Multifocal intraocular lenses (MF-IOL) are implanted for visual rehabilitation after cataract operation and refractive lens exchange (RLE). In this retrospective study, the frequency, causes and course of MF-IOL explantation are investigated. Private eye clinic, Cologne, Germany. Between 2009 and 2014, a total of 1438 eyes were supplied with a hydrophobic, aspherical, diffractive, multifocal posterior chamber lens (PCL) of type: Acrysof ReSTOR and ReSTOR toric, with near additions of + 2.5, + 3.0 and + 4.0 (Alcon, Fort Worth, USA). 78 % (n = 1116 eyes) were indicated because of a cataract and 22 % (n = 322 eyes) as RLE. All procedures were either performed by OK or GG, as ultrasound phacoemulsification under topical anaesthesia. Since 2013, a femtosecond laser (LensX, Alcon, Fort Worth the USA) has been used in some cases. Data analysis was performed with the help of the digital patient's recordings. In a total of 12 cases, the MF-IOL needed to be explanted. Causes for the explantation were strong deviations from the expected target refraction (4 eyes), epiretinal gliosis accompanied by surgically membrane peeling (2 eyes), optical discomfort (waxy vision, 4 eyes), unstable toric lens due to a vast zonulolysis (1 eye), and 5 years post-implantation glistening (1 eye). The overall frequency of MF-IOL explantationen was 0.83 %. The frequency of explantations due to specific optical side effects and discomfort was 0.28 %. In all cases, 12 months post MF-IOL explantation recovery was achieved to full visual acuity. Diffractive MF-IOL of the type Alcon Acrysof ReSTOR are generall very well accepted. In only 0.28 % of all cases, was an explantation performed on grounds of optical discomfort. In the other cases, the causes for explantation were not related to the optical geometry of the MF-IOL.

Impact of low mesopic contrast sensitivity outcomes in different types of modern multifocal intraocular lenses.

To investigate the low mesopic contrast sensitivity function (LMCSF) of patients implanted with different modern optical bifocal and trifocal designs of multifocal intraocular lenses (mfIOLs). This prospective, comparative, nonrandomized consecutive case series included 180 eyes that underwent cataract surgery. Six groups of eyes were differentiated: group A, eyes with the diffractive AT LISA tri 839MP; group B, eyes with diffractive FineVision; group C, eyes with the bifocal Lentis Mplus-LS313; group D, eyes with the diffractive bifocal Acri.Lisa 366D; group E, eyes with the diffractive apodized Acrysof ReSTOR SN6AD1; group F, as the control group, implanted with a monofocal spherical intraocular lens. The LMCSF was evaluated with the OPTEC® 6500 device at 3 months postoperatively using a luminance of 3 cd/m2. No significant differences among groups were detected in LMCSF for the spatial frequencies of 1.5, 3.0, 6.0, and 12.0 cpd (1.5 cpd: F = 1.81, p = 0.13; 3.0 cpd: F = 1.14, p = 0.14; 6.0 cpd: F = 1.87, p = 0.11; 12.0 cpd: F = 1.26, p = 0.29), but significant differences were found among groups for the spatial frequency of 18 cpd (F = 2.62, p = 0.03). When comparing the groups in pairs, only statistically significant differences were observed between groups E and F for the spatial frequency of 18.0 cpd (t = 3.27, p = 0.03) with better values for group F. No significant differences were observed in LMCSF among the different mfIOLs studied. The third focus of trifocal IOL models did not adversely affect the LMCSF. The ReSTOR SN6AD1 showed the poorest LMCSF for the highest spatial frequency analyzed when compared with the control group.

Comparison of the Visual Outcomes after Cataract Surgery with Implantation of a Bifocal and Trifocal Diffractive Intraocular Lens

Purpose: To evaluate and compare visual outcomes and optical quality after implantation of a bifocal (Acrysof ReSTOR SN6AD1) or trifocal (AT LISA tri 839MP) diffractive intraocular lens (IOL). Methods: Fifty-one eyes of 43 patients undergoing cataract surgery were enrolled and assigned to one of two groups: the trifocal group, comprising 24 eyes implanted with the trifocal diffractive IOL (AT LISA tri 839MP), and the bifocal group, comprising 27 eyes implanted with the bifocal diffractive IOL (Acrysof ReSTOR SN6AD1). Visual acuity (distant, intermediate, and near vision) and refractive postoperative outcomes were evaluated at one and three months postoperatively. Measurements of optical quality (using OQAS II), contrast sensitivity (using CGT-2000), automated visual field examination, and evaluation of defocus curve were performed three months postoperatively. Results: No statistically significant differences between the two groups were found in three-month postoperative distant and near (40 cm) visual acuities and optical quality. However, intermediate (63 cm, 80 cm, and 100 cm) visual acuities were significantly better in the trifocal group. Distant contrast sensitivity (5 m) under mesopic conditions was significantly better with the bifocal lens, whereas near contrast sensitivity (30 cm) under mesopic and scotopic conditions was significantly better with trifocal lens. There was no statistical difference between the groups under photopic conditions. In the defocus curve, the visual acuity was significantly better at intermediate distance in the trifocal group. Conclusions: Trifocal diffractive IOLs provide significantly better intermediate vision than bifocal IOLs, with equivalent postoperative levels of distant and near vision and ocular optical quality. Further, they provide better near contrast sensitivity under scotopic condition compared to diffractive bifocal IOLs. J Korean Ophthalmol Soc 2016;57(3):405-412

Disk halo size measured in individuals with monofocal versus diffractive multifocal intraocular lenses

To compare disk halo size in response to a glare source in eyes with an aspheric apodized diffractive multifocal intraocular lens (IOL) or aspheric monofocal IOL. Rementeria Ophthalmological Clinic, Madrid, Spain. Prospective randomized masked study. Halo radius was measured using a vision monitor (MonCv3) with low-luminance optotypes in eyes that had cataract surgery and bilateral implantion of an Acrysof Restor SN6AD1 multifocal IOL or Acrysof IQ monofocal IOL 6 to 9 months previously. The visual angle subtended by the disk halo radius was calculated in minutes of arc (arcmin). Patient complaints of halo disturbances were recorded. Monocular uncorrected distance visual acutity (UDVA) and corrected distance visual acuity (CDVA) were measured using high-contrast (96%) and low-contrast (10%) logMAR letter charts. The study comprised 39 eyes of 39 subjects (aged 70 to 80 years); 21 eyes had a multifocal IOL and 18 eyes a monofocal IOL. The mean halo radius was 35 arcmin larger in the multifocal IOL group than the monofocal group (P < .05). Greater halo effects were reported in the multifocal IOL group (P < .05). The mean monocular high-contrast UDVA and low-contrast UDVA did not vary significantly between groups, whereas the mean monocular high-contrast CDVA and low-contrast CDVA were significantly worse at 0.12 logMAR and 0.13 logMAR in the multifocal than in the monofocal IOL group, respectively (P < .01). A significant positive correlation was detected by multiple linear regression between the halo radius and low-contrast UDVA in the multifocal IOL group (r = 0.72, P < .001). The diffractive multifocal IOL gave rise to a larger disk halo size, which was correlated with a worse low-contrast UDVA. None of the authors has a financial or proprietary interest in any material or method mentioned.

Anterior segment changes after femtosecond cataract surgery measured with optical coherence tomography and scheimpflug imaging technology

PurposeTo determine changes in anterior chamber depth (ACD), iridocorneal angle size (IAS) and central corneal thickness (CCT) using optical coherence tomography (OCT) and Scheimpflug imaging technology (SIT) in subjects implanted with multifocal intraocular lens (IOL) after femtosecond cataract surgery.MethodsProspective study of 36 healthy eyes (68.8 ± 7.9 years) undergoing femtosecond laser assisted‐cataract surgery and AcrySof REsTOR SN6AD1 IOL implantation. The anterior segment parameters were measured preoperatively and 1 month after surgery with the Visante‐OCT (Zeiss) and the Oculyzer™ II (WaveLight® AG) systems. Analysis of agreement and interchangeability of the preoperative 2 systems measurements was performed by the Bland‐Altman method.ResultsAfter femtosecond cataract surgery, the ACD and IAS measured with Oculyzer™ II showed a significant mean increase of 1.54 ± 0.28 mm and 10.2 ± 4.23 respectively. Also, using the Visante‐OCT there was a significant mean increase: 1.27 ± 0.34 mm for ACD and 9.38 ± 6.52 (Temporal) and 8.29 ± 7.13 (nasal) for IAS. CCT showed no significant changes. The range of agreement indicated that the 2 techniques cannot be used interchangeably for preoperative measurement of ACD and IAS.ConclusionsAfter cataract surgery with femtosecond laser, ACD and IAS increased significantly when measured using OCT and SIT. Visante‐OCT and Oculyzer™ II systems can be used interchangeably for CCT evaluation but not for ACD and IAS.

Clinical Results and Optical Quality of Diffractive Multifocal Intraocular Lens

Purpose: To compare postoperative clinical outcomes, optical quality, and patient satisfaction between two types of diffractive multifocal intraocular lens (IOL, Acri Lisa 366D and Acrysof ReSTOR +3.00 D). Methods: In a total of 68 eyes, one of two diffractive multifocal IOL (Acri Lisa 366D and Acrysof ReSTOR +3.00 D) was implanted after cataract extraction. Visual acuity was measured postoperatively at one week, 1 month, and 6 months. Contrast sensitivity, wavefront aberration, and visual function were determined via questionnaire at postoperative 1 month. Results: Intermediate visual acuity of Acri Lisa 366D and Acrysof ReSTOR at 6 months were 0.31 ± 0.14, and 0.24 ± 0.11 (log MAR), respectively. At 6 months, near and distant visual acuity results showed no significant differences between the two groups. The photopic contrast sensitivity of Acri Lisa 366D at 6 cycles/degree was 55.36 ± 7.40 and showed significant differences with Acrysof ReSTOR (47.25 ± 9.67). The mesopic contrast sensitivity values of Acri Lisa 366D and Acrysof ReSTOR were 40.26 ± 11.38 and 28.97 ± 10.45, respectively, and the spherical aberration values were 0.037 ± 0.039 μm and 0.105 ± 0.066 μm. The spherical aberration of Acri Lisa 366D was significantly lower than that of Acrysof ReSTOR. Total and high order aberration, coma, and trefoil show no significant differences between the two groups. Conclusions: The Acri Lisa 366D multifocal IOL showed better contrast sensitivity and spherical aberration compared to Acrysof ReSTOR multifocal IOL, which had an effective intermediate visual acuity. J Korean Ophthalmol Soc 2015;56(12):1867-1873

Comparison of Clinical Outcomes between Diffractive and Refractive Multifocal Intraocular Lens with Same Near Added

Purpose: To compare the clinical outcomes between refractive-type multifocal intraocular lenses (IOL) (Lentis Mplus LS 313, Oculentis GmbH., Berlin, Germany) and diffractive-type multifocal IOL (Acrysof Restor; SN6AD1, Alcon Lab., Fort Worth, TX, USA) with same near added. Methods: We evaluated 30 eyes implanted with Lentis Mplus IOL and 33 eyes implanted with Acrysof Restor IOL after phacoemulsification. The distant, intermediate, and near uncorrected visual acuities of the 2 groups were evaluated at 2 weeks and 1, 3, and 6 months postoperatively. Optical quality obtained using the Optical Quality Analysis System II (OQAS II, Visiometrics, Castelldefels, Barcelona, Spain), higher-order aberrations (HOAs), and patient satisfaction questionnaire of the 2 groups were evaluated at 3 months postoperatively. Results: The visual acuity of intermediate 100 cm was statistically better in the Lentis Mplus group (p < 0.05). There were no significant differences between the 2 groups with distant, intermediate 63 cm, and near vision. At the 3-month postoperative follow-up, objective scatter index, modulation transfer function (MTF) cutoff value, and pseudo-accommodation range measured by OQAS II showed no differences between the 2 groups, but Strhel ratio was higher in the Acrysof Restor group. HOAs of 5 mm and 6 mm increased significantly in the Lentis Mplus group. No significant differences were found in the patient satisfaction questionnaire. Conclusions: Both refractive and diffractive-type multifocal IOL implantation in patients with cataracts and presbyopia offered good and comparable visual acuity at distance and near. However, the Lentis Mplus IOL provided better intermediate vision than the Acrysof Restor IOL. J Korean Ophthalmol Soc 2015;56(6):875-884