Aspheric Multifocal Intraocular Lens Research Articles

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.

Presbyopia Correction in Astigmatic Eyes Using a Toric Trifocal Intraocular Lens With Quadrifocal Technology.

To evaluate the visual performance after bilateral implantation of a toric diffractive aspheric multifocal intraocular lens (IOL) with a +2.17 diopters (D) (60 cm) intermediate and a +3.25 D (40 cm) addition (add) power. This prospective single-arm study was conducted at the Department of Ophthalmology, Goethe University, Frankfurt, Germany. Twenty-five patients (50 eyes) received bilateral implantation of the toric PanOptix IOL (AcrySof IQ PanOptix; Alcon Research LLC) before enrollment. Exclusion criteria were previous ocular surgeries excluding lens surgery and ocular pathologies or corneal abnormalities. Examination at 3 months postoperatively included manifest refraction; monocular and binocular uncorrected distance (UDVA) and distance-corrected (DCVA) visual acuity at 4 m and 80, 60, and 40 cm; and slit-lamp examination. At 3 months postoperatively, monocular and binocular defocus, binocular contrast sensitivity under photopic and mesopic conditions, and optical phenomena, and spectacle independence were evaluated. Mean refractive spherical equivalent was 0.12 ± 0.380 D and mean refractive cylinder was -0.21 ± 0.237 D at 3 months postoperatively. A significant decrease in refractive cylinder was observed postoperatively (P < .05), with 98% showing a postoperative astigmatism below 0.75 D. Monocular UDVA was better than 0.14 logMAR in all distances. Binocular defocus curve showed peaks at 0.00 D (-0.09 logMAR) and -1.50 and -2.00 D (-0.02 and 0.00 logMAR). The worst values between far (4 m) and near (40 cm) distance were 0.04 logMAR at -1.00 D. Despite some optical phenomena, 92% of patients would choose the same IOL again and recommend it to others. The visual performance of the toric PanOptix IOL showed good visual acuity at all distances; more than 90% achieved a decrease of refractive cylinder below 0.75 D, high patient satisfaction despite some optical phenomena, and high spectacle independence 3 months postoperatively. [J Refract Surg. 2020;36(10):638-644.].

Comparison of three different diffractıve multifocal intraocular lenses with a +2.5, +3.0, and +3.75 diopter additıon power

PurposeTo compare the functional outcomes and astigmatic tolerability after implantation of multifocal intraocular lenses (IOLs) with a +2.5, +3.0, and +3.75 diopter (D) addition power. MethodsThis study included 122 eyes of 61 patients who had bilateral cataract extraction and implantation of diffractive aspheric multifocal acrylic IOLs with +2.5 D (+2.5 group), +3.0 D (+3.0 group), and +3.75 D (+3.75 group) addition powers. 1-year after surgery, distance corrected near (DNVA) and intermediate (DIVA) visual acuities at 32, 40, 45, 50, 55, and 60 cm; and contrast sensitivity measurements under photopic, mesopic and mesopic with glare conditions; spherical and astigmatic defocus testing; distance-intermediate-near vision patient satisfaction levels; spectacle dependance; patient-reported outcomes were assessed binocularly. ResultsThe +2.50 D group had better DIVA than both +3.0 group and +3.75 groups at 45 cm, 50 cm, 55 cm, and 60 cm (p < 0.05). The +3.75 group had better DNVA than both +2.5 and +3.0 IOL groups at 32 cm (p < 0.05). There was no significant difference in mean contrast values at all frequencies between three IOL groups (p > 0.05). The +2.50 D group showed better astigmatic tolerability than +3.00 group (at 2.00 D) and +3.75 group (at 1.50 D, and at 2.00 D) (p < 0.05). ConclusionMultifocal IOLs with +2.5 add power have better intermediate vision, but worse near vision compared to multifocal IOLs with +3.00 D and +3.75 D add power. Multifocal IOLs with +2.50 D add power tend to have better astigmatic defocus tolerability than multifocal IOLs with +3.00 D and +3.75 D add powers.

Long-term clinical effect of aspheric multifocal intraocular lens implantation for developmental cataracts in childhood

Objective To observe the long-term visual quality and clinical effect of aspheric diffractive multifocal intraocular lens (IOL) implantation for congenital and developmental cataracts in childhood. Methods A retrospective cohort study on multifocal IOL implantation for congenital and developmental cataracts in childhood (aged 8 to 14 years) was performed in the First Affiliated Hospital of Zhengzhou University from August 2013 to January 2015.The clinical data of 67 eyes from 46 congenital cataract patients who received phacoemulsification with IOL implantation were collected.The AMO (ZMB00) IOL was implanted in 34 eyes of 24 patients in the multifocal IOL group, and Bausch & Lomb (MI60) IOL was implanted in 33 eyes of 22 patients in the monofocal IOL group.The distance, intermediate and near vision acuity were analyzed in 3, 6 and 12 months after surgery, including uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA). The wavefront aberrations, modulation transfer functions (MTF) and stereopsis were obtained with iTrace Analysis System, Optec-6500 Visual Functional Analyzer and Titmus Stereo Test Chart, respectively in 12 months after surgery.The near additional degree, removing glasses rate and myopic shift were compared between the two groups in postoperative 12 months. Results The intermediate and near UCVA in the multifocal IOL group were obviously better than those in the monofocal IOL group 3, 6 and 12 months after surgery (intermediate: Z=-3.74, -4.36, -3.66; all at P=0.00.near: Z=-2.67, -2.50, -2.33; all at P 0.05). The MTFs under the 5.0 mm optical zone and 5, 10, 15, 20, 25, 30 c/d in the multifocal IOL group were insignificantly lower than those in the monofocal IOL group (all at P>0.05). In addition, the near stereopsis, near additional degree and myopic shift (ΔD) were reduced in the multifocal IOL group compared with monofocal IOL group (both at P 0.05). The myopic shifting rates were 16.7% and 83.3% in the multifocal IOL group and monofocal IOL group, with a significant difference between the two groups (χ2=15.02, P=0.00). Conclusions The aspheric multifical IOL implantation can achieve good and stable distance, intermediate and near visual acuities, provide better near stereopsis, reduce postoperative dependence on spectacles and decrease the incidence of myopic shift in child cataract patients. Key words: Congenital cataract; Intraocular lens; Prosthesis implantation; Aspheric; Multifocal; Wavefront aberration; Modulation transfer function; Childhood

Clinical outcomes of a new diffractive multifocal intraocular lens.

To evaluate clinical outcomes after implantation of a new diffractive aspheric multifocal intraocular lens (IOL) with +3.00 addition power. This is a retrospective, consecutive case series of cataract patients who underwent bilateral implantation of the Optiflex MO/HF D012 (Moss Vision Inc. Ltd, London, UK) multifocal IOL. Patients followed for 6mo were included in the study. Data on distance, intermediate and near visual acuity, refractive error [manifest spherical equivalent (MSE)], contrast sensitivity, adverse events, subjective symptoms, spectacle independence and patient satisfaction [visual function questionnaire (VFQ)-25 questionnaire] were retrieved from electronic medical records and analyzed. Forty eyes of 20 patients with a mean age of 66.7±8.5y (range: 53-82) were included in the study. Mean uncorrected distance, near and intermediate visual acuity remained stable through postoperative visits and was 0.19±0.19 logMAR, Jaeger 4 and Jaeger 3 respectively at the 6mo visit. At the end of postoperative 6mo, MSE was -0.14±0.42 diopters (D) and 98% of the eyes were within 1.00 D of target refraction. Postoperative low contrast (10%) visual acuity remained stable (P=0.54) through follow up visits with a mean of 0.35±0.17 logMAR at the 6mo visit. There were no reported adverse events. None of the patients reported subjective symptoms of halo or glare. Spectacle independence rate was 90%. Mean VFQ-25 questionnaire score was 93.5±6.12. The Optiflex MO/HF-DO12 IOL was safely implanted and successfully restored distance, intermediate and near visual acuity without impairing contrast sensitivity. High levels of spectacle independence were achieved at all distances including intermediate distance.

Comparison on the efficacy between the multifocal and monofocal aspheric toric intraocular lens in cataract patients

Objective To compare the clinical efficacy between the multifocal and monofocal aspheric toric intraocular lens in cataract patients. Methods Seventy-two eyes of 56 patients with age-related cataract underwent phacoemulsification were randomly divided into 2 groups. In group A, the aspheric multifocal toric intraocular lens were implanted in 37 eyes of 29 patients. In group B, the aspheric monofocal toric intraocular lens were implanted in 35 eyes of 27 patients. After surgery, the visual acuity, postoperative residual corneal astigmatism, the IOL axis rotational stability, higher-order aberrations and contrast sensitivity were observed and statistically analyzed. Results At 3 months after surgery, the differences in uncorrected near visual acuities (log MAR) were statistically significant between two groups (t=8.569, P=0.003). There was no significant difference in the uncorrected distance, corrected distance or near visual acuity (log MAR) between two groups (t=1.578、1.325、1.098, P= 0.236、0.281、0.217). There was no significant difference in postoperative residual corneal astigmatism between two groups (t=1.775, P=0.135). There was no significant difference in the axis rotation between two groups (t=2.165, P=0.117). There was no significant difference in the general higher-order aberration, 3-order aberration, 4-order aberration or 5-order aberration root mean square value between two groups (t=1.567, 1.256, 1.457, 1.298, P=0.167, 0.158, 0.136, 0.237). There was no significant differrence at any spatial frequenciy of contrast sensitivity function between two groups (t=1.256, 2.359, 1.238, 2.258, 2.156, 1.982, 2.032, 2.987, P= 0.982, 0.758, 0.875, 0.702, 0.112, 0.189, 0.238, 0.356). Conclusion Phacoemulsification combined with aspheric multifocal toric intraocular lens implantation is an effective method for the correction of preexisting corneal astigmatism in cataract patient. The better uncorrected distance and near visual acuities are obtained for cataract patients. The surgery improves spectacles independence for distance vision and spectacles independence for near vision, with a high patient satisfaction. Key words: Cataract, age-related; Lens, intraocular, multifocal, monofocal, astigmatism-correcting, aspherical

In vitro optical quality comparison of 2 trifocal intraocular lenses and 1 progressive multifocal intraocular lens

To evaluate the optical quality of 3 multifocal intraocular lenses (IOLs): the Mini Well Ready progressive multifocal aspheric IOL, the AT LISA trifocal diffractive IOL, and the Finevision full diffractive trifocal IOL. University of Valencia, Valencia, Spain. Experimental study. An instrument designed for measuring real-time modulation transfer function (MTF) and IOL power was used to measure the optical quality of each IOL for 3.0 mm and 4.5 mm apertures. This instrument measures both sagittal and tangential MTFs. The optical quality of each IOL was evaluated with the MTF, through-focus MTF, defocus tolerance, Strehl ratio MTF, and relative percentage of light in each focus. These metrics were evaluated at best focus for each IOL. Through-focus graphs corresponding to trifocal IOLs showed 3 mean peaks. Nevertheless, the progressive multifocal aspheric IOL showed 2 main areas, 1 corresponding to distance vision focus and the other including both intermediate and near vision foci. The results obtained in the present study suggest that the progressive multifocal aspheric IOL might be considered for cataract surgery. None of the authors has a financial or proprietary interest in any method or material mentioned.

Influence on Visual Quality of Intraoperative Orientation of Asymmetric Intraocular Lenses

To evaluate visual quality when changing the intraocular orientation of the Lentis Mplus LS-312MF nonrotational symmetric +3.00 diopters aspheric multifocal intraocular lens ([IOL] Oculentis GmbH, Berlin, Germany) in normal eyes. An artificial eye was used to measure the in vitro wavefront of the IOL. The corneal topography of 20 healthy patients was obtained. For each eye, a computational analysis simulated the implantation of the IOL. The modulation transfer function (MTF) and an image quality parameter (visually modulated transfer function [VSMTF] metric) were calculated for a 5.0-mm pupil and for three conditions: distance, intermediate, and near vision. The procedure was repeated for each eye after a rotation of the IOL with respect to the cornea from 0° to 360° in 1° steps. Statistical analysis showed significant differences in mean VSMTF values between orientations for distance vision. Optimal orientation of the IOL (different for each eye) showed a mean improvement of 58% ± 19% (range: 20% to 121%) in VSMTF values with respect to the worst possible orientation. For these orientations, intermediate and near vision quality were statistically indistinguishable. The MTFs were different between orientations, showing a mean difference of approximately 5 cycles per degree in the maximum spatial frequencies that can be transferred between the best and the worst orientations for distance vision. The results suggest that implantation of this nonrotational symmetric IOL should improve visual outcomes if it is oriented to coincide with a customized meridian. A simple, practical method is proposed to find an approximation to the angle that an Mplus IOL should be inserted.

Clinical Outcomes of Patients with Refractive Aspheric Multifocal IOL Implantation

Purpose: To evaluate the clinical outcomes of patients with refractive aspheric multifocal intraocular lens (IOL) (Lentis Mplus LS-313) implantation. Methods: Sixty-eight eyes of 53 patients received refractive aspheric multifocal IOL implantation. Uncorrected visual acuity (UCVA) at a long distanc, as well as intermediate and near distances were measured on the first day, after two weeks, and during the first, third and sixth months postoperatively. Optical quality was evaluated using the Optical Quality Analysis System II (OQAS II). High-order aberrations (HOA) and patient satisfaction questionnaires were evaluated at three months post-operation. Results: At the six-month postoperative visit, the mean UCVA at a long, two intermediate (63 cm, 100 cm) and a near distance were 0.06 ± 0.07, 0.18 ± 0.14, 0.15 ± 0.13 and 0.11 ± 0.10 log MAR, respectively. The means of the objective scatter index, modulation transfer function (MTF) cut off value, Strehl ratio and pseudo-accommodation range measured by OQAS II were 1.20 ± 0.69, 34.15 ± 9.53 cdp, 0.17 ± 0.05 and 3.09 ± 0.25 D, respectively. HOA of 5 mm and 6 mm were each 0.61 ± 0.14 and 1.07 ± 0.20, respectively. Eighty-two percent of patients were satisfied with the postoperative results, and 71% of the patients reported that they would recommend the procedure to others, while 24% of patients reported moderate or severe visual disturbance at night. Conclusions: Implantation of the refractive aspheric multifocal IOLs in patients with cataracts provided excellent distant, intermediate, and near visual outcomes and high patient satisfaction as well as presbyopia correction. J Korean Ophthalmol Soc 2014;55(7):991-1000

Visual function and higher order aberration after implantation of aspheric and spherical multifocal intraocular lenses: a meta-analysis.

To assess the visual outcomes of aspheric multifocal intraocular lenses (IOLs) compared with spherical multifocal IOL after cataract surgery. Potential prospective controlled trials that comparing aspheric multifocal IOL implantation with spherical multifocal IOL group were extracted from the computer database. The statistical analysis was carried out using Stata 10 software. Standardized mean differences with 95% confidence intervals (CIs) were calculated for continuous variables. The pooled estimates were computed in the use of a random-effects model. A systematic review identified five prospective nonrandomized controlled trials, including 178 aspheric multifocal IOL and 164 spherical multifocal IOL. There was no significant difference in uncorrected distance visual acuity (95%CI, -0.248 to 0.152;P=0.641) and uncorrected near visual acuity (95%CI, -0.210 to 0.428;P=0.504) between aspheric multifocal IOL and spherical multifocal IOL. Statistically significant differences were detected less spherical aberration in aspheric multifocal IOL (95%CI, -1.111 to -0.472; P<0.001) when compared to spherical multifocal IOL. Spherical multifocal IOL showed a greater higher order aberration compared to the aspheric multifocal IOL (95%CI, -1.024 to-0.293; P<0.001). Sensitivity analysis suggested that the results were relatively reliable. The overall findings indicated that aspheric multifocal IOL and spherical multifocal IOL provided similar visual acuity at near and distance. Patients implanted with aspheric multifocal IOL had less spherical aberration and higher order aberration than patients with spherical multifocal IOL. Further well-organized, prospective controlled trials involving larger patient numbers are needed.

백내장 환자에서 비구면 다초점 인공수정체 삽입 후 시기능 평가

목적: 비구면 다초점 인공수정체인 ReSTOR<TEX>$^{(R)}$</TEX> SN6AD3 삽입안의 시력과 시기능 변화를 분석하였다. 방법: 양안 또는 단안에 비구면 다초점 인공수정체(ReSTOR<TEX>$^{(R)}$</TEX> SN6AD3)를 삽입한 백내장 환자 19명의 30안을 대상으로 하였다. 수술 전, 수술 후 1주일, 1개월 및 3개월 후에 시력과 객관적인 시기능을 측정하였고 수술 3개월 후 인공수정체 삽입안의 시기능 측정값을 동일 연령대의 정상안 20명(38안)과 비교하였다. 원거리 시력은 2 m 거리에서 LCD chart ETDRS 시력표를 이용하여 측정하였고, 중간거리(50 cm)과 근거리(30 cm) 시력은 Jaeger chart를 이용하였다. 객관적인 시기능은 OQAS 장비를 이용하여 OSI (objective scatter index, 객관적 산란지수), MTF (modulation transfer function, 변조전달함수) cut off, Strehl ratio를 4 mm 동공크기에서 측정하여 수술 후 경과기간에 따른 측정값을 비교 평가하였다. 수술 3개월 째 시력 및 시기능은 객관적 평가와 주관적인 평가를 통해 동일 연령대의 정상안과 비교하였다. 결과: 나안 원거리 시력과 OSI, MTF와 Strehl ratio는 다초점 인공수정체 삽입 1개월까지 유의하게 향상되었다(p<0.05). 수술 3개월 후 다초점 인공수정체 삽입안의 MTF와 Strehl ratio는 정상 대조군의 수준으로 회복되었지만, OSI는 대조군보다 높은 값으로 측정되었다(p<0.001). 자각적인 원거리 및 근거리 시력에 대한 만족도는 높았지만, 중간거리 시력에 대한 만족도가 낮으며 눈부심과 빛 번짐 증상이 나타났다. 결론: 비구면 다초점 인공수정체 삽입안의 시기능은 수술 1개월 후부터 안정화되며 동일 연령대의 정상안의 수준으로 개선되지만 만족스러운 중간거리 시력을 제공하지 못하며 눈부심과 빛 번짐의 시각적 불편감이 나타나는 것으로 사료된다. Purpose: To evaluate the visual acuity and visual performance after implantation of a aspheric multifocal (ReSTOR<TEX>$^{(R)}$</TEX> SN6AD3) intraocular lens (IOL). Methods: Nineteen cataract patients (30 eyes) implanted with an aspheric multifocal IOL (ReSTOR<TEX>$^{(R)}$</TEX> SN6AD3) either unilaterally or bilaterally were participated. Visual acuity (VA) and objective optical performance were evaluated at the time of preoperation, 1 week, 1 month, and 3 month after operation. At 3 month of post-operation, objective visual performance were measured and compared with the 38 eyes of 20 age-matched normal control. Distance VA was measured by using the ETDRS LCD chart and intermediate and near visual acuity were measured using Jaeger chart. Objective visual performance was assessed preoperatively and 1 week, 1 month and 3 month postoperatively using a double-pass system (Optical Quality Analysis System) with a 4-mm pupil diameter, the OSI (objective scatter index), MTF (modulation transfer function) cut off and strehl ratio. At 3 month of post-operation, visual acuity and visual performance compared with age matched normal control. Results: The uncorrected distance VA, OSI, MTF cut off and strehl ratio were significantly improved (p<0.05) until 1 month postoperatively. Visual performance of MTF cut off and strehl ratio after 3 month of operation were significantly improved compared to the normal control (p=0.063, p=0.103 respectively), however, OSI was higher than normal control. Patients implanted with aspheric multifocal IOL were satisfied with distance and near VA however, were unsatisfied with intermediate VA and reported glare and halos. Conclusions: The visual performance reaches to a stable condition in 1 month of implantation of aspheric multifocal IOL and improved to the level of age-mated normal patients. Also patients were satisfied with their quality of vision, however, intermediate VA, glare and halos were reported as complications.

Visual Performance after Bilateral Implantation of a new Diffractive Aspheric Multifocal Intraocular Lens with a 3.5 D Addition

To evaluate visual performance after implantation of a new diffractive aspheric multifocal intraocular lens (MIOL) with a +3.50 D addition power. A total of 24 cataract patients were bilaterally implanted with the Diffractiva-aA MIOL in 2 ophthalmologic centers and followed for 6 months. Postoperative evaluations included visual acuities (VA) at various distances, defocus testing, contrast sensitivity (CS) measurements, and patient satisfaction questionnaire. Six months postoperatively, binocular uncorrected VA (mean ± SD; logMAR) was 0.00 ± 0.05 (≈ 20/20) for distance, 0.06 ± 0.13 (≈ 20/23) for intermediate (1 m), and 0.00 ± 0.05 (≈ 20/20) for near (40 cm). All patients achieved uncorrected VA of 20/25 or better for distance and near, and 20/40 or better at 1 m. Monocular and binocular defocus curves showed 2 peaks of maximum VA at the distance focus (0.0 D) and the near focus (-2.5 D) and a good range of intermediate vision with the lowest mean acuity being at -1.5 D defocus. Photopic and mesopic CS were within the standard normal range. The majority of patients (n = 22; 91.7%) were spectacle independent; 8.3% (n = 2) reported wearing glasses occasionally for very small print (1 patient) or for watching television (1 patient). Overall, all patients were "very satisfied" (n = 22; 91.7%) or "satisfied" (n = 2; 8.3%) with the procedure. The new Diffractiva-aA MIOL provided a full range of vision from near to far generating highly satisfied, spectacle independent patients with only minimal visual disturbances at night.

In vitro optical performance of nonrotational symmetric and refractive–diffractive aspheric multifocal intraocular lenses: Impact of tilt and decentration

To evaluate the optical quality of Acrysof Restor SN6AD1 refractive-diffractive +3.00 D and Lentis Mplus LS-312 nonrotational symmetric +3.00 D aspheric multifocal intraocular lenses (IOLs) and analyze the effect of tilt and decentration. University of Valencia, Valencia, and University of Murcia, Murcia, Spain. Experimental study. An artificial model eye was used to measure wavefront aberrations of both IOL models. The modulation transfer function (MTF) and point-spread function (PSF) were calculated for a 5.0 mm pupil and under 5 situations: centered, 0.2 mm and 0.4 mm decentered, and 2 degrees and 4 degrees tilted. The refractive-diffractive IOL had the highest MTF values at all spatial frequencies. Similarly, the PSF was worse for the refractive-diffractive IOL. The MTFs for the refractive-diffractive IOL decreased when the IOL was decentered or tilted, being more robust for tilting than decentration. The MTFs for the nonrotational symmetric IOL were similar under all testing conditions. Cutoff frequencies for the refractive-diffractive IOL were stable over the range of tilting studied and comparable with the cutoff when the IOL was centered (approximately 50 cycles per degree [cpd]). When the IOL was decentered, the cutoff frequency decreased by approximately 40 cpd. The nonrotational symmetric IOL cutoff frequencies for misalignment and tilt were low (approximately 30 cpd) and similar under all conditions. The refractive-diffractive IOL provided better optical quality than the nonrotational symmetric IOL. Tilt and decentration had a significant impact on optical quality with both IOLs, being more severe with the nonrotational symmetric IOL.

Internal spherical aberration by ray tracing-type aberrometry in multifocal pseudophakic eyes

To demonstrate the results of the ray tracing-type aberrometer in measuring spherical aberration (SA) in pseudophakic eyes with monofocal intraocular lens (IOL), aspheric monofocal IOL, or aspheric diffractive multifocal IOL. Total, corneal, and internal SA were measured using iTrace at a 6-mm pupil size in 27 eyes of 27 patients implanted with a monofocal spherical IOL (group 1: Natural, SN60AT), 30 eyes of 30 patients implanted with a monofocal aspheric IOL (group 2: IQ, SN60WF), and 30 eyes of 30 patients implanted with a multifocal aspheric IOL (group 3: ReSTOR, SN6AD1) at 3 months after cataract surgery. We compared the internal SAs of these IOLs in pupil sizes of 3, 4, 5, and 6 mm. There were no demographic statistically significant differences among the groups. The internal SA of group 1 had a positive value. The internal SA of group 2 was -0.175 ± 0.135 μm in 5-mm pupils and -0.227 ± 0.253 μm in 6-mm pupils. The internal SA of group 3 was -0.072 ± 0.128 μm in 5-mm pupils and -0.173 ± 0.231 μm in 6-mm pupils. Measuring internal SA with iTrace yields relatively accurate results in all types of IOLs with adequate pupil sizes.

Comparison on visual function after implantation of an apodized diffractive aspheric multifocal or monofocal intraocular lens.

To evaluate visual outcomes after implantation of an aspheric multifocal/ intraocular lens (MIOL) or an aspheric monofocal intraocular lens (IOL). This was a prospective nonrandomized study. During 3-months of post-operative follow-up, the following outcomes for SN6AD1 MIOL (multifocal group) and SN60WF IOL (monofocal group) were compared: uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity, Chinese character near visual acuity, uncorrected intermediate visual acuity (UIVA) under high (100% contrast) and low contrast (10% contrast), UIVA for different IOL powers, and a quality-of-life questionnaire. UNVA, DCNVA, and UIVA under high contrast in the multifocal group were significantly better than those in the monofocal group (P<0.05). UDVA, CDVA and UIVA under low contrast did not differ between groups at 63 cm and 100 cm (P>0.05). In most of the cases, Chinese character near visual acuity was significantly better in the multifocal group (P<0.05). UNVA and UIVA at 63cm were improved 3 months post-operatively. Better UIVA was found in emmetropic and mild myopic eyes as compared to hyperopic ones. The patients in the multifocal group had a higher degree of satisfaction and performed better on near and intermediate tasks, although with greater complaints of visual disturbance. The SN6AD1 MIOL provides significantly better UNVA, DCNVA and UIVA under high contrast conditions, and better Chinese character near visual acuity. Patients receiving the SN6AD1 MIOL reported a better quality of vision in spite of more serious visual disturbances. Better UIVA was observed in emmetropic and mildly myopic eyes.

Combining Zonal Refractive and Diffractive Aspheric Multifocal Intraocular Lenses

To assess visual performance with the combination of a zonal refractive aspheric multifocal intraocular lens (MIOL) (Lentis Mplus, Oculentis GmbH) and a diffractive aspheric MIOL (Acri.Lisa 366, Acri.Tech GmbH). This prospective interventional cohort study comprised 80 eyes from 40 cataract patients (mean age: 65.5±7.3 years) who underwent implantation of the Lentis Mplus MIOL in one eye and Acri.Lisa 366 MIOL in the fellow eye. The main outcome measures were refraction; monocular and binocular uncorrected and corrected distance, intermediate, and near visual acuities; monocular and binocular defocus curves; binocular photopic contrast sensitivity function compared to a monofocal intraocular lens (IOL) control group (40 age-matched pseudophakic patients implanted with the AR-40e [Abbott Medical Optics]); and quality of vision questionnaire. Binocular uncorrected visual acuities were 0.12 logMAR (0.76 decimal) or better at all distances measured between 6 m and 33 cm. The Lentis Mplus provided statistically significant better vision than the Acri.Lisa at distances between 2 m and 40 cm, and the Acri.Lisa provided statistically significant better vision than the Lentis Mplus at 33 cm. Binocular defocus curve showed little drop-off at intermediate distances. Photopic contrast sensitivity function for distance and near were similar to the monofocal IOL control group except for higher frequencies. Moderate glare (15%), night vision problems (12.5%), and halos (10%) were reported. Complete independence of spectacles was achieved by 92.5% of patients. The combination of zonal refractive aspheric and diffractive aspheric MIOLs resulted in excellent uncorrected binocular distance, intermediate, and near vision, with low incidence of significant photic phenomena and high patient satisfaction.

Modulation transfer function and optical quality after bilateral implantation of a +3.00 D versus a +4.00 D multifocal intraocular lens

To determine whether the improvement in intermediate vision after bilateral implantation of an aspheric multifocal intraocular lens (IOL) with a +3.00 diopter (D) addition (add) occurs at the expense of optical quality compared with the previous model with a +4.00 D add. Department of Ophthalmology, University of São Paulo, São Paulo, Brazil. Prospective randomized double-masked comparative clinical trial. One year after bilateral implantation of Acrysof Restor SN6AD1 +3.00 D IOLs or Acrysof Restor SN6AD3 +4.00 D IOLs, optical quality was evaluated by analyzing the in vivo modulation transfer function (MTF) and point-spread function (expressed as Strehl ratio). The Strehl ratio and MTF curve with a 4.0 pupil and a 6.0 mm pupil were measured by dynamic retinoscopy aberrometry. The uncorrected and corrected distance visual acuities at 4 m, uncorrected and distance-corrected near visual acuities at 40 cm, and uncorrected and distance-corrected intermediate visual acuities at 50 cm, 60 cm, and 70 cm were measured. Both IOL groups comprised 40 eyes of 20 patients. One year postoperatively, there were no statistically significant between-group differences in the MTF or Strehl ratio with either pupil size. There were no statistically significant between-group differences in distance or near visual acuity. Intermediate visual acuity was significantly better in the +3.00 D IOL group. Results indicate that the improvement in intermediate vision in eyes with the aspheric multifocal + 3.00 D add IOL occurred without decreasing optical quality over that with the previous version IOL with a +4.00 D add.

Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens

To evaluate visual function after bilateral implantation of a zonal refractive aspheric multifocal intraocular lens (IOL). Private practice surgery center, Valencia, Spain. Cohort study. Consecutive eyes with cataract had bilateral implantation of Lentis Mplus LS-312 multifocal IOLs. Distance, intermediate, and near visual acuities; contrast sensitivity; defocus curves; and a quality-of-vision questionnaire, including presence of halos or dysphotopsia, were evaluated 6 months postoperatively. A control group of age-matched monofocal pseudophakic patients was included to compare contrast sensitivity function. In the multifocal group, the mean binocular corrected distance visual acuity (logMAR) was -0.04 ± 0.07 at 6 m, 0.11 ± 0.10 at 1 m, and 0.06 ± 0.07 at 40 cm. The defocus curve showed little intermediate vision drop off. Photopic contrast sensitivity for distance was similar to the monofocal IOL contrast sensitivity function, while photopic contrast sensitivity for near and mesopic contrast sensitivity for distance with or without glare was reduced at high frequencies. The mean patient satisfaction was 8.09 ± 1.30 (scale 0 to 10); 84.4% of patients were completely independent of spectacles. Moderate halos, glare, and night-vision problems were reported by 6.2%, 12.5%, and 15.6% of patients, respectively. The new-generation multifocal IOL provided adequate distance, intermediate, and, to a lesser extent, near vision with high rates of spectacle freedom. Halos occurred, and other photic phenomena should be expected in a small percentage of patients. No author has a financial or proprietary interest in any material or method mentioned.

Visual outcome and patient satisfaction after multifocal intraocular lens implantation: Aspheric versus spherical design

To evaluate visual outcomes and patient satisfaction after implantation of an aspheric apodized diffractive intraocular lens (IOL) or a spherical apodized diffractive IOL in cataract surgery. Maastricht University Medical Center, The Netherlands. Nonrandomized clinical trial. This prospective nonrandomized study with a 6-month follow-up compared the results of cataract surgery with implantation of an aspheric AcrySof ReSTOR SN6AD3 IOL and a spherical AcrySof ReSTOR SN60D3 IOL. Main outcome measures were uncorrected (UDVA) and corrected (CDVA) distance visual acuities, uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuities, straylight levels, incidence of glare and halos, and contrast sensitivity levels. The mean UDVA was 0.14 ± 0.15 logMAR in the aspheric group (47 eyes) and 0.14 logMAR ± 0.17 (SD) in the spherical group (45 eyes) and the mean CDVA, -0.01 ± 0.06 logMAR and 0.02 ± 0.10 logMAR, respectively. The mean UNVA was Jaeger (J) 1 in 83.0% of patients in the aspheric group and 55.5% of patients in the spherical IOL group (P = .003). The DCNVA was J1 in 95.7% and 71.1%, respectively (P = .001). There were no significant differences between the 2 groups in contrast sensitivity levels, intraocular straylight levels, incidence of night-vision symptoms, or subjective rating of vision. Patients with the aspheric multifocal IOL had significantly better near vision than patients with the multifocal spherical IOL. The UDVA, CDVA, intraocular straylight, night-vision symptoms, and contrast sensitivity were similar between the 2 groups.

Visual outcomes after cataract surgery with implantation of a +3.00 D or +4.00 D aspheric diffractive multifocal intraocular lens: Comparative study

To compare the visual performance after cataract surgery with implantation of +3.00 diopter (D) or +4.00 D aspheric multifocal intraocular lenses (IOLs). Department of Ophthalmology, Maastricht University Medical Center, The Netherlands. This prospective study compared the results of bilateral cataract surgery with implantation of a +3.00 D AcrySof ReSTOR SN6AD1 IOL or a +4.00 D AcrySof ReSTOR SN6AD3 IOL. The main outcome measures were binocular uncorrected (UDVA) and corrected distance visual acuities, binocular uncorrected (UNVA) and corrected near visual acuities, binocular uncorrected (UIVA) and corrected intermediate visual acuities, preferred working distance, straylight and contrast sensitivity levels, and wavefront aberrometry measurements. The +3.00 D IOL was implanted in 68 eyes and the +4.00 D IOL, in 46 eyes. The UIVA was significantly better in the +3.00 D IOL group than in the +4.00 D IOL group at 40, 50, 60, and 70 cm. The preferred working distance for near tasks was significantly lower in the +3.00 D IOL group (38.9 cm) than in the +4.00 D IOL group (31.0 cm). The UDVA was better in the +3.00 D IOL group; the UNVA at the preferred working distance was similar in the 2 groups. Contrast sensitivity and intraocular straylight levels were also similar. The mean levels of higher-order and spherical aberrations were lower in the +3.00 D IOL group. Cataract surgery with the +3.00 D IOL resulted in better intermediate vision than with the +4.00 D model without compromising distance and near visual acuity. No author has a financial or proprietary interest in any material or method mentioned.