Depth Of Focus Intraocular Lens Research Articles

Retinal image quality through an operating microscope with wavefront shaping extended depth of focus intraocular lens in model eye

PURPOSETo compare the quality of images of gratings placed in a model eye viewed through an extended depth of focus (EDoF) intraocular lens (IOL) to that of diffractive bifocal IOL or monofocal IOL. DESIGNExperimental laboratory investigation. METHODSNon-diffractive wavefront shaping EDoF (CNAET0, Alcon laboratories), echelette-designed EDoF (ZXR00V, Johnson & Johnson Vision), diffractive bifocal IOL with low power addition (SV25T, Alcon Laboratories), or monofocal IOL (CNA0T0, Alcon laboratories) was placed in a fluid-filled model eye. A USAF Resolution Grating Target was glued to the posterior surface of the model eye and viewed through a flat or a wide-angle contact lens. The contrast of the gratings viewed through the EDoF or multifocal IOLs was compared to that through the monofocal IOL. A wavefront analyzer was used to measure the spherical power of the central 4.5 mm optics of the EDoF, multifocal, and monofocal IOLs. The distribution of the dioptric power and the dioptric power map were compared. RESULTSThe gratings observed through the flat contact lens with the CNAET0, ZXR00V, or SV25T were slightly blurred when viewed through the multifocal optics. The blurred area was in the circumferential area of the CNAET0, the central area of SV25T, and the peripheral area of ZXR00V. The mean contrast was 0.258±0.020 for CNAET0, 0.227±0.025 for ZXR00V, and 0.221±0.020 for SV25T for the 16.0 cyc/mm grating. The contrast was significantly lower for ZXR00V (P=0.004) and SV25T (P=0.004) than the 0.303±0.015 for CNA0T0 but the differences were not significant. For the wide-angle contact lens, the contrast for CNAET0 was 0.182±0.009, for ZXR00V was 0.162±0.011, and for SV25T was 0.163±0.007 for the 16.0 cyc/mm grating, and none was significantly different from the 0.188±0.012 for CNA0T0. The dioptric variations of the CNAET0 indicated a ring-shaped area of higher power corresponding to the circumferential blurred zone observed through the flat contact lens. CONCLUSIONThe wavefront shaping and echelette-designed EDoF-IOLs reduce the contrast of the grating more than the monofocal IOL when viewed through the flat contact lens. The degree of reduction depended on the design of the extended-focus optics. The difference was less through the wide-angle contact lens.

Extended depth of focus IOL in eyes with different axial myopia and targeted refraction

AimTo evaluate the objective visual outcomes following implantation of extended depth of focus intraocular lens (EDOF IOL) in individuals with varying axial lengths (AL) and targeted refraction.MethodsThis retrospective study comprised age-matched eyes that underwent implantation of the EDOF IOL. Eyes were categorized based on AL into groups: control group with AL < 26 mm; high myopia group with AL ≥ 26 mm. Each group was then subdivided based on postoperative spherical equivalent (SE). Follow-up at three months included assessment of uncorrected visual acuity at different distances, contrast sensitivity (CS), refractive outcomes, and spectacle independence.ResultsOverall, this study included 100 eyes from 100 patients, comprising 50 males (50.00%) and 50 females (50.00%), with 20 eyes in each group. In the control group, the uncorrected distance visual acuity (UDVA) at 5 and 3 m (m) in the − 1.50 to -0.75 group was inferior to that of the − 0.75 to 0.00 group (P = 0.004). Conversely, the uncorrected near visual acuity (UNVA) at 33 cm in the − 1.50 to -0.75 group was superior to that of the − 0.75 to 0.00 group (P = 0.005). Within the high myopia group, the UDVA at 5 and 3 m in the − 2.25 to -1.50 group was worse than in the − 0.75 to 0.00 group (P = 0.009 and 0.008, respectively). However, the UNVA at 33 cm in the − 2.25 to -1.50 group was better than in the − 0.75 to 0.00 group (P = 0.020). No significant differences were observed among the groups for corrected distance visual acuity (CDVA) (P > 0.05). Additionally, in the high myopia group, the CS of the − 2.25 to -1.50 group was lower compared to that of the − 0.75 to 0.00 group (P = 0.017). Among high myopia patients, 90.00% with refraction ranging from − 1.50 to -0.75 reported achieving overall spectacle independence.ConclusionsImplantation of extended depth of focus intraocular lenses (IOLs) yields satisfactory visual and refractive outcomes in eyes with axial myopia. Among high myopia patients, a refraction ranging from − 1.50 to -0.75 diopters achieves superior visual quality compared to other postoperative myopic diopters.

Optical power profiles and aberrations of a non-diffractive wavefront-shaping extended depth of focus intraocular lens.

This study is to evaluate the optical characteristics of a non-diffractive wavefront-shaping intraocular lens which incorporates surface refractive modifications for shaping the wavefront in order to achieve extended depth of focus (EDoF) and to assess whether the nominal power of this IOL influences the attainable add power. A commercially available optical bench NIMO TR1504 device (LAMBDA-X, Nivelles, Belgium) was employed to obtain full optical characterization of three non-diffractive EDoF intraocular lenses with + 10 D, + 20 D, and + 30 D powers. After NIMO measurements, data were computed using a custom-made MATLAB program (Mathworks, Inc., Natick, MA, USA) to evaluate the optical quality functions, such as the point spread function (PSF), wavefront profiles, and modulation transfer function (MTF) for two pupil sizes: 3mm and 4.0mm. The non-diffractive EDoF intraocular lens showed a central serrated power profile behavior with additions of + 2.00 to + 2.50 D over the nominal power. Higher order aberrations were found to be driven mainly by the spherical aberration, with almost null comatic influence. Optical quality metrics showed good values, better for a 3mm pupil compared to a 4.5mm one, as expected. The three IOL powers tested showed a very similar behavior in terms of power and aberrometric profiles, with minimal to null differences related to the nominal power. The non-diffractive wavefront-shaping EDoF intraocular lens achieves a near addition up to + 2.50 D aiming for an extended range of vision, almost independently of the base power.

Quality of vision clinical outcomes for a new fully-refractive extended depth of focus Intraocular Lens.

To evaluate the visual performance of a purely refractive extended depth of focus (EDF) intraocular lens (IOL). A prospective, multi-center, randomized, subject/evaluator-masked study. Subjects were bilaterally implanted with the EDF test (Model ZEN00V, N = 60) or an enhanced monofocal control (Model ICB00, N = 57) IOL. Monocular corrected distance (CDVA), intermediate (DCIVA), near acuities (DCNVA) and patient reported visual symptoms were evaluated at the 6-month visit. Monocular mesopic contrast sensitivity (CS) and depth of focus (DOF) testing were assessed at 3 months. CDVA (Mean ± SD) was -0.06 ± 0.08 for test and -0.05 ± 0.08 logMAR for control groups. DCIVA was 0.13 ± 0.08 for test and 0.18 ± 0.14 logMAR for control groups (p = 0.0127). DCNVA was 0.37 ± 0.10 for test and 0.43 ± 0.16 logMAR for control groups (p = 0.0137). Test lens was statistically superior for intermediate and near. Overall, 91.7% (halos), 95.0% (starbursts) and 95.0% (glare) of test lens patients reported that they did not experience, were not bothered, or were slightly bothered by specific visual symptoms, compared to 98.2%, 100% and 96.5% in the control group. The DOF range over which monocular visual acuity was 0.20 logMAR or better was -1.6 D for the test lens. Mesopic CS was comparable between both groups, falling within 0.11 log units for all measured cycles per degree with and without glare. The EDF IOL demonstrated extended range of vision and statistically superior intermediate and near performance compared to the monofocal IOL. Distance visual acuity, contrast sensitivity and dysphotopsia profile were similar to the monofocal IOL.

Optical and clinical simulated performance of a new refractive extended depth of focus intraocular lens.

The purpose of this study is to evaluate the optical and expected clinical performance of a new refractive Extended Depth of Focus (EDF) intraocular lens (IOL) designed to maintain a monofocal-like dysphotopsia profile. Simulated visual acuity (sVA) with varying defocus was calculated using the area under the Modulation Transfer Function measured in an average eye model and from computer simulations in eye models with corneal higher-order aberrations. Tolerance to defocus was evaluated using computer simulations of the uncorrected distance sVA under defocus. To evaluate the dysphotopsia profile, halo pictures obtained using an IOL-telescope, as well as simulated images in a realistic eye model under defocus were assessed. The results of the refractive EDF were compared to those of a diffractive EDF of the same platform. The refractive EDF IOL provides similar range of vision to the diffractive EDF IOL with the same distance, and similar intermediate and near sVA. The refractive EDF IOL provides the same tolerance to hyperopia as the diffractive EDF but more tolerance to myopia. Halo pictures and simulations showed that the refractive EDF provides comparable dysphotopsia profile to the monofocal IOL and better than the diffractive EDF. The results of this preclinical study in clinically relevant conditions show that the new refractive EDF IOL is expected to provide similar range of vision to the diffractive IOL of the same platform and higher tolerance to refractive errors. The refractive EDF provides a dysphotopsia profile that is better than the diffractive EDF and comparable to that of the monofocal IOL, also in the presence of residual refractive errors.

Tolerance to refractive error with a new extended depth of focus intraocular lens.

To evaluate the tolerance to refractive errors of a new purely refractive extended depth of focus (EDF) intraocular lens (IOL) using preclinical and clinical metrics. Preclinical evaluation included computer simulations of visual acuity (sVA) and dysphotopsia profile of different IOL designs (refractive EDF, diffractive EDF, multifocal, standard, and enhanced monofocals) using an appropriate eye model with and without ±0.50 D defocus and/or +0.75 D of astigmatism. Patients bilaterally implanted with a refractive EDF (Model ZEN00V) or an enhanced monofocal (Model ICB00) IOL from a prospective, randomized study were included. At the 6-month postoperative visit, uncorrected and corrected distance vision (UDVA and CDVA), visual symptoms, satisfaction and dependency on glasses were evaluated in a subgroup of patients with absolute residual refractive error of >0.25 D in one or both eyes. In the presence of defocus and astigmatism, sVA was comparable for all except the multifocal IOL design. The refractive EDF was more tolerant to myopic outcomes and maintained a monofocal-like dysphotopsia profile with defocus. Binocular logMAR UDVA was -0.03 ± 0.08 for ZEN00V and -0.02 ± 0.11 for ICB00. 100% ZEN00V and 97% ICB00 patients did not need glasses and were satisfied with their distance vision. Monocular CDVA, contrast sensitivity and visual symptoms were also similar between both groups. The clinical outcomes of the refractive EDF IOL demonstrated high quality distance vision and dysphotopsia comparable to a monofocal IOL, even in the presence of refractive error, thus matching the design expectations of the EDF IOL.

Patient-Reported Outcome Measures (PROMs) with Refractive and Diffractive Extended Depth of Focus (EDOF) Intraocular Lenses.

Extended depth of focus intraocular lenses (EDOF-IOLs) provide unaided far- and mid-range vision. Refractive IOLs, in contrast to diffractive designs, are associated with a lower depth of focus and absence of dysphotopsia. The aim of this study was to assess spectacle independence for far-range, mid-range, and near-vision activities in patients after implantation of refractive or diffractive EDOF-IOLs using patient-reported outcome measures (PROMs) in a real-world setting. In 2021 and 2022, all patients in a single center referred for bilateral cataract surgery were assigned to 7 experienced cataract surgeons who either bilaterally implanted only a diffractive EDOF-IOL (Carl Zeiss Meditec AG, AT LARA Jena, Germany, three surgeons) or refractive EDOF-IOL (Johnson & Johnson Vision Inc., Tecnis Eyhance Irvine, California, USA, four surgeons) at the surgeon's discretion, with the aim of bilateral emmetropia. Six months after both cataract surgeries, all patients were contacted by telephone and asked to report their outcomes using a structured questionnaire investigating their spectacle usage for various daily activities and their experience with night glare or halos. Inclusion criteria were a normal postoperative visual potential based on the preoperative examination and completion of the questionnaire regarding postoperative visual experience. Of the patients, 514 underwent bilateral cataract surgery aiming for bilateral emmetropia with the implantation of EDOF-IOLs (422 with Tecnis Eyhance and 92 with AT LARA). A complete questionnaire was obtained from 472 (92%) patients, who were included in the study (393 vs. 79). Comparing Tecnis Eyhance with AT LARA IOL, 54 vs. 57% patients were able to perform most of their daily activities without spectacles, 9 vs. 19% reported not being dependent on spectacles at all, 25 vs. 29% reported using their smartphones without spectacles, 15 vs. 49% patients reported experiencing glares or halos at night, and 1 vs.15% with driving disturbance. Overall, 95 vs. 93% patients described themselves as "satisfied" or "highly satisfied" with their IOL. With both types of EDOF-IOLs, the majority of patients could perform most of their daily activities without spectacles, except reading, and were highly satisfied with their IOLs. Patients with diffractive Zeiss AT LARA EDOF-IOLs were more likely to accomplish unaided near-range visual tasks; however, they were also at a higher risk of experiencing glares or halos at night.

Long-term Results after Bilateral Implantation of Extended Depth of Focus Intraocular Lenses with Mini-Monovision.

To assess long-term clinical results following bilateral Tecnis Symfony ZXR00 intraocular lens implantation with mini-monovision. The medical records of cataract patients who underwent bilateral implantation of ZXR00 with intended mini-monovision (target refraction of -0.3 diopters [D] in dominant eye and -0.6D in nondominant eye) between April 2019 and March 2021 were assessed. Postoperative uncorrected distance visual acuity (UDVA), corrected distance VA (CDVA), uncorrected intermediate VA (UIVA), uncorrected near VA (UNVA), and rate of spectacle dependence for near distance were investigated at 3 months and 2 years after surgery. This study included 61 patients (122 eyes) with average age of 61.8 ± 7.7 years. At 2 years postoperatively, binocular logarithm of the minimum angle of resolution UDVA, UIVA, UNVA, and CDVA were 0.086 ± 0.094, 0.056 ± 0.041, 0.140 ± 0.045, and 0.012 ± 0.024, respectively. The monocular manifest refraction spherical equivalent was -0.31 ± 0.38 in the dominant eye and -0.53 ± 0.47 in the nondominant eye at 3 months postoperatively, and -0.38 ± 0.43 in the dominant eye and -0.61 ± 0.54 in the nondominant eye at 2 years postoperatively. Eight out of 61 patients (13.1%) needed glasses 3 months after surgery, and nine out of 61 patients (14.8%) needed glasses 2 years after surgery. The bilateral implantation of ZXR00s with mini-monovision allows for a good VA at wide range of distance from far to near, thereby resulting in high rate of spectacle independence. These results have held up well even after 2 years after surgery.

Comparison of modal and zonal wavefront measurements of refractive extended depth of focus intraocular lenses.

Extended depth-of-focus (EDoF) intraocular lenses (IOLs) are typically evaluated using commercially available aberrometers. Given the intricate optical design of these IOLs, employing an appropriate wavefront reconstruction method with a sufficient sampling resolution of the aberrometer is crucial. A high-resolution Shack-Hartmann wavefront sensor was developed by magnifying the pupil aperture by a factor of five onto a lenslet array (pitch: 133 µm) and utilizing a full-frame CMOS sensor (24 by 36 mm), resulting in a 26.6 µm sampling resolution. Zonal wavefront reconstruction was used and compared with Zernike-based modal wavefront reconstruction to retain detailed local slope irregularities. Four refractive EDoF IOLs with a power of 20D were examined, and the wavefront difference between the zonal and modal methods, expressed as the root mean squared error (RMSE), remained significant for two of the IOLs up to the 16th-order Zernike spherical aberrations (SAs). Conversely, a negligibly small RMSE was observed for the other two IOLs, as long as the Zernike SAs were higher than the 6th order. The raytracing simulation results from the zonal wavefronts exhibited a stronger correlation with the results of recent optical bench studies than those from the modal wavefronts. The study suggests that certain recent refractive EDoF IOLs possess a complex optical profile that cannot be adequately characterized by limited orders of SAs.

Clinical performance after implantation of the Symfony extended depth of focus intraocular lens in the dominant eye and the Synergy presbyopia correcting intraocular lens in the non-dominant eye.

To evaluate subjective and objective outcomes after combined implantation of an extended depth of focus (EDOF) intraocular lens (IOL) and a combined technology multifocal lens (CT-IOL). Two clinical practices in the USA. Prospective, unmasked, multi-center, non-randomized bilateral eye study. Patients interested in reducing their dependence on spectacles were implanted with an EDOF IOL in the dominant eye and a CT-IOL in the non-dominant eye. Refractive and visual acuity data at various distances (4 m, 66 cm, 40 cm, 33 cm) were collected 3 months post-surgery, along with the distance-corrected binocular defocus curve and responses to questionnaires related to spectacle independence, visual disturbances, and overall visual function. Data from 37 subjects were analyzed. The distance corrected binocular defocus curve showed a mean VA better than 0.1 logMAR (20/25) at all vergences from +1.00 D to -2.50 D. Thirty-six subjects (97%) had an uncorrected binocular VA of 0.3 logMAR or better, at all test distances. Seventy percent of subjects (26/37) reported never wearing glasses at any distance and 84% (31/37) were "completely" or "mostly" satisfied with their overall vision after surgery. Halos were the disturbance reported most frequently, and reported as most bothersome, with difficulty driving at night the most common visual function issue. Difficulty reading was the next most reported issue. Overall eyesight was rated as "excellent" or "good" by 92% (34/37) of subjects. This combined EDOF/CT-IOL approach was well tolerated by subjects and provided some potential benefits relative to bilateral implantation of either lens.

Soczewka wewnątrzgałkowa LuxSmart™ – soczewka EDOF na miarę potrzeb współczesnego pacjenta

Enhanced depth of focus intraocular lenses had been successfully introduced few years ago. This heterogenous class of intraocular lenses aims to correct presbyopia and provide a spectacle independence for daily activities over a wider range than classic monofocal intraocular lenses. LuxSmart (Bausch &amp; Lomb) is a high-quality enhanced depth of focus intraocular lens. This single piece, acrylic hydrophobic and aspheric intraocular has a small central zone which combines 4&lt;sup&gt;th&lt;/sup&gt; and 6&lt;sup&gt;th&lt;/sup&gt; orders of spherical aberration of opposite signs to increase the subjective depth of focus and further improve intermediate vision while maintaining good performance at distance. This article presents preliminary clinical outcomes and patient satisfaction of LuxSmart™ intraocular lens.

Clinical outcomes with a novel extended depth of focus intraocular lens Tecnis Symfony

Relevance. Some of the most current intraocular lenses (IOL) are lenses with an extended depth of focus. Lenses of this type allow you to reduce dependence on glasses by distributing light energy to long-range and focus at medium distance, without losing the quality of vision. Studies that analyze the results of implantation of this type of lens are few. Purpose: to evaluate the clinical outcomes of extended depth of focus (EDOF) intraocular lens (IOL) implantation. Materials and methods. Prospective randomized study enrolled 61 patients of 79 eyes (18 to 86 years) undergone uncomplicated phacoemulsifi cation with EDOF IOL Tecnis Symfony (USA) implantation. The study was conducted from November 2020 through November 2022. Uncorrected near visual acuity (UNVA); corrected near visual acuity (CNVA) and uncorrected and corrected distance visual acuity (UDVA and CDVA), monocular defocus curve and refractive outcomes were evaluated during a 3-month period. When calculating the IOL, the target spherical equivalent was –0.35 ± 0.11 D. Results. In the postoperative period 3 months, visual acuity were 0.7 or better in 82.4% UCDVA, 100% CDVA and 50% UCNVA. 3 months after surgery, UDVA and UNVA at 40 cm averaged 0.85 ± 0.15 and 0.69 ± 0.18, respectively. CDVA and CNVA at 40 cm was 0.98 ± 0.04 and 0.8 ± 0.14, respectively. A total of 85.7% of eyes achieved postoperative visual acuity about 0.5 for the range of defocus levels between +1.00 and −1.50 D. Conclusions. Cataract surgery with Tecnis Symfony EDOF IOL implantation provide functional levels of visual acuity in distance, intermediate zones. The near visual performance with this IOL might be signifi cantly enhanced using a micro-monovision approach

Refractive Predictability of a Swept Source Optical Coherence Tomography Biometer in Long and Short Eyes Implanted with Extended Depth of Focus Intraocular Lenses.

To determine the refractive predictability of Argos (Movu, a Santec company) measurements and the Barrett Universal II formula in long and short eyes implanted with an extended depth of focus (EDOF) intraocular lens (IOL). This retrospective, non-interventional study included 86 eyes (55 long and 31 short) of 55 patients. Preoperative biometry was performed using the Argos. Preoperative IOL power formulas were the preprogrammed Barrett Universal II (BUII). Data were collected for refractive outcomes, postoperative prediction error (directional and absolute), and monocular corrected distance visual acuity (CDVA, Snellen). The mean absolute prediction error for BUII was 0.27 ± 0.26 D overall, 0.24 ± 0.20 D in long eyes, and 0.33 ± 0.33 D in short eyes. Overall, the percentage of eyes with ≤ 0.5 D prediction error was 84% for BUII. In long eyes, the percentage of eyes with ≤ 0.5 D prediction error was 90% for BUII. In short eyes, the percentage of eyes with ≤ 0.5 D prediction error was 74% for BUII. The percentage of eyes with ≤ 0.5 D of MRSE was 89% for long eyes and 94% for short eyes. Visual acuities were excellent in both long and short eyes, with > 90% of eyes 20/25 or better in each group. The prediction error of Argos using BUII was low in long and short eyes at one month after EDOF IOL implantation.

Optical Quality and Higher Order Aberrations of Refractive Extended Depth of Focus Intraocular Lenses.

To compare the optical quality and higher order aberrations of four different refractive extended depth of focus intraocular lens (EDOF IOL) models (Lentis Comfort [Teleon Surgical BV], MiniWell (SIFI), LuxSmart [Bausch & Lomb], and AcrySof IQ Vivity [Alcon Laboratories, Inc]) and a monofocal IOL (Tecnis ZCB00; Johnson & Johnson Surgical Vision, Inc). An optical metrology instrument (OptiSpheric IOL PRO2; Trioptics GmbH) was used to study image quality metrics of the different IOLs. The modulation transfer function (MTF) was measured at pupil sizes 1 to 5 mm in 1-mm steps. Area under the MTF and simulated visual acuity were calculated for different pupil diameters. Wavefront aberrations were measured with the SHS Ophthalmic device (Optocraft GmbH), which features a Hartmann-Shack sensor. All EDOF lenses yielded a simulated far visual acuity of 0.00 logMAR (20/20 Snellen) or better. At the 0.20 logMAR visual acuity level, the EDOF IOLs showed an increased depth of focus of at least 0.75 diopters compared to the monofocal IOL. Pupil dependency was more pronounced with the MiniWell, LuxSmart, and Vivity, whereas the Lentis showed a more consistent behavior at different apertures. The wavefront measurement revealed increased central aberrations for the MiniWell, LuxSmart, and Vivity IOL compared to the monofocal control. All EDOF IOLs demonstrated increased depth of focus while maintaining good simulated visual acuity at the far focus. Pupil dependency differed between the IOL models. The wavefront analysis revealed the complex design of the different EDOF IOLs with several zones with varying aberrations. [J Refract Surg. 2023;39(10):668-674.].

The tolerance of refractive errors of extended depth of focus intraocular lens in patients with previous corneal refractive surgery.

To evaluate the tolerance for refractive errors and visual outcomes of extended depth of focus intraocular lens (EDOF IOLs) in patients with previous corneal refractive surgery for myopia. Patients from Aier Eye Hospital of Wuhan University with previous myopia excimer laser correction underwent cataract surgery and implantation of an EDOF IOL. The follow-up period was three months. The uncorrected distance, intermediate, and near visual acuities (UDVA, UIVA, UNVA), corrected distance visual acuity (CDVA), spherical equivalent (SE), defocus curve, optical quality, including modulation transfer functions (MTF) and Strehl ratio (SR), National Eye Institute Visual Functioning Questionnaire-14 for Chinese people (VF-14-CN), spectacle independence, and dysphotopsia were assessed. At the final visit, UDVA, CDVA, UIVA, and UNVA (LogMAR) were 0.06 ± 0.09, 0.01 ± 0.06, 0.11 ± 0.08, 0.20 ± 0.10, respectively. The mean spherical equivalent (SE) was - 0.57 ± 0.58D, sphere and cylinder were - 0.24 ± 0.60D, - 0.70 ± 0.58D respectively. No statistical difference in UDVA between eyes with SE in ± 0.50 D and in ± 1.0 D (p > 0.05). Corneal astigmatism > 1.00D has no significant effect on postoperative visual acuity (p > 0.05). The defocus curve showed that visual acuity could reach 0.2 in the refractive range of + 0.50D ~ - 1.50D. SR and MTF values were all higher than before the surgery. In bilateral implantation patients, the VF-14-CN questionnaire score and visual quality were quite excellent. The EDOF IOL have a certain tolerance for refractive errors and corneal astigmatism, and it's recommended for patients with prior myopia excimer laser surgery to achieve satisfactory visual performance.

Comparison of the Polychromatic Image Quality of Two Refractive-Segmented and Two Diffractive Multifocal Intraocular Lenses.

Evaluating chromatic aberration for a multifocal intraocular lens (MIOL) in vitro is essential for studying its performance because it helps determine the most appropriate lens for each patient, enhancing surgical outcomes. While refractive MIOLs with angular power variation have shown positive clinical outcomes, studies of these MIOLs on optical benches primarily employed monochromatic green light, neglecting the impact of longitudinal chromatic aberration (LCA) on MIOL performance. To address this gap, we evaluated the through-focus modulation transfer function (TF-MTF) and the point spread function (PSF) of two refractive segmented extended depth of focus intraocular lenses (IOLs) (Femtis Comfort and Precizon Presbyopic), comparing the results with those obtained with two widely known diffractive multifocal intraocular lenses (AcrySof IQ ReSTOR and FineVision Pod F). Measurements of the TF-MTF were conducted using both monochromatic and polychromatic light in a customized optical bench. The refractive designs exhibited distinct haloes in the PSFs. When comparing the refractive and diffractive designs, opposite signs of LCA were observed at near foci. These findings emphasize the influence of the optical design of IOLs on their performance under polychromatic light, providing valuable information for vision care professionals when selecting the most suitable lens for each patient.

Comparative Analysis of Optical Quality of Monofocal, Enhanced Monofocal, Multifocal, and Extended Depth of Focus Intraocular Lenses: A Mobile Model Eye Study.

To use the revised model eye to observe and compare how the world is perceived by patients with monofocal intraocular lens (IOL), Eyhance, bifocal IOL, and Symfony, and check its performance. The new mobile model eye consists of an artificial cornea, an IOL, a wet cell, an adjustable lens tube, a lens tube, an objective lens, a tube lens, and a digital single-lens reflex camera. We collected photographs of distant buildings and streets at night, videos of the focusing process, and videos of United States Air Force resolution target from 6m to 15 cm and analyzed them quantitatively. In this revised model eye using an objective lens, an artificial cornea similar to the human cornea could be used. Using a digital single-lens reflex camera, high-resolution imaging was possible without an additional computer. Fine focusing was possible using an adjustable lens tube. For monofocal IOL, the contrast modulation was 0.39 at 6m and decreased consistently. It was nearly 0 as the model eye got closer than 1.6m. For Eyhance, the contrast modulation was 0.40 at 6m. It then decreased and increased again. At 1.3 m, it was 0.07 and then decreased again. For Symfony, the contrast modulation was 0.18 at 6m. Symfony showed the characteristics of a bifocal IOL with low add diopter. Halos (234 pixels) were observed around lights, although smaller than those seen with bifocal IOL (432 pixels). We could objectively observe and compare how patients with monofocal IOL, Eyhance, bifocal IOL, and Symfony perceived the world using this revised model eye. Data obtained by this new mobile model eye can be used to help patients select their IOLs before cataract surgeries.

Clinical Outcomes with Extended Depth of Focus Intraocular Lenses in Cases in Which Multifocal Lenses Are Not Primarily Recommended.

The purpose of the study is to evaluate the visual and patient-reported outcomes of patients undergoing cataract surgery with implantation of an extended depth of focus (EDOF) intraocular lens (IOL) who were not primarily good candidates for multifocal IOL implantation. Retrospective analysis of data from 30 eyes (23 patients) undergoing cataract surgery with implantation of one of two EDOF IOLs (follow-up: 37.9 ± 16.2 months) and prospective observational study including 106 eyes (78 patients) implanted with one of 6 different EDOF models (follow-up: 8.0 ± 7.7 months). Patients recruited had one of the following conditions: monofocal IOL implanted in the fellow eye, previous corneal refractive surgery, mild and nonprogressive maculopathy or glaucoma, age > 75 years, amblyopia, or previous vitrectomy. In the retrospective phase, significant improvements were found in uncorrected distance (UDVA), corrected distance (CDVA), and corrected near visual acuity (CNVA) (p ≤ 0.013), with a nonsignificant trend to improvement in uncorrected near visual acuity (UNVA). A total of 90% of patients were completely to moderately satisfied with the outcome achieved. In the prospective phase, significant improvements were found in UDVA, CDVA, UNVA, and CNVA (p ≤ 0.032), with a total of 85.5% of patients being completely to moderately satisfied (dissatisfaction 3.3%). In both phases, extreme difficulties were only reported by a limited percentage of patients for performing some near vision activities. EDOF IOLs seem to be a viable option for providing an efficient visual rehabilitation with good levels of patient satisfaction and spectacle independence associated in patients that are not primarily good candidates for multifocal IOL implantation.

Rotational stability and refractive outcomes of the DFT/DATx15 toric, extended depth of focus intraocular lens

PurposeTo quantitatively assess postoperative rotational stability and visual acuity with the DFT/DATx15 extended depth of focus (EDOF) toric intraocular lens (IOL).MethodsIn this prospective case series, thirty-five patients with a calculated IOL power between + 15.0 D and + 25.0 D, corneal astigmatism between 0.75 D and 2.25 D, and no significant ocular pathology underwent cataract surgery. Primary outcome was rotational stability of the IOL at 1 month post-operatively. Secondary outcomes included residual refractive astigmatism, absolute residual astigmatism prediction error, and monocular distance and intermediate visual acuities.ResultsMean absolute postoperative IOL rotation was 1.1 ± 0.2 degrees, with no rotation of more than 3 degrees at the final visit. Monocular mean best spectacle-corrected distance visual acuity (BSCDVA) improved from logMAR 0.27 ± 0.030 to 0.078 ± 0.017 (P < .001). Monocular uncorrected distance visual acuity (UCDVA) improved from 0.93 ± 0.096 to 0.18 ± 0.022 (P < .001). Best spectacle-corrected intermediate visual acuity (DSCIVA) was 0.17 ± 0.025, and uncorrected intermediate visual acuity (UCIVA) was 0.27 ± 0.040. Residual regular astigmatic refractive error was 0.21 ± 0.047 D.ConclusionsThe toric DFT/DATx15 EDOF lens showed excellent rotational stability and effective and predictable correction of astigmatism. Its refractive outcomes and safety profile were similar to those identified in prior studies of the non-toric DFT/DAT015 EDOF IOL. A small difference in monocular BSCDVA, of uncertain clinical significance, was found when comparing these outcomes with prior DFT/DAT015 data. The trial was retrospectively registered on November 5, 2021 (TRN ​​NCT05119127).

Patient reported outcomes after implementation of an enhanced depth of focus intraocular lens with low postoperative myopia

BackgroundEnhanced depth-of- focus intraocular lenses (EDOF IOL) have filled the gap between monofocal and multifocal intraocular implants with optical qualities of monofocal lenses and usually minor dysphotopsias typical for multifocal lenses. The purpose of this study was to evaluate visual outcomes after bilateral implantation of a new EDOF IOL in patients with requirements for perfect near and intermediate vision. MethodsThe study included 15 patients (29 eyes as one was amblyopic) with bilateral implantation of LUXSMART EDOF IOL (Bausch & Lomb) with a targeted myopia (between –0.25 and –0.50D) in both eyes. Monocular corrected and uncorrected visual acuity for far, intermediate and near as well as refractive outcomes were evaluated at 1, 3, 6 and 12 months after the surgery. Additionally, binocular visual acuity, contrast sensitivity and defocus curve were measured at the final follow-up visit. At 12 months’ visit patients completed a questionnaire evaluating patient satisfaction, spectacle independence and presence of dysphotopsias. ResultsBinocular uncorrected visual acuities at 12 month’s visit were 0.13 ​± ​0.16, 0.06 ​± ​0.08, 0.07 ​± ​0.09 and 0.15 ​± ​0.09 logMAR for far distance, 80 ​cm, 66 ​cm and 40 ​cm respectively. Corrected binocular visual acuities at 12 months were 0.00 ​± ​0.00, 0.05 ​± ​0.07, 0.05 ​± ​0.06, 0.13 ​± ​0.16 respectively for distance, 80 ​cm, 66 ​cm and 40 ​cm. Automated refraction spherical equivalent at 12 months’ visit stood at –0.70 ​± ​0.48D, which was 0.46D less than calculated biometric target, however spherical equivalent of subjective refraction at 12 months equaled –0.49 ​± ​0.46D, which was closer to preoperative biometric target. Defocus curve had gentle shape without peaks typical for monofocal IOLs. Binocular contrast sensitivity results were superior to average results for that age group and equaled 1.78 ​± ​0.16 logMAR without correction and 1.81 ​± ​0.13 logMAR with correction. Spectacle independence for near and intermediate distances was achieved in all patients and for far distance in 73.3% of patients. Burdensome dysphotopsias were not reported in any case. ConclusionsEDOF IOLs targeted bilaterally at low myopia can provide excellent near and intermediate visual acuity and independence of any optical correction in majority of cases. This approach can be used in selected patients who are focused on stationary activities.