Diffractive Intraocular Lens Implantation Research Articles

Visual and Refractive Outcomes After Bi-aspheric Trifocal Toric Diffractive Intraocular Lens Implantation

Purpose: To assess clinical outcomes after cataract surgery with bilateral implantation of a new bi-aspheric diffractive intraocular lens (IOL). Methods: Thirty patients underwent bilateral implantation of the Asqelio Trifocal Toric IOL (AST Products, Inc) and were evaluated 3 months postoperatively. Main outcomes included refractive error, photopic monocular and binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, CDIVA) at 60 cm, and near (UNVA, CDNVA) at 40 cm visual acuities. Mesopic monocular and binocular CDNVA were also measured. Defocus curves, binocular contrast sensitivity under photopic and mesopic conditions with and without glare and rotational stability were determined. Patients completed Catquest-9SF and visual symptoms questionnaires. Results: Average values of binocular photopic CDVA, CDIVA, and CDNVA, and mesopic CDNVA were −0.04 ± 0.06, 0.02 ± 0.08, 0.02 ± 0.07, and 0.22 ± 0.11 logMAR, respectively. All patients achieved cumulative CDVA ⩾ 20/25, and CDIVA and CDNVA of 20/32 or better. Binocular depth of focus was approximately 3.25 diopters (D). Mean postoperative spherical equivalent was −0.08 ± 0.26 D, with 95% of eyes within ±0.50 D. Mean postoperative refractive cylinder was −0.22 ± 0.27 D, with 91.67% of eyes within 0.50 D or less, respectively. IOL rotation averaged 0.25 ± 0.65 degrees, all eyes having rotation of less than 5 degrees. Contrast sensitivity was within or above normal levels under photopic and mesopic conditions, with or without glare, except for 12 cpd under mesopic conditions with glare. Questionnaire responses indicated 96.67% of patients were satisfied or very satisfied with postoperative vision, and 80.00% to 96.67% reported no difficulty in different daily activities. Conclusions: The Asqelio Trifocal Toric IOL demonstrated favorable outcomes, providing excellent visual performance at all distances, precise refractive results, and remarkable rotational stability. Patients reported high satisfaction levels and minimal difficulty in daily activities. [ J Refract Surg . 2024;40(6):e407–e419.]

Short-term Visual Outcomes of Trifocal Diffractive Intraocular Lens Implantation in Patients Who Had Retinal Surgery

Short-term Visual Outcomes of Trifocal Diffractive Intraocular Lens Implantation in Patients Who Had Retinal Surgery

Trifocal diffractive intraocular lens implantation in patients after previous corneal refractive laser surgery for myopia

BackgroundWith the difficulties in IOL power calculation and the potential side effects occurring postoperatively, multifocal IOL implantation after previous corneal refractive surgery are rarely reported especially for the trifocal IOL. Herein we report the clinical observation of trifocal IOL implantation in patients with previous myopia excimer laser correction. In this study, a multi-formula average method was performed for the IOLs power calculation to improve the accuracy. Visual and refractive outcomes were analyzed, and the subjective quality of patients’ life was evaluated by questionnaires survey.MethodsThis retrospective case series included patients with previous myopia excimer laser correction who underwent femtosecond laser assisted phacoemulsification and trifocal IOL (AT LISA tri 839 MP) implantation. Follow-up was done at 1-day, 1-month and 3-month to assess the visual outcomes. Outcome measures were uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, UNVA), manifest refraction, defocus curve, and subjective quality of vision.ResultsTwenty-one Eyes from sixteen patients (14 eyes with previous laser in situ keratomileusis and 7 eyes with previous photorefractive keratectomy) were included. Mean postoperative spherical equivalent (SE) at 3-month was − 0.56 D ± 0.49 SD, wherein, 10 eyes (47.6%) were within ±0.50 D of the desired emmetropia and 19 eyes (90.5%) were within ±1.0 D. Mean monocular UDVA, UIVA and UNVA (logMAR) at last visit were 0.02 ± 0.07, 0.10 ± 0.10, and 0.15 ± 0.11 respectively. Three patients (19%) reported halos and glare in postoperative 3 months, two of them needed to use spectacles to improve the intermediate visual acuity. Fifteen patients (94%) reported a satisfaction score of ≥3.5 out of 4.0, without any difficulty in daily activity. Thirteen patients (81%) did not need spectacles at all distances, while the other 3 patients (19%) used spectacles for near-distance related visual activity. Mean composite score of the VF-14 questionnaire was 95.00 ± 7.29 out of 100.ConclusionsTrifocal IOL implantation after myopia excimer laser correction could restore good distance, intermediate visual acuity and acceptable near visual acuity, and provide accurate refractive outcomes as well as high spectacles independence rate.

Clinical experience after tetrafocal intraocular lens implantation “PANOPTIX”

Abstract Purpose: To assess long, intermediate and near uncorrected visual acuity after a tetrafocal diffractive intraocular lens implantation, presence of dystopic phenomenon and patient satisfaction after surgery. Methods: Retrospective, observational study performed in Puerta de Hierro Specialties Hospital, in Jalisco, Mexico. That included 100 eyes after phacoemulsification surgery by femtosecond assistance, followed by tetrafocal diffractive intraocular lens implantation due to cataract. Long, intermediate and near visual acuity without correction was measured, and presence or absence of dystopic phenomenon, plus patient satisfaction after surgery. Results: A total of 100 eyes in 50 patients who underwent cataract surgery with phacoemulsification by femtosecond assistance were evaluated. 100% underwent bilateral phacoemulsification. Long, intermediate, and near visual acuity after three months was in the most patients 20/20 (46%), 20/15 (44%) and Jaeger 1 (48%) respectively. The percentage or patients who refers halos was 7%; and other associated symptoms in 18%, being astenopia the most prevalent. The removal of the lens was not required in any case. Conclusion: Tetrafocal diffractive intraocular lenses provides excellent intermediate vision (at 60 centimeters) and satisfactory near (30 centimeters) and long (6 meters) visual acuity.

Predictive factors for postoperative visual acuity following multifocal diffractive intraocular lens implantation using corneal topography and tomography

Predictive factors for postoperative visual acuity following multifocal diffractive intraocular lens implantation using corneal topography and tomography

Effects of Bifocal versus Trifocal Diffractive Intraocular Lens Implantation on Visual Quality after Cataract Surgery.

PurposeTo compare the effects of bifocal versus trifocal diffractive intraocular lens (IOL) implantation on visual quality after phacoemulsification in patients with cataracts.MethodsEighty-eight eyes from 63 patients were analyzed. Trifocal (AT LISA tri 839MP), bifocal (AcrySof IQ ReSTOR) and bifocal (Tecnis MF ZLB00) IOLs were implanted into 53, 18, and 17 eyes, respectively. Uncorrected distance, intermediate and near visual acuity, refractive errors, contrast sensitivity, and patient satisfaction were measured at 1 week and 1 month after surgery. Refractive error was converted to a spherical equivalent and compared to predicted refraction calculated by IOL calculation formulas.ResultsUncorrected distance, intermediate, and near visual acuity did not differ significantly between groups. One month after surgery, the mean refractive errors were −0.07 diopters (D) in the AT LISA tri 839MP group, +0.18 D in the AcrySof IQ ReSTOR group, and +0.31 D in the Tecnis MF ZLB00 group (p < 0.001). The predictive accuracy of IOL calculation formulas did not differ between groups. Contrast sensitivity, satisfaction, and spectacle independence in the trifocal group were comparable with those of the two bifocal groups.ConclusionsTrifocal IOL and two different types of bifocal IOL implantation were all effective for improving visual quality, although refractive error in patients with trifocal IOL shows myopic tendencies.

Clinical outcomes following trifocal diffractive intraocular lens implantation for age-related cataract in China.

PurposeThe aim of this study was to evaluate visual, refractive and patient satisfaction outcomes following implantation of a trifocal diffractive intraocular lens (IOL).Patients and methodsThis prospective, consecutive study included patients undergoing lens phacoemulsification of cataract and implantation of a trifocal diffractive IOL (AT LISA tri 839MP). Visual outcomes, including near, intermediate and distance visual acuity (VA), refractive error, contrast sensitivity, defocus curve and patient satisfaction were assessed preoperatively and postoperatively.ResultsThirty IOLs were implanted in 26 patients. Distance VA improved significantly from 0.70±0.45 to 0.08±0.11 logMAR (p<0.0001) 1 week postoperatively, and to 0.07±0.13 logMAR (p<0.0001) at 1 month and 0.05±0.10 logMAR (p<0.0001) at 3 months. Uncorrected near and intermediate VA, as well as corrected near, intermediate and distance VA, were stable and maintained during the follow-up period. Preoperative anterior chamber depth demonstrated an association with effective adjustment of postoperative spherical equivalent using a regression formula (p=0.007). No significant differences were observed for VA at defocus curves of 0 to −3 D. Contrast sensitivity at each spatial frequency improved significantly at 1 week, 1 month and 3 months under photopic and photopic with glare conditions. Under mesopic and mesopic with glare conditions, significant differences were observed postoperatively at low and medium spatial frequencies. Patients reported a high level of satisfaction and an absence of glare or halo 3 months postoperatively.ConclusionIn this study, the trifocal diffractive IOL provided excellent visual performance at all distances and improved contrast sensitivity under different conditions, resulting in high levels of patient satisfaction and spectacle independence in Chinese patients.

高度近视合并白内障患者三焦点人工晶体植入的临床效果观察

高度近视合并白内障患者三焦点人工晶体植入的临床效果观察

Visual outcomes after progressive apodized diffractive intraocular lens implantation.

To assess photopic and mesopic vision in patients implanted with the Bi-Flex® M 677 MY bifocal intraocular lens (IOL). In this prospective clinical study, 25 patients with cataract in both eyes were subjected to cataract surgery and bilateral implantation of the Bi-Flex® M 677MY (Medicontur, Hungary) IOL. Three months after surgery, high-contrast photopic uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were determined. Intermediate at 65 cm (DCIVA) and near at 40 cm (DCNVA) visual acuity were also measured, both with best distance correction. The CSV-1000 test chart was used to assess contrast sensitivity (CS). Defocus curves were constructed under photopic and mesopic conditions, determining binocular best-corrected visual acuity over the range +1.50 D to -4.00 D in 0.50-D steps. A KR-1W Wavefront Analyzer was used to measure pupil size and aberrometric outcomes. Presence and type of dysphotopsia were evaluated with the Likert scale. Mesopic mean pupil diameter was 4.58 ± 0.73 mm. The mean values at 3 months were UDVA 0.03 ± 0.09, CDVA -0.05 ± 0.06, DCIVA 0.20 ± 0.07, and DCNVA 0.11 ± 0.08. Mean CS for the 4 frequencies examined were 1.66 ± 0.16, 1.75 ± 0.14, 1.39 ± 0.22, and 0.96 ± 0.19. Significant differences were observed in defocus curves for photopic and mesopic conditions. A significant correlation between pupil diameter and the dysphotopic photopic was found (r = 0.62; p = 0.02). The evaluated progressive apodized diffractive design IOL provides effective restoration of visual function in far and near vision distance with an adequate intermediate visual quality between -1.00 and -1.50 focus.

Functional Magnetic Resonance Imaging to Assess the Neurobehavioral Impact of Dysphotopsia with Multifocal Intraocular Lenses

To investigate the association between dysphotopsia and neural responses in visual and higher-level cortical regions in patients who recently received multifocal intraocular lens (IOL) implants. Cross-sectional study. Thirty patients 3 to 4 weeks after bilateral cataract surgery with diffractive IOL implantation and 15 age- and gender-matched control subjects. Functional magnetic resonance imaging (fMRI) was performed when participants viewed low-contrast grating stimuli. A light source surrounded the stimuli in half of the runs to induce disability glare. Visual acuity, wavefront analysis, Quality of Vision (QoV) questionnaire, and psychophysical assessment were performed. Cortical activity (blood oxygen level dependent [BOLD] signal) in the primary visual cortex and in higher-level brain areas, including the attention network. When viewing low-contrast stimuli under glare, patients showed significant activation of the effort-related attention network in the early postoperative period, involving the frontal, middle frontal, parietal frontal, and postcentral gyrus (multisubject random-effects general linear model (GLM), P < 0.03). In contrast, controls showed only relative deactivation (due to lower visibility) of visual areas (occipital lobe and middle occipital gyrus, P < 0.03). Patients also had relatively stronger recruitment of cortical areas involved in learning (anterior cingulate gyrus), task planning, and solving (caudate body). Patients reporting greater symptoms induced by dysphotic symptoms showed significantly increased activity in several regions in frontoparietal circuits, as well as cingulate gyrus and caudate nucleus (q < 0.05). We found no correlation between QoV questionnaire scores and optical properties (total and higher order aberration, modulation transfer function, and Strehl ratio). This study shows the association between patient-reported subjective difficulties and fMRI outcomes, independent of optical parameters and psychophysical performance. The increased activity of cortical areas dedicated to attention (frontoparietal circuits), to learning and cognitive control (cingulate), and to taskgoals(caudate) likely represents the beginning of the neuroadaptation process to multifocal IOLs.

Implante de lente intraocular trifocal difractivo: análisis y resultado de la agudeza visual

PurposeTo assess long, intermediate and near visual acuity, dysphotopsia, corneal aberrometry and patient's visual satisfaction after the implantation of a trifocal diffractive intraocular lens. MethodsProspective, longitudinal, observational study that included patients who underwent phacoemulsification followed by trifocal diffractive intraocular lens implantation due to cataract or dysfunctional lens syndrome. Long, intermediate and near visual acuity after one month of surgery was measured, presence of dysphotopsia, corneal aberrometry and visual satisfaction described by the patient. ResultsA total of 94 eyes in 52 patients were evaluated. 80.7% underwent bilateral phacoemulsificacion. Long, intermediate and near visual acuity after one month was 0.06±0.15, 0.04±0.10 y -0.03±0.10 in LogMAR scale respectively, with a spherical equivalent of -0.31±0.60. 23.4% presented glare, 1.1% photopsias and 1.1% both. 97% of the eyes were satisfied after the IOL implantation. There was no significant changes if preoperative and postoperative aberrometry. ConclusionTrifocal diffractive intraocular lens provide excellent long, intermediate and near visual acuity, with few optical aberrations, allowing better visual quality applied to different distances.

Visual outcomes after bilateral trifocal diffractive intraocular lens implantation.

BackgroundIn recent years new models of intraocular lenses are appearing on the market to reduce requirements for additional optical correction. The purpose of this study is to assess visual outcomes following bilateral cataract surgery and the implant of a FineVision® trifocal intraocular lens (IOL).MethodsProspective, nonrandomized, observational study. Vision was assessed in 44 eyes of 22 patients (mean age 68.4 ± 5.5 years) before and 3 months after surgery. Aberrations were determined using the Topcon KR-1 W wave-front analyzer. LogMAR visual acuity was measured at distance (corrected distance visual acuity, CDVA 4 m), intermediate (distance corrected intermediate visual acuity, DCIVA 60 cm) and near (distance corrected near visual acuity, DCNVA 40 cm). The Pelli-Robson letter chart and the CSV-1000 test were used to estimate contrast sensitivity (CS). Defocus curve testing was performed in photopic and mesopic conditions. Adverse photic phenomena were assessed using the Halo v1.0 program.ResultsMean aberration values for a mesopic pupil diameter were: total HOA RMS: 0.41 ± 0.30 μm, coma: 0.32 ± 0.22 μm and spherical aberration: 0.21 ± 0.20 μm. Binocular logMAR measurements were: CDVA −0.05 ± 0.05, DCIVA 0.15 ± 0.10, and DCNVA 0.06 ± 0.10. Mean Pelli-Robson CS was 1.40 ± 0.14 log units. Mean CSV100 CS for the 4 frequencies examined (A: 3 cycles/degree (cpd), B: 6 cpd, C: 12 cpd, D: 18 cpd) were 1.64 ± 0.14, 1.77 ± 0.18, 1.44 ± 0.24 and 0.98 ± 0.24 log units, respectively. Significant differences were observed in defocus curves for photopic and mesopic conditions (p < 0.0001). A mean disturbance index of 0.28 ± 0.22 was obtained.ConclusionsBilateral FineVision IOL implant achieved a full range of adequate vision, satisfactory contrast sensitivity, and a lack of significant adverse photic phenomena.Trial registrationEudract Clinical Trials Registry Number: 2014-003266-2.

Clinical Outcomes after Binocular Implantation of a New Trifocal Diffractive Intraocular Lens.

Purpose. To evaluate visual, refractive, and contrast sensitivity outcomes, as well as the incidence of pseudophakic photic phenomena and patient satisfaction after bilateral diffractive trifocal intraocular lens (IOL) implantation. Methods. This prospective nonrandomized study included consecutive patients undergoing cataract surgery with bilateral implantation of a diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec). Distance, intermediate, and near visual outcomes were evaluated as well as the defocus curve and the refractive outcomes 3 months after surgery. Photopic and mesopic contrast sensitivity, patient satisfaction, and halo perception were also evaluated. Results. Seventy-six eyes of 38 patients were included; 90% of eyes showed a spherical equivalent within ±0.50 diopters 3 months after surgery. All patients had a binocular uncorrected distance visual acuity of 0.00 LogMAR or better and a binocular uncorrected intermediate visual acuity of 0.10 LogMAR or better, 3 months after surgery. Furthermore, 85% of patients achieved a binocular uncorrected near visual acuity of 0.10 LogMAR or better. Conclusions. Trifocal diffractive IOL implantation seems to provide an effective restoration of visual function for far, intermediate, and near distances, providing high levels of visual quality and patient satisfaction.

Visual quality after diffractive intraocular lens implantation in eyes with previous hyperopic laser in situ keratomileusis

To evaluate distance, intermediate, and near visual quality in eyes with diffractive intraocular lens (IOL) implantation after previous hyperopic laser in situ keratomileusis (LASIK). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Cohort study. Corrected distance visual acuity (CDVA) at 12.5%, 25.0%, and 100% contrast levels under photopic and mesopic conditions; uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity, defocus curves, and corneal higher-order aberrations (HOAs) were measured in eyes that had AcrySof Restor SN60D3 spherical IOL implantation (study group) and in phakic eyes (control group) after hyperopic LASIK. Under photopic conditions at 100% contrast, there were no statistically significant differences between the 2 groups (P > .01) and the CDVA was 0.1 logMAR or better (approximately 20/25) in both groups. At 25.0% and 12.5% contrast, there were no statistically significant differences between the 2 groups (P > .01). Under mesopic conditions, the control group had better CDVA than the study group without glare at all contrasts (P < .01). In the study group, the mean UNVA was 0.017 logMAR ± 0.030 (SD) (approximately 20/20) and the mean DCNVA, 0.009 ± 0.030 logMAR. There was statistically significant worsening of visual acuity as a function of the distance to the test (P < .01). There were no statistically significant differences in HOAs between the 2 groups (P > .01). In eyes with previous hyperopic LASIK, the diffractive IOL provided good visual quality at distance, comparable to that obtained in phakic eyes under photopic conditions, although visual performance was slightly poorer under mesopic conditions. No author has a financial or proprietary interest in any material or method mentioned.

Apodized diffractive intraocular lens implantation after laser in situ keratomileusis with or without subsequent excimer laser enhancement

To evaluate the long-term refractive and visual outcomes of apodized diffractive multifocal intraocular lens (IOL) implantation after myopic laser in situ keratomileusis (LASIK) with or without subsequent excimer laser enhancement. University of Texas Southwestern Medical Center at Dallas, Texas, USA. Comparative case series. This study comprised consecutive patients who had implantation of an AcrySof ReSTOR multifocal IOL after previous LASIK. Included were eyes that had refractive surgery enhancement with a Visx Star S4 excimer laser for residual refractive error correction and eyes that had neodymium:YAG (Nd:YAG) capsulotomy. Of the 49 eyes (38 patients), 21 (42.9%) had laser enhancement and 25 (51.0%) had an Nd:YAG capsulotomy. The mean follow-up was 14.2 months ± 7.23 (SD) (range 9 to 29 months). Although the uncorrected distance visual acuity (UDVA) was significantly worse in eyes with enhancement than in those with no enhancement at 1 month and 6 months (P<.05), there was no significant difference in UDVA between the 2 groups at the last follow-up (P>.05). At the last follow-up, 36 (73.5%) of the 49 eyes had a UDVA of 20/25 or better and an uncorrected near visual acuity of Jaeger 1 or better concurrently; 46 eyes (93.9%) were within ±1.00 diopter (D) of emmetropia, and 41 (83.7%) were within ±0.50 D. Apodized diffractive multifocal IOL implantation and excimer laser enhancement in eyes with previous myopic LASIK provided good results.

Refractive lens exchange with spherical diffractive intraocular lens implantation after hyperopic laser in situ keratomileusis

To assess the safety, efficacy, and predictability in eyes that had refractive lens exchange (RLE) with implantation of a spherical diffractive intraocular lens (IOL) after previous hyperopic laser in situ keratomileusis (LASIK). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. This prospective study evaluated eyes that had RLE and implantation of an AcrySof ReSTOR SN60D3 IOL after hyperopic LASIK. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and residual refractive errors were analyzed using vector analysis and recorded preoperatively and 6 months postoperatively. The study evaluated 41 eyes of 23 patients. The mean UDVA was 0.189 logMAR +/- 0.175 (SD) preoperatively and 0.113 +/- 0.101 logMAR 6 months postoperatively (P = .009) and the mean CDVA, 0.049 +/- 0.071 logMAR and 0.046 +/- 0.063 logMAR, respectively (P = .44). At 6 months, the efficacy index was 0.87 and the safety index, 1.00. The mean UNVA was 0.014 +/- 0.026 logMAR, with an efficacy index of 1.00. There were no differences in corrected near visual acuity between preoperatively (with spectacle addition) and postoperatively (P = .3); the safety index was 1.01. All eyes were within +/-1.25 diopters (D) of the targeted refraction and 73.17% were within +/-0.50 D. The mean postoperative spherical equivalent was -0.064 +/- 0.513 D. Implantation of a spherical multifocal IOL after hyperopic LASIK was safe, effective, and predictable.

Optical and visual performance of diffractive intraocular lens implantation after myopic laser in situ keratomileusis

To evaluate the optical and visual quality in eyes with diffractive intraocular lenses (IOLs) after myopic laser in situ keratomileusis (LASIK). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. The best corrected visual acuity (BCVA [distance]) at 12.5%, 25.0%, and 100% contrasts under photopic and mesopic conditions; best distance-corrected near acuity; corneal total higher-order aberrations (HOAs); and optical quality by modulation transfer function (MTF) were measured after myopic LASIK in eyes with a spherical AcrySof ReSTOR SN60D3 IOL or an aspheric Acri.LISA 366D IOL and phakic eyes (control). Under photopic conditions at 100% contrast, the BCVA was 0.1 logMAR or better in all groups. At 25.0% and 12.5% contrasts, there were no statistically significant differences between the aspheric IOL group and the spherical IOL or control group (P >.01). The control group had better BCVA than the spherical IOL group (P = .0002, 25.0%; P<.0001, 12.5%). Under mesopic conditions, the aspheric IOL group had better BCVA than the spherical IOL group at all contrasts (P<.01). There was no statistically significant difference between the 2 IOL groups in mean best distance-corrected near acuity or between all 3 groups in HOAs (P >.01). With 6.0 mm and 3.0 mm pupils, there were no statistically significant differences in MTF between the aspheric IOL group and the control group; both groups had better MTF than the spherical IOL group with a 6.0 mm pupil (P<.01). After LASIK, the aspheric IOL provided better visual quality and optical quality than spherical IOL under mesopic conditions (large pupil).

Visual quality after diffractive intraocular lens implantation in eyes with previous myopic laser in situ keratomileusis

To evaluate distance, intermediate, and near visual quality in eyes having diffractive intraocular lens (IOL) implantation after previous myopic laser in situ keratomileusis (LASIK). Fernández-Vega Ophthalmological Institute, Oviedo, Spain. Best corrected distance visual acuity at 12.5%, 25%, and 100% contrasts under photopic and mesopic conditions, best distance-corrected near visual acuity, defocus curve, and corneal higher-order aberrations (HOAs) were measured in eyes with a spherical AcrySof ReSTOR SNA60D3 IOL or aspherical Acri.LISA 366D IOL after myopic LASIK and in phakic eyes after myopic LASIK (control group). Under photopic conditions at 100% contrast, best corrected distance acuity was 0.1 logMAR or better in all groups. At 25% and 12.5%, there were no statistically significant differences between the Acri.LISA and AcrySof ReSTOR groups or the Acri.LISA and control groups (P >.01). The control group had better best corrected distance acuity than the AcrySof ReSTOR group (P = .0002 and P < .0001 at 25% and 12.5%, respectively). Under mesopic conditions, the Acri.LISA group had better best corrected distance acuity than the AcrySof ReSTOR group at all contrasts (P > .01). The best distance-corrected near acuity was comparable in the 2 IOL groups (P < .01). Intermediate visual acuity was statistically significantly better in the Acri.LISA group than in the AcrySof ReSTOR group (P < .01). There were no statistically significant differences in HOAs between the 3 groups (P > .01). Both multifocal IOLs provided good and comparable visual acuity at distance and near. However, the aspherical Acri.LISA IOL gave better intermediate visual acuity than the spherical AcrySof ReSTOR IOL.

Clinical Results and Some Problems of Multifocal Apodized Diffractive Intraocular Lens Implantation

Purpose: To evaluate near and far visual outcomes, subjective visual symptoms, and patient satisfaction with AcrySof® ReSTOR® diffractive multifocal intraocular lenses (IOL), and to study the reasons for postoperative dissatisfaction. Methods: Twenty-three eyes of 19 patients received phacoemulsifications and implantation of AcrySof® ReSTOR® IOL. The main outcome measures, taken at postoperative 1 day, 1 week, 1 month, and 3 months, were uncorrected and corrected near and distant visual acuity, refractory errors, subjective visual symptoms (glare, halo, and night vision), and satisfaction. Results: At the 3-month postoperative visit, the mean uncorrected near and distant visual acuities were 0.59±0.24 (0.25±0.22 LogMAR unit) and 0.78±0.27 (0.13±0.10 LogMAR unit), respectively. In addition, patients’ satisfaction with uncorrected near vision, intermediate vision, far vision, and general visual performance were better than their satisfaction with night vision. Glare and halos were reported as severe by only 10.2% and 5.3% of patients, respectively. The seven eyes with poor patient satisfaction included eyes with a high incidence of preoperative ocular diseases or preoperative and postoperative high corneal astigmatisms of more than 1.0 diopter. Conclusions: The AcrySof® ReSTOR® IOL demonstrated good near and distant visual acuity with good patient satisfaction. Previous ocular disease, corneal astigmatism less than 1.0 diopter, and patient lifestyle should be considered to enhance patient satisfaction. J Korean Ophthalmol Soc 49(8):1235-1241, 2008

Clear Lens Extraction with Multifocal Apodized Diffractive Intraocular Lens Implantation

To assess efficacy, safety, predictability, and stability after clear lens extraction (CLE) with multifocal diffractive intraocular lens (IOL) implantation. Prospective, nonrandomized, masked observational case series (self-controlled). Two hundred twenty-four eyes of 112 consecutive patients after CLE with bilateral AcrySof ReSTOR Natural IOL implantation. Eyes were divided into myopic (mean spherical equivalent [SE], -6.01+/-2.71 diopters [D]) and hyperopic (mean SE, +3.86+/-2.52 D) groups. Monocular and binocular uncorrected distance visual acuity (VA), best-corrected distance VA, uncorrected distance near VA, and best distance-corrected near VA were recorded preoperatively and 6 months after surgery. Efficacy, safety, predictability, and stability. At 6 months postoperatively, uncorrected distance VA was 20/25 or better in 100% of the eyes. Efficacy indexes were 0.97 for myopic and 0.96 for hyperopic patients. No eye lost > or =2 lines of best-corrected distance VA; for the myopic group, 10 eyes gained 1 line, and 10 eyes gained > or =2 lines; for the hyperopic group, 20 eyes gained 1 line, and 15 eyes gained > or =2 lines. Safety indexes were 1.05 for myopic and 1.02 for hyperopic patients. All eyes were within +/-1.00 D of the desired refraction. No eye lost >2 lines of best distance-corrected near VA; for the myopic group, 10 eyes lost 1 or 2 lines, 15 eyes gained 1 line, and 5 eyes gained 2 lines; for the hyperopic group, 8 eyes lost 1 or 2 lines, 20 eyes gained 1 line, and 16 eyes gained 2 lines. Safety indexes at near were 1.05 for myopic and 1.11 for hyperopic patients. Uncorrected distance near VA was better for hyperopic than myopic patients (0.95+/-0.08 vs. 0.88+/-0.15). Efficacy indexes at near were 1.03 for myopic and 1.10 for hyperopic patients. Clear lens extraction with multifocal IOL implantation is an effective procedure for correcting ametropia and presbyopia. Safety and efficacy indexes at distance were comparable in myopic and hyperopic patients. However, at near, both indexes were larger for hyperopic patients.