Implantation Of Diffractive Multifocal Intraocular Lens Research Articles

Analysis of Korean Retinal Specialists' Opinions on Implanting Diffractive Multifocal Intraocular Lenses in Eyes with Underlying Retinal Diseases.

Multifocal intraocular lenses (MF-IOLs) are increasingly implanted as the need for good near- and intermediate-distance vision increases. Although retinal disease is known to be a relative contraindication for MF-IOL implantation, there are no detailed guidelines for MF-IOL implantation with respect to the type and severity of retinal diseases/statuses. In this study, because retinal diseases can affect the performance of MF-IOLs, we analyzed the opinions of 111 retinal specialists, who were members of the Korean Retina Society, on the implantation of diffractive MF-IOLs in eyes with 15 retinal diseases/statuses using a web-based survey. For each underlying condition, retinal specialists were asked to rate their approval regarding implantation of MF-IOLs on a scale from 1 (completely disapprove) to 7 (completely approve), under the assumption that there were no known contraindications except for a given retinal disease/status. As a result, retinal specialists disapproved MF-IOL implantation (median value of Likert score < 4) in the eyes with wet age-related macular degeneration, dry age-related macular degeneration with geographic atrophy, proliferative diabetic retinopathy, nonproliferative diabetic retinopathy with macular edema, previous macula-off retinal detachment, previous retinal vein occlusion, and epiretinal membrane, but the scores varied by disease/status. The factors that affected the specialists’ opinions were the type of practice and the frequency of MF-IOL implantation (p = 0.013 and p = 0.021, respectively; one-way ANOVA).

Visual acuity, contrast sensitivity, and quality of life after bilateral implantation of multifocal diffractive intraocular lens.

To evaluate visual outcomes, satisfaction, and quality of life of patients assisted in a Medical School hospital by the Brazilian Public Health System, who underwent bilateral diffractive multifocal intraocular lens implantation. Case series study with intervention, including 20 patients who underwent bilateral implantation of multifocal IOL EyeDiff® (Eyeol UK, Dunstable, UK). Exclusion criteria were corneal astigmatism >1.5 cylindrical diopters, previous ocular surgery or ocular disease, and intra- or postoperative complications. Patients were evaluated one, three, and six months after surgery. Monocular and binocular visual acuity for distance, intermediate and near, under photopic and mesopic conditions, monocular contrast sensitivity under photopic conditions, defocus curve, and quality of life were assessed. Monocular distance-corrected visual acuity was 0.3 logMAR or better and monocular distance-corrected near visual acuity was J3 or better in all eyes under photopic conditions. Binocular distance-corrected near visual acuity was J1 in all cases. Contrast sensitivity was at the minimum level of normality for low and high spatial frequencies and within normal limits for intermediate spatial frequency. The quality of life questionnaire showed a high level of patient satisfaction. Bilateral implantation of the multifocal intraocular lens EyeDiff® provides patients with good visual acuity and quality of life, besides spectacle independence. The visual acuity and contrast sensitivity progressively improved between one and six postoperative months.

Diffractive multifocal intraocular lens implantation in patients with monofocal intraocular lens in the contralateral eye.

To evaluate clinical outcomes of unilateral implantation of a diffractive multifocal intraocular lens (IOL) in patients with contralateral monofocal IOL. Twenty-two patients who already had implantation of a monofocal IOL in unilateral eye underwent implantation of a diffractive multifocal IOL in contralateral eye were enrolled. After 1, 6, and 12mo, uncorrected and distant corrected distant visual acuity (UCDVA and DCDVA), uncorrected and distant corrected intermediate-visual acuity (UCIVA and DCIVA), uncorrected and distant corrected near visual acuity (UCNVA and DCNVA), and contrast sensitivity were obtained. Halo/glare symptoms, spectacle dependence, and patient satisfaction were also evaluated. The mean age was 67.86±7.25y and the average interval between two IOL implantations was 645.82±878.44d. At 1mo, binocular UCDVA was lower than 0.20 logMAR in 76% of patients (mean 0.12±0.13 logMAR), which increased to 90% by 6 and 12mo. The binocular UCDVA was significantly better than the monocular results (P<0.05) at 1, 6, and 12mo. Additionally, UCNVA was lower than 0.40 logMAR in 82% of patients, increasing to 90% by 6 and 12mo. Mean UCNVA in the multifocal IOL implanted eye was statistically significantly better than that in the monofocal IOL implanted eye (P<0.05) at 1, 6, and 12mo. About 5% of patients at 1 and 6mo, reported "severe glare or halo". Patient satisfaction rates were 95% and 91% at 6 and 12mo, respectively. Unilateral implantation of multifocal IOL in patients with a contralateral, monofocal IOL implantation results in high patient satisfaction rate, with low severe glare or halo rate during follow-up. It can represent a good option for patients who have previously had a monofocal IOL implantation regardless of two year interval duration between two IOL implantations.

Clinical outcomes after mix-and-match implantation of diffractive multifocal intraocular lenses with +\u20092.75 and\u2009+\u20094.00 diopter add powers

BackgroundTo evaluate the clinical outcomes of bilateral mix-and-match implantation of diffractive multifocal intraocular lenses (IOLs) with different add powers.MethodsWe retrospectively reviewed the medical records of 18 patients who underwent bilateral mix-and-match implantation of diffractive multifocal IOLs with different add powers. Multifocal IOLs with add powers of + 2.75 diopters (D) and + 4.00 D were implanted into the patients’ dominant and nondominant eyes, respectively. At 1 and 3-month postoperatively, monocular and binocular visual acuity was measured using logMAR charts and manifest refraction was performed. Specifically, logMAR charts were used to measure uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA). Defocus curves, contrast sensitivity, and patient satisfaction were assessed at 3-month postoperatively.ResultsBinocular logMAR measurements (mean ± standard deviation) at 3-month postoperatively were 0.01 ± 0.04 (UDVA), 0.16 ± 0.05 (UIVA), and 0.11 ± 0.07 (UNVA). Postoperative spherical equivalent was − 0.43 ± 0.35 D and − 0.39 ± 0.21 D in the dominant and nondominant eyes, respectively. Defocus curves showed significant differences between − 1.50 and − 4.00 D among binocular, dominant, and nondominant eye measurements, except between − 2.50 and − 3.00 D. Eyes implanted with + 2.75 and + 4.00 D IOLs showed good contrast sensitivity under photopic and mesopic conditions. Over 80% of patients reported high satisfaction with their near vision.ConclusionsBilateral mix-and-match implantation of diffractive multifocal IOLs with add powers of + 2.75 D and + 4.00 D showed good near, intermediate, and far vision.

Prospective study of bilateral mix-and-match implantation of diffractive multifocal intraocular lenses in Koreans

BackgroundTo evaluate monocular and binocular visual outcomes for near, intermediate, and far distance in patients implanted with diffractive multifocal intraocular lenses (IOLs) with different add power contralaterally.MethodsThis is a prospective contralateral study. Two diffractive multifocal IOLs with different added power were implanted bilaterally in twenty patients. TECNIS® ZKB00 (+ 2.75 D) was implanted in a dominant eye, and TECNIS® ZLB00 (+ 3.25 D) was implanted in a non-dominant eye. Uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), and manifest refraction (MR) values were measured at 1 month and 3 months postoperatively. At the 3-month follow-up, defocus curve, contrast sensitivity, and reading performance were evaluated. Quality of vision, overall satisfaction, and spectacle independence were evaluated by questionnaire.ResultsPostoperative binocular UDVA, visual acuity at 80 cm, 60 cm, 50 cm, 43 cm, 33 cm were − 0.08 ± 0.10, 0.12 ± 0.14, 0.09 ± 0.09, 0.07 ± 0.11, 0.14 ± 0.09, 0.25 ± 0.11 logMAR. The binocular defocus curve showed an extended range of good visual acuity with sharp vision being observed from 0 D to − 2.50 D defocus (logMAR≤0.1). Reading performance was significantly improved compared to baseline. All patients were spectacle-free at distance, and 94.74% of the patients did not require glasses for near and intermediate vision.ConclusionsMix-and-match implantation of diffractive multifocal IOLs with different add power provides an excellent wide range of vision, as well as high levels of visual quality and patient satisfaction.Trial registrationClinicalTrials.gov, NCT02556944,https://clinicaltrials.gov/show/NCT02556944

Photorefractive keratectomy for correcting residual refractive error following cataract surgery with premium intraocular lens implantation.

PURPOSE:The aim of this study is to evaluate the effectiveness and predictability of photorefractive keratectomy (PRK) for correcting residual refractive error following cataract surgery with premium intraocular lens (IOL) implantation.METHODS:We conducted a retrospective review of the medical records of patients who received PRK for correcting residual hyperopia, myopia, and/or astigmatism due to unsatisfied uncorrected distance visual acuity (UDVA) after cataract extraction with implantation of aspheric, diffractive multifocal, or toric IOL from September 2011 to December 2017. Pre-cataract surgery, pre- and post-PRK data including UDVA, best-corrected distance visual acuity, and refractive status were analyzed.RESULTS:A total of 18 consecutive eyes in 17 patients were included in this study. The UDVA after PRK improved 1 line or more in 10 eyes, remained unchanged in five eyes, and decreased in three eyes. The overall improvement in the logarithm of minimal angle of resolution (logMAR) UDVA after PRK was significant (P < 0.05). While dividing patients into subgroups based on IOL type, significant improvement in logMAR UDVA was found in patients with aspheric IOL or diffractive multifocal IOL implantation (P < 0.05). No significant improvement of UDVA was found in patients with toric IOL implantation. All eyes achieved ± 1.00 D of the attempted spherical correction, demonstrating good predictability of PRK.CONCLUSIONS:PRK was a safe and effective procedure to correct residual refractive error following cataract extraction with premium IOL implantation. Although satisfactory for all patients, the outcome is better and more predictable in patients with aspheric and diffractive multifocal IOL implantation and is less satisfactory and unpredictable in patients with toric IOL implantation.

Visual Outcomes, Quality of Vision, and Quality of Life of Diffractive Multifocal Intraocular Lens Implantation after Myopic Laser In Situ Keratomileusis: A Prospective, Observational Case Series

Purpose. To report visual performance and quality of life after implantation of a bifocal diffractive multifocal intraocular lens (MIOL) in postmyopic laser in situ keratomileusis (LASIK) patients. Methods. Prospective, observational case series. Patients with prior myopic LASIK who had implantation of Tecnis ZMA00/ZMB00 MIOL (Abbott Medical Optics) at Hong Kong Sanatorium and Hospital were included. Postoperative examinations included monocular and binocular distance, intermediate and near visual acuity (VA), and contrast sensitivity; visual symptoms (0–5); satisfaction (1–5); spectacle independence rate; and quality of life. Results. Twenty-three patients (27 eyes) were included. No intraoperative complications developed. Mean monocular uncorrected VA at distance, intermediate, and near were 0.13 ± 0.15 (standard deviation), 0.22 ± 0.15, and 0.16 ± 0.15, respectively. Corresponding mean values for binocular uncorrected VA were 0.00 ± 0.10, 0.08 ± 0.13, and 0.13 ± 0.10, respectively. No eyes lost >1 line of corrected distance VA. Contrast sensitivity at different spatial frequencies between operated and unoperated eyes did not differ significantly (all P > 0.05). Mean score for halos, night glare, starbursts, and satisfaction were 1.46 ± 1.62, 1.85 ± 1.69, 0.78 ± 1.31, and 3.50 ± 1.02, respectively. Eighteen patients (78%) reported complete spectacle independence. Mean composite score of the quality-of-life questionnaire was 90.31 ± 8.50 out of 100. Conclusions. Implantation of the MIOL after myopic LASIK was safe and achieved good visual performance.

Primary posterior continuous curvilinear capsulorhexis combined with diffractive multifocal intraocular lens implantation.

PurposeTo evaluate the effect of mild posterior capsule opacity (PCO) on visual acuity (VA) in eyes implanted with a diffractive multifocal intraocular lens (IOL) compared with a monofocal IOL, and the effect of posterior continuous curvilinear capsulorhexis (PCCC) combined with diffractive multifocal IOL implantation.MethodsFor the initial evaluation, we compared charge-coupled device (CCD) camera photographs taken through both a monofocal IOL-loaded model eye and a diffractive IOL-loaded model eye under the conditions of both with and without an opaque filter for the simulation of mild PCO. The clinical evaluation involved 20 patients who underwent bilateral implantation of the same diffractive multifocal IOL. In all 20 cases, PCCC was performed in 1 eye (PCCC group) and not performed in the fellow eye (NCCC group). Postoperative clinical results were then compared between the two groups.ResultsThe CCD photographs revealed that the diffractive IOL-loaded eye was more strongly affected by the simulated PCO than was the monofocal IOL-loaded eye. In the clinical setting, the PCCC group registered better results than NCCC group in distance and near VA, low-contrast VA, and contrast sensitivity testing.ConclusionsDiffractive multifocal IOLs tend to be more influenced by mild PCO than do monofocal IOLs, and PCCC prior to IOL implantation can contribute to the avoidance of this effect.

Clinical Results and Optical Quality of Diffractive Multifocal IOL Implantation after Myopic Refractive Surgery

Purpose: To evaluate the visual outcome and optical quality in eyes with diffractive multifocal intraocular lens (DMIOL) implantation after myopic refractive surgery. Methods: Nineteen eyes (15 patients) were implanted with AcriSof ReSTOR SN6AD1, the aspheric DMIOL after myopic refractive surgery (laser-assisted in situ keratomileusis [LASIK] 14 eyes, photorefractive keratectomy [PRK] 4 eyes, laser-assisted subepithelial keratomileusis [LASEK] 1 eye). Preoperative and postoperative visual acuities and manifest refraction were measured. Preoperative corneal higher-order aberrations (HOAs) were measured using Hartmann-Shack (H-S) aberrometer in dilated pupils, and optical qualities were measured 1 month postoperatively using H-S aberrometer and a double-pass system under mesopic conditions. Patient satisfaction was investigated using a questionnaire at 2 months postoperatively. Results: Uncorrected distant and near visual acuities at postoperative 2 months were 0.11 ± 0.19, and 0.19 ± 0.12 (log MAR), respectively. Postoperative spherical equivalent (SE) of 16 eyes (84.2%) was within ±0.50 diopters (D) and all eyes were within ±1.00 D from emmetropia. Preoperative corneal and postoperative ocular spherical aberrations in a 4.0 mm pupil diameter were 0.08 ± 0.08 and 0.07 ± 0.07 (μm), respectively. Objective scatter index was 3.42 ± 1.71 and modulation transfer function (MTF) cut-off value was 21.03 ± 12.37 cpd. General satisfaction score was 3.52 ± 0.96 points out of 5, and 8 patients (11 eyes) were not satisfied with DMIOL implantation. Conclusions: After DMIOL implantation in the eyes with previous myopic refractive surgery, postoperative SE was close to the target D, but optical qualities and patient satisfaction were poor. J Korean Ophthalmol Soc 2014;55(12):1779-1786

Five-year postoperative outcomes of apodized diffractive multifocal intraocular lens implantation.

To assess the long-term postoperative visual performance of an apodized diffractive multifocal intraocular lens (IOL). Twenty-one patients (42 eyes) underwent cataract surgery with bilateral implantation of an apodized diffractive multifocal IOL. The monocular uncorrected and corrected distance visual acuities, uncorrected, distance-corrected and corrected near visual acuities, and manifest refractive spherical equivalent were measured 1 and 5years postoperatively. The contrast sensitivity, incidence of glare or halos, and rate of neodynium:YAG (Nd:YAG) posterior capsulotomy were evaluated 5years postoperatively. No significant differences were found between the distance and near visual acuities at 1 and 5years postoperatively. The contrast sensitivity was within the normal range for all spatial frequencies. No patients reported severe glare or halos. Six (14.3%) eyes required Nd:YAG posterior capsulotomy. The apodized diffractive multifocal IOL provides good, stable distance and near visual acuity levels over a 5-year follow-up period.

Repeatability of Peripheral Aberrations in Young Emmetropes: Erratum

To report an unfortunate case of patient selection for multifocal intraocular lens (MIOL) implantation. Interventional case report. A 69-year-old woman with bilateral corticonuclear cataract underwent uneventful phacoemulsification with diffractive MIOL implantation within 1 week. She reported no previous medical history. A few days later she had persisting dizziness and experienced extreme photic phenomena, which progressively deteriorated. After intensive conversation, we discovered that our patient had a medical history of Meniere's disease. Bilateral intraocular lens exchange surgery was performed. One week after monofocal intraocular lens implantation, the patient was satisfied with the final visual outcome and did not report any visual complaints. Retinocortical processing of visual information is impaired in patients with peripheral vestibular disorders such as Meniere's disease. Therefore, these patients are probably not good candidates for MIOL implantation, which requires an intact sensory system with rigorous visuovestibular interaction.

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.

Limbal relaxing incisions at the time of apodized diffractive multifocal intraocular lens implantation to reduce astigmatism with or without subsequent laser in situ keratomileusis

To evaluate the visual and refractive outcomes of limbal relaxing incisions (LRIs) to reduce astigmatism at the time of apodized diffractive multifocal intraocular lens (IOL) implantation. University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, USA. This retrospective review comprised consecutive patients who had LRIs at the time of lens extraction and AcrySof ReSTOR IOL implantation. A subgroup of patients had subsequent laser in situ keratomileusis (LASIK) for residual refractive error correction. The study evaluated 73 eyes (59 patients); 21 eyes (28.7%) of 59 patients had further LASIK (LRI+LASIK). The mean follow-up was 13.2 months +/- 6.4 (SD). The mean keratometric astigmatism decreased from 1.49 +/- 0.71 diopters (D) preoperatively to 0.56 +/- 0.57 D at the last follow-up (P<.001). Although the LRI+LASIK group had significantly greater corneal astigmatism than the LRI-only group preoperatively (P = .005) and 1 month (P = .030) and 6-months (P = .014) postoperatively, there was no statistically significant difference between the 2 groups at the last follow-up (P = .528). At the last follow-up, the uncorrected distance visual acuity was 20/25 or better and the uncorrected near visual acuity was J1 or better in 32 (76%) of 42 eyes in the LRI-only group and in 17 (81%) of 21 eyes in the LRI+LASIK group. Limbal relaxing incisions at the time of apodized diffractive multifocal IOL implantation, with or without subsequent LASIK, were effective and safe in reducing astigmatism.

Laser in situ keratomileusis for residual refractive errors after apodized diffractive multifocal intraocular lens implantation

To evaluate the visual and refractive outcomes of laser in situ keratomileusis (LASIK) to correct residual refractive error after apodized diffractive multifocal intraocular lens (IOL) implantation. University of Texas Southwestern Medical Center, Dallas, Texas, USA. This retrospective study reviewed eyes of consecutive patients who had LASIK using the IntraLase FS60 femtosecond laser and Visx Star S4 excimer laser to correct residual refractive error after AcrySof ReSTOR IOL implantation. The review comprised 85 eyes of 59 patients. Thirty-six eyes (42.3%) had myopic correction, 35 (41.2%) had mixed astigmatic correction, and 14 (16.5%) had hyperopic correction; 45 eyes (52.9%) also had neodymium:YAG (Nd:YAG) capsulotomy. Six months after LASIK, 91.8% of eyes had an uncorrected distance visual acuity (UCVA) of 20/25 or better, 92.9% had an uncorrected near visual acuity (UCNVA) of J1 or better, and 85.9% had 20/25 or better UCVA concurrent with J1 or better UCNVA. No eye lost more than 1 line of best spectacle-corrected visual acuity; 2 eyes (2.4%) lost 1 line. Ninety-nine percent of eyes were within +/-1.00 diopter (D) of emmetropia, and 98% of eyes were within +/-1.00 D cylinder. There was no significant difference in postoperative UCVA or UCNVA between the 3 refraction groups (P >.05) or between eyes that had Nd:YAG capsulotomy and those that did not (P >.05). Laser in situ keratomileusis for residual ametropia after apodized diffractive multifocal IOL implantation was predictable, effective, and safe.

Contrast sensitivity after refractive lens exchange with diffractive multifocal intraocular lens implantation in hyperopic eyes

To evaluate distance and near contrast sensitivity under photopic and mesopic conditions before and after refractive lens exchange (RLE) with implantation of a diffractive multifocal intraocular lens (IOL). University of Valencia, Valencia, Spain. Monocular contrast sensitivity function was measured with the Functional Acuity Contrast Test chart at distance and near under 3 luminance levels (85.0 cd/m(2), 5.0 cd/m(2), and 2.5 cd/m(2)) before and after RLE with bilateral AcrySof ReSTOR IOL implantation in 30 hyperopic eyes with presbyopia and low astigmatism (<or=1.0 diopter). Results after surgery were compared with those before surgery. Six months postoperatively, the mean residual spherical equivalent refractive error was 0.21 diopter+/-0.19 (SD). The best corrected distance and near visual acuities were comparable to those before surgery. For distance vision, the safety index was 1.02 and the efficacy index was 0.91. For near vision, the values were 1.04 and 1.02, respectively. There were no statistically significant differences between preoperative and postoperative results at any distance or spatial frequency or under any lighting condition (P>.1, t test). Refractive lens exchange with implantation of a diffractive multifocal IOL gave good distance and near contrast sensitivity under photopic and mesopic conditions. Although mesopic contrast sensitivity was reduced at distance and near compared to that under photopic conditions, the performance was comparable to that with the natural lens preoperatively.