Diffractive Trifocal Intraocular Lens Research Articles

Visual, Refractive, Functional, and Patient Satisfaction Outcomes After Implantation of a New Trifocal Diffractive Intraocular Lens.

To describe the visual, refractive, functional, and patient satisfaction outcomes of the Clareon® PanOptix® trifocal intraocular lens (IOL). This was a prospective longitudinal descriptive study. Patients who underwent cataract surgery with implantation of Clareon® PanOptix® (Alcon Laboratories, Inc.) were included. Monocular refractive outcomes and visual acuity at distance, intermediate, and near were evaluated 1- and 6-months post-op. Binocular contrast sensitivity (M&S® Technologies), binocular defocus curve, and patient satisfaction with the IOL Satisfaction (IOLSAT) and Questionnaire for Visual Disturbance (QUVID) questionaries were assessed at 6-month post-op. Seventy-six Clareon® PanOptix® were implanted bilaterally in 38 patients. The mean age of the patients was 67.63±5.18 years. At 1-month post-op, the monocular Corrected Distance Visual Acuity (CDVA), CIVA and CNVA were 0.00±0.09, 0.02±0.17, and 0.12±0.12 LogMAR, respectively, and CDVA and CNVA were stable at 6-month post-op (p>0.05). No statistical differences were found in post-op spherical equivalent at 1 and 6 months (-0.08±0.27 D and -0.05±0.24 D; p=0.351). A 100% of eyes were within ±0.5 D at 1 month and 6-month post-op. Binocular defocus curve shows three peaks of maximum visual acuity (VA) at 0D (-0.04±0.08 LogMAR), at -1.50D, and -2.50 D (0.01±0.10 LogMAR and 0.03±0.07 LogMAR, respectively). Contrast sensitivity decreased at high spatial frequencies. In patient satisfaction, IOLSAT questionary reveals 78.94% patients "Never" or "Rarely" Needing Glasses and according QUVID questionnaire, 100% of patients report no hazy vision. The PanOptix® IOL platform with the new material Clareon® provides good visual outcomes for distance, intermediate, and near vision, with adequate contrast sensitivity and low visual disturbances.

Effect of monofocal, wavefront-shaped and diffractive trifocal intraocular lenses on scanning-slit automated refraction

PurposeTo compare scanning-slit retinoscopy automated refraction spherical equivalent (ARSE) to subjective manifest refraction spherical equivalent (MRSE) in normal eyes with four different types of intraocular lenses (IOLs). DesignRetrospective cross-sectional study Methods279 pseudophakic eyes that underwent lens extraction at a private center with implantation of either a wavefront shaped IOL (Acrysof® Vivity, DFT015), a nonapodized diffractive trifocal IOL (Acrysof® Panoptix), or a monofocal IOL with negative spherical aberration (Tecnis ZCBOO) or aberration-free (Envista Mx60E). Patients who had an automated refraction measurement with retinoscopy refractometer and aberrometer (NIDEK OPD Scan III, Nidek Technologies) and subjective refraction data 1-2 months postoperatively were included in the study. Main outcome measured was the difference between automated refraction and subjective refraction. ResultsSixty-one eyes implanted with a DFT015 IOL, 78 eyes with a TFNT00 IOL, 40 with a ZCBOO IOL and 100 with a Mx60E IOL were enrolled in this study. Statistically significant myopic results were observed when using ARSE compared to MRSE in the DFT015 (-0.95±0.64, -0.33±0.65, p < .001), TFNT00 (-0.43±0.36, -0.2±0.35, p <.001), ZCBOO (-0.81±0.63, -0.4±0.69, p = .008) and Mx60E (-0.75±0.65, -0.45±0.52; p <0.05) IOL groups. The absolute difference between the 2 methods was statistically significant in the DFT015 IOL group (0.65±0.49; p< 0.05). ConclusionAutomated refraction yields myopic results in pseudophakic eyes with monofocal and presbyopia correcting IOLs and may be used with caution. Manifest refraction “push-plus” technique should be used in all pseudophakic eyes to avoid over-minus prescriptions, especially in patient with residual refractive error following cataract surgery.

Clinical efficacy evaluation of the implantation of a diffractive trifocal intraocular lens in high myopia eyes: Two-year follow-up.

To evaluate the long-term subjective and objective visual quality after implantation of a diffractive trifocal intraocular lens (IOL) in high myopic eyes. A total of 53 eyes from 38 patients with high myopia who underwent phacoemulsification and trifocal IOL implantation were investigated. The visual acuity, contrast sensitivity, diopter, defocus curve, and objective visual quality at 1 month, 3 months, 1 year, and 2 years after surgery, as well as the satisfaction questionnaire and VF-14 scale, were statistically analyzed. The average age was 53.14 ± 4.70 years. The average preoperative spherical equivalent was -10.77 ± 3.98 D. Two years after surgery, 94.3% of the patients achieved an uncorrected distance visual acuity of 0.1 (LogMAR), and 84.9% and 94.3% of the patients had SE within ±0.50 D and ±1.0 D, respectively. The defocus curve was smooth and at a high value within the range of 0 D to -2.50 D. In CS or objective visual quality, there was no significant difference at 3 months, 1 year, and 2 years after operation (all P > 0.05). The rate of spectacle independence was 100%. The proportion of patients with moderate or severe glare and halo was 10.5% and 13.2%, respectively. Furthermore, 23.7%, 26.3%, and 18.4% of the patients had difficulties in reading small font, doing delicate tasks, and driving or riding at night, respectively. The diffractive trifocal IOL implantation provided good distance, intermediate, and near uncorrected visual acuity for patients with cataracts and high myopia. It was safe, effective, predictable, and stable. It provided long-term good visual quality after surgery, with high spectacle independence and high patient satisfaction.

Comparison of Objective and Subjective Visual Outcomes Between Pentafocal and Trifocal Diffractive Intraocular Lenses.

To compare the clinical and aberrometric outcomes obtained with a new diffractive pentafocal intraocular lens (IOL) and a diffractive trifocal IOL. Patients bilaterally implanted with the pentafocal Intensity SeeLens IOL (Hanita Lenses) (n = 30) and the trifocal FineVision POD F IOL (PhysIOL) (n = 30) during cataract surgery were studied after 1 month for refraction, visual acuity, defocus curve, contrast sensitivity, Hartmann-Shack aberration, and double-pass aberration. The Quality of Vision (QoV) questionnaire was used to evaluate visual comfort. Distance and near visual acuities were similar with the two IOLs, but distance-corrected intermediate visual acuity was better with the Intensity IOLs (0.03 ± 0.04 vs 0.11 ± 0.04 logMAR in the FineVision eyes, P < .01). The difference between objective and subjective refraction was more myopic for the Intensity IOL (-1.15 vs -0.29 diopters [D]). The defocus curve was flatter with the Intensity IOL. Contrast sensitivity was similar in both IOLs. Hartmann-Shack aberration and double-pass aberration were similar, but the modulation transfer function cut-off value was worse with the Intensity IOL: 11.6 ± 2.7 vs 15.3 ± 4.9 (P < .01). QoV scores were better with the Intensity IOL, in particular for glare, halos, and starburst. In this comparative series, the pentafocal Intensity IOL provided better intermediate vision and better defocus curve than the FineVision IOL, with comparable distance and near vision. The optical disturbances as reported by the patients were higher with the FineVision IOL. Additional studies will better define the aberration profile obtained with the pentafocal IOL. [J Refract Surg. 2024;40(9):e604-e613.].

Functional Outcomes After Refractive Lens Exchange With Implantation of a Glistening-Free Diffractive Trifocal Intraocular Lens

PurposeTo evaluate visual outcomes and patient-reported results after bilateral femtosecond-laser assisted refractive lens exchange (RLE) with the implantation of a diffractive trifocal intraocular lens (IOL). DesignProspective interventional case series MethodsA study of 27 patients (54 eyes) implanted with the Clareon PanOptix (Alcon) multifocal IOL during femtosecond laser assisted RLE in a university hospital setting. The uncorrected (UDVA) and corrected (CDVA) distance visual acuity, uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 60cm, uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 40cm and 33cm were evaluated at three months postoperatively and compared with the preoperative values. In addition, we assessed the postoperative defocus curve, mesopic and photopic contrast sensitivity, and patient-reported spectacle independence. ResultsThe mean postoperative binocular UDVA was -0.02±0.06 logMAR and CDVA was -0.11±0.05 logMAR. The UIVA was -0.07±0.05 logMAR and DCIVA was -0.07±0.07 logMAR. The UNVA at 40cm was 0.03±0.09 logMAR and DCNVA was -0.02±0.06 logMAR; and, at 33cm UNVA was 0.14±0.10 logMAR and DCNVA was 0.11±0.08 logMAR. In comparison to the preoperative binocular CDVA (-0.12±0.08 logMAR), no statistically significant change was observed (p=1.0), while all the other binocular visual acuities improved (p<0.01). In the mean binocular defocus curve, the visual acuity was better than 0.10 logMAR in the range between +0.5 D and -3.0 D. The mean contrast sensitivity was within the normal range, and most patients reported complete spectacle independence. ConclusionThe RLE surgery improved uncorrected visual acuity at far, intermediate and near distances without negatively affecting the CDVA. Patients achieved a high level of spectacle independence.

Refractive and Visual Outcomes Using a Trifocal, Diffractive, Hydrophobic Intraocular Lens in Japanese Eyes.

To report the refractive and visual outcomes after implantation of a trifocal, diffractive, hydrophobic intraocular lens (IOL) in Japanese eyes following cataract surgery. A total of 45 eyes implanted with FineVision HP IOLs (Beaver-Visitec International, Inc. USA) were enrolled in this retrospective study. The clinical outcomes assessed after 3-months were refraction and monocular logarithm of the minimum angle of resolution (LogMAR) uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA) at 80 and 66 cm, uncorrected near visual acuity (UNVA), and distance-corrected near visual acuity (DCNVA) at 40 cm. 97.78% of the eyes were within ±0.50D of spherical equivalent and all of them were within ±1.00D (mean: -0.00±0.22 D, with 75.56% within ±0.13D), while 91.11% of the eyes had ≤0.50D residual astigmatism and all of them had ≤1.00D (mean: -0.08±0.24D, with 88.89% ≤0.25D). UDVA and CDVA showed mean values of -0.05±0.07 logMAR and -0.07±0.06 logMAR, respectively. 86.67% and 95.56% of the eyes had ≥20/20 UDVA and CDVA, respectively, with 100% achieving ≥20/25 for both UDVA and CDVA. At 80 cm, the mean monocular logMAR UIVA and DCIVA were 0.18±0.14 and 0.14±0.14, and at 66 cm the values were 0.20±0.15 and 0.19±0.15, respectively. At 80 cm 20% of the eyes had ≥20/25 DCIVA and 60% had ≥20/32 DCIVA. These values changed to 15.56% and 40% of the eyes at 66 cm. In terms of near vision, the mean monocular logMAR UNVA and DCNVA were 0.04±0.10 and 0.03±0.10, respectively. 53.33% of the eyes had ≥20/20 UNVA and DCNVA, with 86.67% achieving ≥20/25 UNVA and DCNVA. The FineVision HP trifocal diffractive IOL provided accurate refractive outcomes with good visual acuity at different distances in Japanese eyes.

Visual Outcomes and Patient Satisfaction of Trifocal or Trifocal Toric IOLs in Chinese Cataract Patients: Focus on Near Vision at 33 cm.

To examine the visual outcomes, particularly at 33 cm, and assess patient satisfaction following the implantation of a diffractive trifocal intraocular lens (IOL) and its toric variant. This prospective single-arm observational study involved 45 Chinese patients (90 eyes) underwent bilateral cataract surgery and PanOptix or PanOptix toric intraocular lenses (IOLs) implantation. Postoperatively, visual acuity was evaluated at various distances, including 40 cm and 33 cm, for both monocular and binocular outcomes. Patient satisfaction was evaluated using the VF-14 questionnaire. 72 eyes underwent PanOptix IOLs implantation, and 18 eyes received PanOptix toric IOLs. At 3-month postoperative mark, the mean monocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.02±0.09, 0.00±0.07, 0.02±0.07, and 0.07±0.14 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 96.7%, 96.7%, 94.4%, and 74.4%, respectively. The mean binocular UDVA, UIVA, and UNVA at 40 cm and 33 cm were -0.05±0.06, -0.03±0.05, 0.00±0.05, and 0.04±0.07 logMAR, respectively, with proportions of visual acuity exceeding 0.1 logMAR were 97.8%, 100.0%, 100.0%, and 91.1%, respectively. When the near point shifted from 40cm to 33cm, some patients showed a decline for UDVA, but the average reduction was less than one line. The overall VF-14 questionnaire score was 4.02±4.19. PanOptix can provide Chinese patients with a full range of satisfying visual acuity, near to 33cm. Though the visual acuity of some patients at 33 cm did not match the level at 40 cm, the gap of one line may not carry clinical significant.

Comparison of short-term clinical outcomes of a diffractive trifocal intraocular lens with phacoemulsification and femtosecond laser assisted cataract surgery

PurposeTo evaluate short-term visual and refractive outcomes after implantation of a diffractive trifocal intraocular lens (IOL) in cataract patients with phacoemulsification (PHACO) and femtosecond laser assisted cataract surgery (FLACS).SettingDepartment of Ophthalmology, Shanghai Aier Eye Hospital, China.DesignA retrospective, observational study.MethodsPatients who underwent cataract surgery combined with Acrysoft IQ PanOptix trifocal IOL implantation were enrolled and divided into three groups: PHACO group, LAstig-FLACS group (astigmatism less then 1D) and HAstig-FLACS group (astigmatism more than 1D). Logarithm of the minimum angle of resolution (logMAR) visual acuity of uncorrected distance (UDVA), intermediate (UIVA), near visual (UNVA), defocus curve, surgically induced astigmatism (SIA) were evaluated in 1 months postoperatively and wavefront aberrations were evaluated in 6 months.Results101 eyes of 60 patients were included with 31 eyes in PHACO group, 45 eyes in LAstig-FLACS group and 25 eyes in HAstig-FLACS group. Significant difference was found of internal Strehl Ratio (SR) between PHACO and LAstig-FLACS group (P = 0.026). In PHACO group, 79.31%, 86.21%, 72.41% of eyes gain visual acuity LogMAR 0.1 or more in UDVA, UIVA and UNVA, while 83.72%, 93.02%, 93.02% of those in LAstig-FLACS group and 92.00%, 84.00%, 76.00% in HAstig-FLACS group.ConclusionsPanoptix diffractive trifocal IOL provides satisfied visual outcome in no matter FLACS or PHACO. Besides, trifocal IOL implantation via FLACS can provide a better accumulative visual acuity outcome at all distance than PHACO in 1 month. Femtosecond laser assisted limbal relaxing incisions (FLLRIs) is an excellent way to reduce a patient’s corneal astigmatism.

Comparison of visual performance between diffractive bifocal and diffractive trifocal intraocular lenses

To evaluate the visual performance of a diffractive bifocal intraocular lens (IOL) with + 4.0 D near addition (ZMB00) and a diffractive trifocal IOL with + 2.17 D and + 3.25 D near addition (AcrySof IQ PanOptix TFNT00), we investigated the 10-week postoperative parameters after cataract surgery in which ZMB00 or TFNT00 lenses were implanted bilaterally from 2011 to 2020 (with a 3-month interval between implantation of the right and left lenses). The study included 1448 eyes of 724 patients. The diffractive bifocal group comprised 1326 eyes of 663 patients (aged 67.0 ± 7.8 years; females/males, 518/145), and the diffractive trifocal group comprised 122 eyes of 61 patients (aged 66.6 ± 7.3 years; females/males, 35/26). A linear mixed-effects model using data for both eyes, with strict adjustments for sex, age, subjective refraction spherical equivalent, subjective refraction cylinder, corneal astigmatism, axial length, corneal higher-order aberrations, and pupil diameter, ensured statistical validity. Uncorrected near visual acuity and higher-order aberrations (ocular/internal, scaled to a pupil size of 4 mm) (Wavefront_4mm_postoperative_Ocular/Internal_Spherical) were significantly better in the bifocal group (p < 0.00068, Wald test). Uncorrected intermediate visual acuity, contrast sensitivity (6.3/4.0/2.5/1.6/1.0/0.7 degrees), and contrast sensitivity with glare (4.0/1.6/1.0/0.7 degrees) were significantly better in the trifocal group (p < 0.00068, Wald test).

Visual and Refractive Outcomes of Diffractive Trifocal Versus Hybrid Multifocal-extended Depth of Focus Intraocular Lenses

Purpose: We compared the clinical outcomes of patients who received AcrySof IQ Panoptix TFNT00 (Alcon, Fort Worth, TX, USA), a diffractive trifocal intraocular lens (IOL), or TECNIS Synergy ZFR00V (Johnson &amp; Johnson Vision, Santa Ana, CA, USA), a hybrid multifocal-extended depth of focus (EDOF) IOL.Methods: In total, 26 eyes of 13 patients who underwent bilateral implantation of the diffractive trifocal IOL (group A) and 24 eyes of 12 patients who underwent bilateral implantation of the hybrid multifocal-EDOF IOL (group B) were included. We assessed visual acuity using the logarithm of the minimal angle of resolution (logMAR) scale and evaluated the visual performance of both groups, including uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA) and the defocus curve at 1 month postoperatively. In addition, we measured contrast sensitivity and administered a satisfaction questionnaire at 3 months postoperatively.Results: At 1 month postoperatively, group B demonstrated significantly better monocular UDVA, UNVA and binocular UNVA compared to group A (0.07 ± 0.07, 0.24 ± 0.16, and 0.18 ± 0.15 vs. 0.13 ± 0.09, 0.33 ± 0.14, and 0.29 ± 0.11; &lt;i&gt;p&lt;/i&gt; &lt; 0.05). In addition, group B exhibited higher visual acuities in the monocular and binocular defocus curves at +1.00 diopters (D), -3.00 D, -3.50 D, and +1.00 D (&lt;i&gt;p&lt;/i&gt; &lt; 0.05). Notably, the binocular defocus curves of both groups demonstrated excellent logMAR visual acuities (better than 0.2) in the range of 0.00 to -3.00 D. However, no significant differences were observed between the groups in contrast sensitivity or satisfaction questionnaire responses for visual acuity at 3 months postoperatively (&lt;i&gt;p&lt;/i&gt; &gt; 0.05).Conclusions: The hybrid multifocal-EDOF IOL demonstrates superior near visual acuity compared to the diffractive trifocal IOL. However, both IOLs exhibit excellent visual acuity at distant, intermediate, and near distances.

Long-term Clinical Outcomes After Bilateral Implantation of Two Trifocal Diffractive IOLs

Purpose: To show clinical outcomes after bilateral implantation of either a hydrophobic FineVision POD F GF or a hydro-philic FineVision POD F intraocular lens (IOL) (Beaver-Visitec International, Inc). Methods: A total of 110 patients with cataract were randomized to receive either POD F GF or POD F IOLs and followed up for 2 years. The measurements included refraction, monocular and binocular uncorrected and corrected distance (UDVA and CDVA), intermediate (UIVA and DCIVA), and near (UNVA and DCNVA) visual acuities, defocus curve, photopic and mesopic contrast sensitivity, photic phenomena, and patient-reported outcomes. Results: The mean spherical equivalent was similar in both groups and stable across visits (&lt; 0.25 diopters [D]). At 2 years, 81.8% and 90.5% of eyes were within ±0.50 D in the POD F GF and POD F IOL groups, respectively (100% for ±1.00 D in both groups). At 2 years, 100% and 90.5% of the patients presented a binocular CDVA of 20/25 or better; 93.9% and 85.7% of patients a DCIVA of 20/25 or better and 87.5% and 70% of patients a DCNVA of 20/25 or better, for the POD F GF and POD F IOL groups, respectively. The defocus curve showed continuous visual acuity, being 20/32 or better in both groups over a 4.50 D range. Both groups presented good contrast sensitivity for photopic and mesopic conditions, and the size and intensity of halo and glare phenomena were similar between the two. Both groups also included a high percentage of patients who reported that they had stopped wearing glasses and greater than 80% satisfaction and recommendation levels. Conclusions: This study showed comparable long-term visual and refractive outcomes of both IOL models after cataract surgery. [ J Refract Surg . 2023;39(12):798–807.]

Comparison of Patients With Emmetropia and Presbyopia and Different Accommodation Who Undergo Unilateral or Bilateral Implantation of a Trifocal IOL

Purpose: To compare visual outcomes and satisfaction in patients with emmetropia, presbyopia, and greater or lesser residual accommodation who undergo unilateral or bilateral implantation of a trifocal diffractive intraocular lens (IOL). Methods: A multicenter, multisurgeon study was performed to evaluate outcomes in patients with emmetropia and presbyopia who underwent refractive lens exchange followed by implantation of a FineVision trifocal IOL (PhysIOL). The inclusion criteria were as follows: emmetropia, sphere −0.25 to +0.50 diopters (D), cylinder less than 0.75 D, and manifest refractive spherical equivalent (MRSE) of −0.25 to +0.25 D. All patients also had to have an uncorrected distance visual acuity (UDVA) of Snellen 0.9 or better in each eye. The sample was divided into different clusters based on two variables: eyes operated on (monocular or binocular) and age either younger than 55 years or 55 years or older. Thus, four possible groups were created. Visual and refractive performance, patient satisfaction, and spectacle independence were assessed. Results: A total of 690 eyes from 431 patients were evaluated. There was no difference in postoperative uncorrected (UDVA) and corrected (CDVA) distance visual acuity between the groups. Binocular uncorrected near vision (UNVA) was better in patients who underwent surgery on both eyes regardless of age (median [interquartile range]: 0.00 [0.00; 0.10] vs 0.10 [0.00; 0.10] logMAR; P &lt; .001). Binocular uncorrected intermediate vision (UIVA) was better in patients who underwent surgery on both eyes aged younger than 55 years than in those who underwent surgery in one eye aged 55 years or older (median [interquartile range]: 0.18 [0.10; 0.18] vs 0.30 [0.18; 0.30] logMAR; P &lt; .001). The efficacy and safety indexes were 0.98 ± 0.09 and 1.01 ± 0.06, respectively. A total of 93.3% of eyes were within the 0.50 D range in postoperative MRSE. Visual dysphotopsia was worse in patients with both eyes operated on, although the differences were not statistically significant. Conclusions: The study shows that after refractive lens exchange, patients with emmetropia and presbyopia who received a trifocal IOL in one or both eyes achieved good UNVA, UIVA, and UDVA. Regarding near binocular visual acuity, results were better for patients who underwent surgery on both eyes than for those who underwent surgery on one eye. Regarding binocular intermediate visual acuity, patients aged younger than 55 years with both lenses replaced had better results than those 55 years or older with only one lens replaced. However, no significant differences were observed in UDVA or patient satisfaction. [ J Refract Surg . 2023;39(12):817–824.]

Comparison of visual performance with iTrace analyzer following femtosecond laser-assisted cataract surgery with bilateral implantation of two different trifocal intraocular lenses.

To compare the postoperative binocular visual performance with an iTrace analyzer following femtosecond laser-assisted cataract surgery (FLACS) combined with bilateral implantation of two different types of diffractive trifocal intraocular lenses (IOL). During this retrospective observational study, patients who received bilateral FLACS combined with implantation of two different types of diffractive trifocal IOLs were evaluated. According to the IOLs' different types and design, the patients were divided into AT LISA tri839MP group (tri839 group) and AcrySof PanOptix TFNT00 group (TFNT group). Study parameters included preoperative and postoperative uncorrected distance visual acuity (UDVA) at 5 m, uncorrected near visual acuity (UNVA) at 30 cm and 40 cm, uncorrected intermediate visual acuity (UIVA) at 60 cm and 80 cm, postoperative refractive status, objective visual qualities and total high order aberrations (HOAs) postoperatively. The postoperative complications were also recorded. Totally 56 eyes of 28 patients (tri839 group, n=26; TFNT group, n=30) were included. Preoperative baseline characteristics between groups were not statistically significantly different. UDVA was not significantly different between groups except for 1wk follow-up due to the postoperative corneal edema. TFNT group showed statistically significant better UNIA at 60 cm than tri839 group at the 1wk (0.05±0.19 vs 0.15±0.10 logMAR, P=0.013), 1mo (0.05±0.12 vs 0.15±0.09 logMAR, P=0.001) and 3mo (0.04±0.12 vs 0.15±0.11 logMAR, P=0.001) follow-up, while tri839 group showed statistically significant better UNIA at 80 cm than TFNT group at the 1d (0.14±0.15 vs 0.20±0.14 logMAR, P=0.041) and 1mo (0.09±0.07 vs 0.14±0.10 logMAR, P=0.042) follow-up. Postoperative refractive status showed stable at every visit. Modulated transfer function (MTF) values and strehl ratio (SR) values were improved and HOAs were lower significantly after surgery. FLACS with bilateral implantations of both tri839 and TFNT00 can achieve satisfactory natural whole-course vision, high postoperative refractive stability and good visual quality but without significantly difference. iTrace aberration instrument can accurately evaluate the visual quality under different status.

Comparison of the optical behaviour of five different multifocal diffractive intraocular lenses in a model eye

The purpose of this study was to investigate and compare the optical performance of five trifocal intraocular lenses (IOLs) following the ISO 11979-2 standards, analysing the impact of tilt and decentration. Five different diffractive trifocal IOLs were evaluated in this experimental study: Acriva Trinova (VSY-Biotechnology) (AT), FineVision HP (PhysIOL) (FVHP), AT LISA tri 839 MP (Zeiss) (ATLT), PanOptix TFNT00 IOL (Alcon) (PO), and Tecnis Synergy (J&J Vision) (TS). In-vitro optical quality analysis of them was performed with the Lambda PMTF system that has an aberration neutral cornea model (Lambda-X Ophthalmics). Measurements were performed on-axis, with 5º of IOL tilt and with 0.5 mm of IOL decentration using 543-nm monochromatic light. Finally, IOL dimensions and diffractive disk profile inspection was performed using the VisIOLA system (Rotlex). On-axis measurements showed a far through-focus MTF > 0.3 at 3 mm aperture, except for TS. FVHP and PO showed better far MTFs for larger apertures (3.75 mm and 4.5 mm) while AT showed good intermediate and near vision for such apertures. With 5º of IOL tilt, the better optical performance at all distances was found with AT for medium-sized pupils (3 mm) and an important reduction of MTF was found for ATLT and PO, especially in the intermediate focus. The induction of 0.5 mm of IOL decentration especially affected the intermediate focus of ATLT and TS and the far focus of FVHP and PO. IOL dimensions and diffractive profile were consistent with those described by the manufacturer. In conclusion, there are differences in the optical performance according to the pupil aperture of the five trifocal IOLs evaluated and this should be considered in clinical practice when selecting the most appropriate implant in each specific case. IOL tilt and decentration can affect significantly in most of the designs evaluated the performance of the IOL at intermediate vision range. It should be noted that measurements were made with an aberration-free cornea, being necessary future studies analysing the impact of different levels of corneal aberrations.

Clinical Performance of a New Trifocal IOL with a 7.0 mm Optical Zone.

To evaluate the refractive and visual outcomes following cataract surgery and implantation of a diffractive trifocal intraocular lens (IOL) with a 7.0 mm optical zone. A total of 23 patients who underwent bilateral implantation with the Triva-aXAY IOL were analyzed at 6 months post-surgery. The main outcome measures were refractive error, monocular and binocular uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected and corrected-distance intermediate visual acuity (UIVA, CDIVA) at 60 cm, uncorrected and corrected-distance near visual acuity (UNVA, CDNVA) at 40 cm, and binocular defocus curve. Patients also completed the Catquest-9SF questionnaire. All eyes were within ±1.00D, and 91.30% of eyes within ±0.50D, with a mean postoperative spherical equivalent of -0.14±0.29D. Similarly, 95.65% of patients showed a binocular UDVA ≥20/25, compared to 100% for CDVA, and the mean binocular UDVA and CDVA were 0.02±0.06 and 0.00±0.05 logMAR, respectively. At intermediate vision, 65.22% of patients showed a binocular UIVA ≥20/25, compared to 86.96% for CDIVA, and the mean binocular UIVA and CDIVA were 0.07±0.06 and 0.06±0.06 logMAR, respectively. At near, 95.65% of patients showed a binocular UNVA and CDNVA ≥20/25, with a mean binocular UDNVA and CDNVA of 0.04±0.07 and 0.02±0.05 logMAR, respectively. Finally, 95.65% of patients reported being quite satisfied to very satisfied with their vision and about 74% did not report any difficulty with their vision in their everyday life. Between 65.22% and 100% of patients reported no difficulty performing different tasks. Our study shows good visual and refractive outcomes with high satisfaction in patients implanted with the Triva-aXAY IOL with a 7.0 mm optical zone.

Visual results and subjective satisfaction after implantation of two different trifocal diffractive intraocular lenses models (AcrySof IQ PanOptix and AT LISA tri 839 MP).

This study aimed to compare visual results following the implantation of two distinct diffractive trifocal IOLs utilizing various vision evaluation techniques and subjective satisfaction. The study included 32 eyes receiving AcrySof IQ PanOptix implantation and 32 receiving AT LISA tri 839 MP. Post-operative examination at one year included uncorrected visual acuity (UCVA), distance-corrected visual acuity (DCVA) at 4 m, 80 cm, 60 cm, and 40 cm, Contrast sensitivity under photopic and mesopic conditions, and a questionnaire on subjective quality of vision, optical phenomena, and spectacle independence. The two groups were similar in baseline demographics, pre-operative visual, biometric data (except for axial length), and surgical paraments. The PanOptix outperformed the AT LISA tri in the intermediate range when using the standard visual acuity testing (UCVA: 0.23 ± 0.14 logMAR vs. 0.31 ± 0.17 logMAR, p = 0.04; BCVA: 0.21 ± 0.12 vs. 0.28 ± 0.14, p = 0.03) and in the intermediate and far range when using the interactive computer program (intermediate: UNVA "E" optotype test: 0.05 ± 0.12 vs. 0.12 ± 0.13, p = 0.03; Far: UNVA "E" optotype: 0.07 ± 0.12 vs. 0.13 ± 0.10, p = 0.05). In addition, the PanOptix group had higher contrast sensitivity under photopic and mesopic conditions with and without glare at all spatial frequencies. There was no difference in subjective outcomes between the groups. Patients who received PanOptix IOL had better visual outcomes for intermediate and far with higher contrast sensitivity under various conditions. Based on patients ' needs and demands, these results could support discussion when tailoring the optimal multifocal IOl.

Assessment of Visual Habituation Measured With the Halo & Glare Simulator and Its Impact on Patient Satisfaction Following Quadrifocal IOL Implantation.

To evaluate the levels of habituation and its influence on outcome satisfaction in patients who underwent bilateral multifocal intraocular lens (IOL) implantation. A total of 24 patients underwent bilateral multifocal IOL implantation surgery with the AcrySof IQ PanOptix trifocal diffractive IOL (Alcon Laboratories, Inc) following cataract extraction or for refractive purposes. Data were collected 3 and 6 months after surgery, which included subjective refraction, corrected and uncorrected visual acuity (distance, intermediate, near), a contrast sensitivity test, simulation with the Halo & Glare Simulator (Carl Zeiss Meditec AG), two visual quality surveys, and a slit-lamp examination by an ophthalmologist. All patients were spectacle independent for distance vision and 92% (n = 22) needed no visual aid for near vision. Minor visual acuity improvement was detected between both examinations at monocular uncorrected distance visual acuity (P = .025). Improvements of presence, size, and intensity of visual disturbances were not statistically significant, but overall patient satisfaction (P = .009) and Weber-Contrast sensitivity under mesopic conditions (P = .029) increased significantly. Diffractive multifocal IOLs are a stable treatment for presbyopia and/or cataract with a high spectacle independence rate. Visual disturbances caused by their optics do not decrease significantly between 3 and 6 months after surgery. Habituation and neuroadaptation play a significant role in patient satisfaction and contrast sensitivity during and possibly beyond that period. [J Refract Surg. 2023;39(8):510-517.].

Randomised placebo-controlled clinical trial evaluating the impact of a new visual rehabilitation program on neuroadaptation in patients implanted with trifocal intraocular lenses

PurposeTo evaluate the efficacy of a new visual training program for improving the visual function in patients implanted with trifocal intraocular lenses (IOLs).MethodsRandomised placebo-controlled clinical trial enrolling 60 subjects (age, 47–75 years) undergoing cataract surgery with implantation of trifocal diffractive IOL. Home-based active visual training was prescribed immediately after surgery to all of them (20 sessions, 30 min): 31 subjects using a serious game based on Gabor patches (study group) and 29 using a placebo software (placebo group). Visual acuity, contrast sensitivity (CS), and perception of visual disturbances (QoV questionnaire) were evaluated before and after training. Likewise, in a small subgroup, resting-state functional magnetic resonance imaging (rs-fMRI) analysis was performed.ResultsNo significant differences were found between groups in compliance time (p = 0.70). After training, only significant improvements in monocular uncorrected intermediate visual acuity were found in the study group (p ≤ 0.01), although differences between groups did not reach statistical significance (p ≥ 0.11). Likewise, significantly better binocular far CS values were found in the study group for the spatial frequencies of 6 (p = 0.01) and 12 cpd (p = 0.03). More visual symptoms of the QoV questionnaire experienced a significant change in the level of bothersomeness in the study group. Rs-fMRI revealed the presence significant changes reflecting higher functional connectivity after the training with the serious game.ConclusionsA 3-week visual training program based on the use of Gabor patches after bilateral implantation of trifocal diffractive IOLs may be beneficial for optimising the visual function, with neural changes associated suggesting an acceleration of neuroadaptation.Trial registration ClinicalTrials.gov, NCT04985097. Registered 02 August 2021, https://clinicaltrials.gov/(NCT04985097).

Optical performance of a new design of a trifocal intraocular lens based on the Devil's diffractive lens.

In this work, we propose a new diffractive trifocal intraocular lens design with focus extension, conceived to provide a high visual performance at intermediate distances. This design is based on a fractal structure known as the "Devil's staircase". To assess its optical performance, numerical simulations have been performed with a ray tracing program using the Liou-Brennan model eye under polychromatic illumination. The simulated through the focus visual acuity was the merit function employed to test its pupil-dependence and its behavior against decentering. A qualitative assessment of the multifocal intraocular lens (MIOL) was also performed experimentally with an adaptive optics visual simulator. The experimental results confirm our numerical predictions. We found that our MIOL design has a trifocal profile, which is very robust to decentration and has low degree of pupil dependence. It performs better at intermediate distances than at near distances and, for a pupil diameter of 3 mm, it works like an EDoF lens over almost the entire defocus range.

Short-term clinical results with a trifocal diffractive toric intraocular lens using an optimized preoperative and intraoperative protocol.

To evaluate the short-term clinical outcomes of a specific toric diffractive trifocal intraocular lens (IOL) implanted following an optimized clinical protocol in a large population. Retrospective analysis of 337 eyes of 231 patients (mean age, 62.2 years) undergoing cataract surgery with implantation of the trifocal diffractive IOL AT.LISA tri toric 939M/MP (Carl Zeiss Meditec). A strict and careful clinical protocol was followed, including an accurate measurement of corneal astigmatism, use of a latest generation IOL power calculator, photography-based method intraoperative control of IOL alignment and IOL reposition at 1 week postoperatively if needed. Clinical outcomes in terms of visual acuity, refraction, efficacy of astigmatic correction analysed by vector analysis and patient satisfaction were evaluated during a 3-month follow-up. A total of 82% and 98% of eyes achieved a postoperative uncorrected distance visual acuity of 0.00 and 0.10 logMAR or better, respectively. Furthermore, 99.7%, and 100.0% of eyes showed a postoperative spherical equivalent within ± 0.50 D and ± 1.00 D, with 97.9% of eyes having a postoperative cylinder ≤ 0.50 D. Uncorrected near and intermediate visual acuities were 0.2 logMAR or better in 89.0% and 99.1% of eyes, respectively. Mean difference vector, magnitude of error and angle of error were 0.02 ± 0.14 D, 0.02 ± 0.13 D and 0.11 ± 1.18°. Patient satisfaction was referred as high or very high by 97.6% of patients. The implantation of the trifocal toric IOL evaluated following a careful clinical protocol provides an efficacious visual rehabilitation and astigmatic correction, leading to high levels of patient satisfaction.